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Gerber TS, Ridder DA, Goeppert B, Brobeil A, Stenzel P, Zimmer S, Jäkel J, Metzig MO, Schwab R, Martin SZ, Kiss A, Bergmann F, Schirmacher P, Galle PR, Lang H, Roth W, Straub BK. N-cadherin: A diagnostic marker to help discriminate primary liver carcinomas from extrahepatic carcinomas. Int J Cancer 2024; 154:1857-1868. [PMID: 38212892 DOI: 10.1002/ijc.34836] [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: 08/19/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 01/13/2024]
Abstract
Distinguishing primary liver cancer (PLC), namely hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA), from liver metastases is of crucial clinical importance. Histopathology remains the gold standard, but differential diagnosis may be challenging. While absent in most epithelial, the expression of the adherens junction glycoprotein N-cadherin is commonly restricted to neural and mesenchymal cells, or carcinoma cells that undergo the phenomenon of epithelial-to-mesenchymal transition (EMT). However, we recently established N- and E-cadherin expression as hallmarks of normal hepatocytes and cholangiocytes, which are also preserved in HCC and iCCA. Therefore, we hypothesized that E- and/or N-cadherin may distinguish between carcinoma derived from the liver vs carcinoma of other origins. We comprehensively evaluated E- and N-cadherin in 3359 different tumors in a multicenter study using immunohistochemistry and compared our results with previously published 882 cases of PLC, including 570 HCC and 312 iCCA. Most carcinomas showed strong positivity for E-cadherin. Strong N-cadherin positivity was present in HCC and iCCA. However, except for clear cell renal cell carcinoma (23.6% of cases) and thyroid cancer (29.2%), N-cadherin was only in some instances faintly expressed in adenocarcinomas of the gastrointestinal tract (0%-0.5%), lung (7.1%), pancreas (3.9%), gynecological organs (0%-7.4%), breast (2.2%) as well as in urothelial (9.4%) and squamous cell carcinoma (0%-5.6%). As expected, N-cadherin was detected in neuroendocrine tumors (25%-75%), malignant melanoma (46.2%) and malignant mesothelioma (41%). In conclusion, N-cadherin is a useful marker for the distinction of PLC vs liver metastases of extrahepatic carcinomas (P < .01).
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Affiliation(s)
- Tiemo S Gerber
- Institute of Pathology, University Medicine, Johannes Gutenberg-University, Mainz, Germany
| | - Dirk A Ridder
- Institute of Pathology, University Medicine, Johannes Gutenberg-University, Mainz, Germany
| | - Benjamin Goeppert
- Institute of Pathology and Neuropathology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Alexander Brobeil
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Philipp Stenzel
- Institute of Pathology, University Medicine, Johannes Gutenberg-University, Mainz, Germany
| | - Stefanie Zimmer
- Institute of Pathology, University Medicine, Johannes Gutenberg-University, Mainz, Germany
| | - Jörg Jäkel
- Institute of Pathology, University Medicine, Johannes Gutenberg-University, Mainz, Germany
| | - Marie Oliver Metzig
- Institute of Pathology, University Medicine, Johannes Gutenberg-University, Mainz, Germany
| | - Roxana Schwab
- Department of Gynecology and Obstetrics, University Medicine, Johannes Gutenberg-University, Mainz, Germany
| | - Steve Z Martin
- Institute of Pathology, Charité-University Medicine, Berlin, Germany
| | - András Kiss
- 2nd Institute of Pathology, Semmelweis University, Budapest, Hungary
| | - Frank Bergmann
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Peter Schirmacher
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Peter R Galle
- 1st Department of Internal Medicine, Gastroenterology and Hepatology, University Medicine, Johannes Gutenberg-University, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medicine, Johannes Gutenberg-University, Mainz, Germany
| | - Wilfried Roth
- Institute of Pathology, University Medicine, Johannes Gutenberg-University, Mainz, Germany
| | - Beate K Straub
- Institute of Pathology, University Medicine, Johannes Gutenberg-University, Mainz, Germany
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Martin SZ, Wagner DC, Hörner N, Horst D, Lang H, Tagscherer KE, Roth W. Ex vivo tissue slice culture system to measure drug-response rates of hepatic metastatic colorectal cancer. BMC Cancer 2019; 19:1030. [PMID: 31675944 PMCID: PMC6824140 DOI: 10.1186/s12885-019-6270-4] [Citation(s) in RCA: 20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/16/2019] [Indexed: 02/08/2023] Open
Abstract
Background The lack of predictive biomarkers or test systems contributes to high failure rates of systemic therapy in metastasized colorectal carcinoma, accounting for a still unfavorable prognosis. Here, we present an ex vivo functional assay to measure drug-response based on a tissue slice culture approach. Methods Tumor tissue slices of hepatic metastases of nine patients suffering from colorectal carcinoma were cultivated for 72 h and treated with different concentrations of the clinically relevant drugs Oxaliplatin, Cetuximab and Pembrolizumab. Easy to use, objective and automated analysis routines based on the Halo platform were developed to measure changes in proliferative activity and the morphometric make-up of the tumor. Apoptotic indices were assessed semiquantitatively. Results Untreated tumor tissue slices showed high morphological comparability with the original “in vivo”-tumor, preserving proliferation and stromal-tumor interactions. All but one patients showed a dosage dependent susceptibility to treatment with Oxaliplatin, whereas only two patients showed responses to Cetuximab and Pembrolizumab, respectively. Furthermore, we identified possible non-responders to Cetuximab therapy in absence of RAS-mutations. Conclusions This is the first time to demonstrate feasibility of the tissue slice culture approach for metastatic tissue of colorectal carcinoma. An automated readout of proliferation and tumor-morphometry allows for quantification of drug susceptibility. This strongly indicates a potential value of this technique as a patient-specific test-system of targeted therapy in metastatic colorectal cancer. Co-clinical trials are needed to customize for clinical application and to define adequate read-out cut-off values.
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Affiliation(s)
- Steve Z Martin
- Institute of Pathology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. .,Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, 10117, Berlin, Germany.
| | - Daniel C Wagner
- Institute of Pathology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Nina Hörner
- Institute of Pathology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - David Horst
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, 10117, Berlin, Germany
| | - Hauke Lang
- Department of General Visceral and Transplantation Surgery, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Katrin E Tagscherer
- Institute of Pathology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Wilfried Roth
- Institute of Pathology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Thamm T, Zweynert S, Piper SK, Madai VI, Livne M, Martin SZ, Herzig CX, Mutke MA, Siebert E, Liebig T, Sobesky J. Diagnostic and prognostic benefit of arterial spin labeling in subacute stroke. Brain Behav 2019; 9:e01271. [PMID: 30912272 PMCID: PMC6520295 DOI: 10.1002/brb3.1271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/31/2019] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Brain perfusion measurement in the subacute phase of stroke may support therapeutic decisions. We evaluated whether arterial spin labeling (ASL), a noninvasive perfusion imaging technique based on magnetic resonance imaging (MRI), adds diagnostic and prognostic benefit to diffusion-weighted imaging (DWI) in subacute stroke. METHODS In a single-center imaging study, patients with DWI lesion(s) in the middle cerebral artery (MCA) territory were included. Onset to imaging time was ≤7 days and imaging included ASL and DWI sequences. Qualitative (standardized visual analysis) and quantitative perfusion analyses (region of interest analysis) were performed. Dichotomized early outcome (modified Rankin Scale [mRS] 0-2 vs. 3-6) was analyzed in two logistic regression models. Model 1 included DWI lesion volume, age, vascular pathology, admission NIHSS, and acute stroke treatment as covariates. Model 2 added the ASL-based perfusion pattern to Model 1. Receiver-operating-characteristic (ROC) and area-under-the-curve (AUC) were calculated for both models to assess their predictive power. The likelihood-ratio-test compared both models. RESULTS Thirty-eight patients were included (median age 70 years, admission NIHSS 4, onset to imaging time 67 hr, discharge mRS 2). Qualitative perfusion analysis yielded additional diagnostic information in 84% of the patients. In the quantitative analysis, AUC for outcome prediction was 0.88 (95% CI 0.77-0.99) for Model 1 and 0.97 (95% CI 0.91-1.00) for Model 2. Inclusion of perfusion data significantly improved performance and outcome prediction (p = 0.002) of stroke imaging. CONCLUSIONS In patients with subacute stroke, our study showed that adding perfusion imaging to structural imaging and clinical data significantly improved outcome prediction. This highlights the usefulness of ASL and noninvasive perfusion biomarkers in stroke diagnosis and management.
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Affiliation(s)
- Thoralf Thamm
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sarah Zweynert
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sophie K Piper
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Vince I Madai
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Michelle Livne
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Steve Z Martin
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Cornelius X Herzig
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Matthias A Mutke
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neuroradiology, Ludwig-Maximilian-University, Munich, Germany
| | - Jan Sobesky
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Johanna-Etienne-Hospital, Neuss, Germany
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Seidmann L, Kamyshanskiy Y, Martin SZ, Fruth A, Roth W. Immaturity for gestational age of microvasculature and placental barrier in term placentas with high weight. Eur J Obstet Gynecol Reprod Biol 2017. [PMID: 28624691 DOI: 10.1016/j.ejogrb.2017.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Villous immaturity for gestational age is a multifactorial developmental deviation associated with unexpected placental insufficiency, fetal hypoxia and term fetal death. In our previous work we have shown that immature CD15+/CD31+/CD34+ endothelial cells were an important indicator of placental villous immaturity and chronic insufficiency. The aim of this study was to perform a comparative analysis of CD15-marked immaturity in the vessel walls between normal and pathological term placentas of clinically and structurally heterogenous groups with normal, low and high weight. STUDY DESIGN 165 clinically normal and pathological placentas of gestational age 39-42 with normal weight (25-75 percentile), low weight (<10 percentile) and high weight (>90 percentile) were structurally and immunohistochemically analyzed. Excluded were placentas with a severe form of placental insufficiency associated with intrauterine fetal death, low APGAR-score, genetic and chromosomal diseases or placental inflammations. The distribution patterns of CD15, CD31 and CD34 were assessed separately in the macrovasculature, microvasculature and placental barrier (PB) - associated capillaries. RESULTS All placental groups with normal weight, low weight and high weight include normal, accelerated villous maturation or villous immaturity independent of their weight. However, a significant increase of immature CD15+/CD31+/CD34+ endothelial cells was detected in microvasculature and PB -associated capillaries in high weight-placentas (63.5%/52.2%), compared to those of normal weight (13.8%/8.2%) and low weight (16.1%/17.8%). The distribution of macrovascular immature CD15+/CD31+/CD34+ endothelial cells did not show such marked differences. CONCLUSION We have identified the immaturity of microvasculature and PB -associated capillaries with a pathological persistency of immature CD15+/CD31+/CD34+ endothelial cells and a reduction of terminally differentiated CD15-/CD31+/CD34+ endothelial cells in a structurally and clinically heterogeneous group of high weight-placentas. We assume that immaturity of placental vessels are part of prenatal adaptational processes that can be recruited in different emergency situations and may provide potential targets of therapeutic correction of placental growth and chronic insufficiency. We therefore recommend the use of CD15-based immunophenotyping as a method to identify latent unfavorable conditions of fetal development in the intrauterine life and individual risk of disease in the postnatal period.
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Affiliation(s)
- L Seidmann
- Institute of Pathology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany.
| | - Y Kamyshanskiy
- Institute of Pathology, Karaganda State Medical University, Kazakhstan
| | - S Z Martin
- Institute of Pathology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - A Fruth
- Department of Obstetrics and Gynecology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - W Roth
- Institute of Pathology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
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Madai VI, Wood CN, Galinovic I, Grittner U, Piper SK, Revankar GS, Martin SZ, Zaro-Weber O, Moeller-Hartmann W, von Samson-Himmelstjerna FC, Heiss WD, Ebinger M, Fiebach JB, Sobesky J. Clinical-Radiological Parameters Improve the Prediction of the Thrombolysis Time Window by Both MRI Signal Intensities and DWI-FLAIR Mismatch. Cerebrovasc Dis 2016; 42:57-65. [DOI: 10.1159/000444887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/18/2016] [Indexed: 11/19/2022] Open
Abstract
Background: With regard to acute stroke, patients with unknown time from stroke onset are not eligible for thrombolysis. Quantitative diffusion weighted imaging (DWI) and fluid attenuated inversion recovery (FLAIR) MRI relative signal intensity (rSI) biomarkers have been introduced to predict eligibility for thrombolysis, but have shown heterogeneous results in the past. In the present work, we investigated whether the inclusion of easily obtainable clinical-radiological parameters would improve the prediction of the thrombolysis time window by rSIs and compared their performance to the visual DWI-FLAIR mismatch. Methods: In a retrospective study, patients from 2 centers with proven stroke with onset <12 h were included. The DWI lesion was segmented and overlaid on ADC and FLAIR images. rSI mean and SD, were calculated as follows: (mean ROI value/mean value of the unaffected hemisphere). Additionally, the visual DWI-FLAIR mismatch was evaluated. Prediction of the thrombolysis time window was evaluated by the area-under-the-curve (AUC) derived from receiver operating characteristic (ROC) curve analysis. Factors such as the association of age, National Institutes of Health Stroke Scale, MRI field strength, lesion size, vessel occlusion and Wahlund-Score with rSI were investigated and the models were adjusted and stratified accordingly. Results: In 82 patients, the unadjusted rSI measures DWI-mean and -SD showed the highest AUCs (AUC 0.86-0.87). Adjustment for clinical-radiological covariates significantly improved the performance of FLAIR-mean (0.91) and DWI-SD (0.91). The best prediction results based on the AUC were found for the final stratified and adjusted models of DWI-SD (0.94) and FLAIR-mean (0.96) and a multivariable DWI-FLAIR model (0.95). The adjusted visual DWI-FLAIR mismatch did not perform in a significantly worse manner (0.89). ADC-rSIs showed fair performance in all models. Conclusions: Quantitative DWI and FLAIR MRI biomarkers as well as the visual DWI-FLAIR mismatch provide excellent prediction of eligibility for thrombolysis in acute stroke, when easily obtainable clinical-radiological parameters are included in the prediction models.
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Madai VI, Wood CN, Galinovic I, Grittner U, Piper SK, Revankar GS, Martin SZ, Zaro Weber O, Moeller-Hartmann W, von Samson-Himmelstjerna FC, Heiss WD, Ebinger M, Fiebach JB, Sobesky J. Abstract WP50: MRI Biomarkers in Acute Stroke: Addition of Clinical Parameters Improves the Identification of Patients Eligible for Thrombolysis. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wp50] [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]
Abstract
Introduction:
Patients with unknown time from stroke onset, e.g. in wake-up stroke, are not eligible for thrombolyic treatment. Relative signal intensities (rSI) of DWI and FLAIR MRI are biomarkers for eligibility for thrombolysis, but have shown heterogeneous results to date. We investigated if the addition of available clinical parameters improves the prediction of the thrombolysis time window in patients with acute stroke.
Hypothesis:
Inclusion of clinical parameters improves the prediction of the thrombolysis time window by quantitative MRI biomarkers
Methods:
Patients from two centers with proven stroke and stroke-onset <12 hours were included in a retrospective design. The DWI lesion was segmented and overlaid on ADC and FLAIR maps. rSI mean and standard deviation (std) were calculated: mean VOI value/mean value of the unaffected hemisphere. Prediction of the thrombolysis time window was evaluated by the area-under-the-curve (AUC) of receiver-operating-characteristic (ROC) curve analysis. Age, NIHSS, MRI field strength, lesion size, vessel occlusion and Wahlund-Score were included in adjusted and stratified regression models.
Results:
82 patients were included. In the unadjusted analysis, DWI-mean and -std (AUC: 0.86, 0.87) performed best. Adjustment for clinical parameters significantly improved the performance of FLAIR-mean (0.87) and DWI-std (0.91). The best performance was found for the final stratified and adjusted models of DWI-std (0.94) and FLAIR-mean (0.96). ADC-rSIs showed no clinically acceptable performance in all models.
Conclusion:
rSIs of DWI and FLAIR MRI predict eligibility for thrombolysis in acute stroke with high precision, when easily available clinical parameters are included in the prediction.
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Affiliation(s)
- Vince I Madai
- Cntr for Stroke Rsch (CSB), Charite Univ Medicine Berlin, Berlin, Germany
| | - Carla N Wood
- Cntr for Stroke Rsch (CSB), Charite Univ Medicine Berlin, Berlin, Germany
| | - Ivana Galinovic
- Cntr for Stroke Rsch (CSB), Charite Univ Medicine Berlin, Berlin, Germany
| | - Ulrike Grittner
- Cntr for Stroke Rsch (CSB), Charite Univ Medicine Berlin, Berlin, Germany
| | - Sophie K Piper
- Cntr for Stroke Rsch (CSB), Charite Univ Medicine Berlin, Berlin, Germany
| | - Gajanan S Revankar
- Cntr for Stroke Rsch (CSB), Charite Univ Medicine Berlin, Berlin, Germany
| | - Steve Z Martin
- Cntr for Stroke Rsch (CSB), Charite Univ Medicine Berlin, Berlin, Germany
| | | | | | | | | | - Martin Ebinger
- Cntr for Stroke Rsch (CSB), Charite Univ Medicine Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Cntr for Stroke Rsch (CSB), Charite Univ Medicine Berlin, Berlin, Germany
| | - Jan Sobesky
- Cntr for Stroke Rsch (CSB), Charite Univ Medicine Berlin, Berlin, Germany
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Madai VI, Martin SZ, von Samson-Himmelstjerna FC, Herzig CX, Mutke MA, Wood CN, Thamm T, Zweynert S, Bauer M, Hetzer S, Günther M, Sobesky J. Correction for Susceptibility Distortions Increases the Performance of Arterial Spin Labeling in Patients with Cerebrovascular Disease. J Neuroimaging 2016; 26:436-44. [DOI: 10.1111/jon.12331] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Vince I. Madai
- Center for Stroke Research Berlin (CSB); Charité-Universitätsmedizin; Berlin Germany
- Department of Neurology; Charité-Universtitätsmedizin; Berlin Germany
| | - Steve Z. Martin
- Center for Stroke Research Berlin (CSB); Charité-Universitätsmedizin; Berlin Germany
| | | | - Cornelius X. Herzig
- Center for Stroke Research Berlin (CSB); Charité-Universitätsmedizin; Berlin Germany
| | - Matthias A. Mutke
- Center for Stroke Research Berlin (CSB); Charité-Universitätsmedizin; Berlin Germany
- Department of Neurology; Charité-Universtitätsmedizin; Berlin Germany
| | - Carla N. Wood
- Center for Stroke Research Berlin (CSB); Charité-Universitätsmedizin; Berlin Germany
| | - Thoralf Thamm
- Center for Stroke Research Berlin (CSB); Charité-Universitätsmedizin; Berlin Germany
| | - Sarah Zweynert
- Center for Stroke Research Berlin (CSB); Charité-Universitätsmedizin; Berlin Germany
- Department of Neurology; Charité-Universtitätsmedizin; Berlin Germany
| | - Miriam Bauer
- Center for Stroke Research Berlin (CSB); Charité-Universitätsmedizin; Berlin Germany
| | - Stefan Hetzer
- Berlin Center for Advanced Neuroimaging (BCAN); Berlin Germany
| | - Matthias Günther
- Fraunhofer MEVIS; Bremen Germany
- University Bremen; Bremen Germany
- mediri GmbH; Heidelberg Germany
| | - Jan Sobesky
- Center for Stroke Research Berlin (CSB); Charité-Universitätsmedizin; Berlin Germany
- Department of Neurology; Charité-Universtitätsmedizin; Berlin Germany
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Zaro-Weber O, Livne M, Martin SZ, von Samson-Himmelstjerna FC, Moeller-Hartmann W, Schuster A, Brunecker P, Heiss WD, Sobesky J, Madai VI. Comparison of the 2 Most Popular Deconvolution Techniques for the Detection of Penumbral Flow in Acute Stroke. Stroke 2015; 46:2795-9. [PMID: 26306755 DOI: 10.1161/strokeaha.115.010246] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 06/02/2015] [Accepted: 07/15/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Dynamic susceptibility-weighted contrast-enhanced (DSC) magnetic resonance imaging (MRI) is used to identify the tissue-at-risk in acute stroke, but the choice of optimal DSC postprocessing in the clinical setting remains a matter of debate. Using 15O-water positron emission tomography (PET), we validated the performance of 2 common deconvolution methods for DSC-MRI. METHODS In (sub)acute stroke patients with consecutive MRI and PET imaging, DSC maps were calculated applying 2 deconvolution methods, standard and block-circulant single value decomposition. We used 2 standardized analysis methods, a region of interest-based and a voxel-based analysis, where PET cerebral blood flow masks of <20 mL/100 g per minute (penumbral flow) and gray matter masks were overlaid on DSC parameter maps. For both methods, receiver operating characteristic curve analysis was performed to identify the accuracy of each DSC-MR map for the detection of PET penumbral flow. RESULTS In 18 data sets (median time after stroke onset: 18 hours; median time PET to MRI: 101 minutes), block-circulant single value decomposition showed significantly better performance to detect PET penumbral flow only for mean transit time maps. Time-to-maximum (Tmax) had the highest performance independent of the deconvolution method. CONCLUSIONS Block-circulant single value decomposition seems only significantly beneficial for mean transit time maps in (sub)acute stroke. Tmax is likely the most stable deconvolved parameter for the detection of tissue-at-risk using DSC-MRI.
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Affiliation(s)
- Olivier Zaro-Weber
- From the Max-Planck-Institute for Metabolism Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.); Center for Stroke Research Berlin (CSB) (M.L., S.Z.M., F.C.v.S.-H., P.B., J.S., V.I.M.) and Department of Neurology (J.S., V.I.M.), Charité-Universitätsmedizin, Berlin, Germany; Fraunhofer MEVIS, Bremen, Germany (F.C.v.S.-H.); Department of Radiology, Ludmillenstift, Meppen, Germany (W.M.-H.); and Max-Planck-Institute for Neurological Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.).
| | - Michelle Livne
- From the Max-Planck-Institute for Metabolism Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.); Center for Stroke Research Berlin (CSB) (M.L., S.Z.M., F.C.v.S.-H., P.B., J.S., V.I.M.) and Department of Neurology (J.S., V.I.M.), Charité-Universitätsmedizin, Berlin, Germany; Fraunhofer MEVIS, Bremen, Germany (F.C.v.S.-H.); Department of Radiology, Ludmillenstift, Meppen, Germany (W.M.-H.); and Max-Planck-Institute for Neurological Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.)
| | - Steve Z Martin
- From the Max-Planck-Institute for Metabolism Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.); Center for Stroke Research Berlin (CSB) (M.L., S.Z.M., F.C.v.S.-H., P.B., J.S., V.I.M.) and Department of Neurology (J.S., V.I.M.), Charité-Universitätsmedizin, Berlin, Germany; Fraunhofer MEVIS, Bremen, Germany (F.C.v.S.-H.); Department of Radiology, Ludmillenstift, Meppen, Germany (W.M.-H.); and Max-Planck-Institute for Neurological Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.)
| | - Federico C von Samson-Himmelstjerna
- From the Max-Planck-Institute for Metabolism Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.); Center for Stroke Research Berlin (CSB) (M.L., S.Z.M., F.C.v.S.-H., P.B., J.S., V.I.M.) and Department of Neurology (J.S., V.I.M.), Charité-Universitätsmedizin, Berlin, Germany; Fraunhofer MEVIS, Bremen, Germany (F.C.v.S.-H.); Department of Radiology, Ludmillenstift, Meppen, Germany (W.M.-H.); and Max-Planck-Institute for Neurological Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.)
| | - Walter Moeller-Hartmann
- From the Max-Planck-Institute for Metabolism Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.); Center for Stroke Research Berlin (CSB) (M.L., S.Z.M., F.C.v.S.-H., P.B., J.S., V.I.M.) and Department of Neurology (J.S., V.I.M.), Charité-Universitätsmedizin, Berlin, Germany; Fraunhofer MEVIS, Bremen, Germany (F.C.v.S.-H.); Department of Radiology, Ludmillenstift, Meppen, Germany (W.M.-H.); and Max-Planck-Institute for Neurological Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.)
| | - Alexander Schuster
- From the Max-Planck-Institute for Metabolism Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.); Center for Stroke Research Berlin (CSB) (M.L., S.Z.M., F.C.v.S.-H., P.B., J.S., V.I.M.) and Department of Neurology (J.S., V.I.M.), Charité-Universitätsmedizin, Berlin, Germany; Fraunhofer MEVIS, Bremen, Germany (F.C.v.S.-H.); Department of Radiology, Ludmillenstift, Meppen, Germany (W.M.-H.); and Max-Planck-Institute for Neurological Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.)
| | - Peter Brunecker
- From the Max-Planck-Institute for Metabolism Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.); Center for Stroke Research Berlin (CSB) (M.L., S.Z.M., F.C.v.S.-H., P.B., J.S., V.I.M.) and Department of Neurology (J.S., V.I.M.), Charité-Universitätsmedizin, Berlin, Germany; Fraunhofer MEVIS, Bremen, Germany (F.C.v.S.-H.); Department of Radiology, Ludmillenstift, Meppen, Germany (W.M.-H.); and Max-Planck-Institute for Neurological Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.)
| | - Wolf-Dieter Heiss
- From the Max-Planck-Institute for Metabolism Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.); Center for Stroke Research Berlin (CSB) (M.L., S.Z.M., F.C.v.S.-H., P.B., J.S., V.I.M.) and Department of Neurology (J.S., V.I.M.), Charité-Universitätsmedizin, Berlin, Germany; Fraunhofer MEVIS, Bremen, Germany (F.C.v.S.-H.); Department of Radiology, Ludmillenstift, Meppen, Germany (W.M.-H.); and Max-Planck-Institute for Neurological Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.)
| | - Jan Sobesky
- From the Max-Planck-Institute for Metabolism Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.); Center for Stroke Research Berlin (CSB) (M.L., S.Z.M., F.C.v.S.-H., P.B., J.S., V.I.M.) and Department of Neurology (J.S., V.I.M.), Charité-Universitätsmedizin, Berlin, Germany; Fraunhofer MEVIS, Bremen, Germany (F.C.v.S.-H.); Department of Radiology, Ludmillenstift, Meppen, Germany (W.M.-H.); and Max-Planck-Institute for Neurological Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.)
| | - Vince I Madai
- From the Max-Planck-Institute for Metabolism Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.); Center for Stroke Research Berlin (CSB) (M.L., S.Z.M., F.C.v.S.-H., P.B., J.S., V.I.M.) and Department of Neurology (J.S., V.I.M.), Charité-Universitätsmedizin, Berlin, Germany; Fraunhofer MEVIS, Bremen, Germany (F.C.v.S.-H.); Department of Radiology, Ludmillenstift, Meppen, Germany (W.M.-H.); and Max-Planck-Institute for Neurological Research, Cologne, Germany (O.Z.-W., A.S., W.-D.H.).
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9
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Martin SZ, Madai VI, von Samson-Himmelstjerna FC, Mutke MA, Bauer M, Herzig CX, Hetzer S, Günther M, Sobesky J. 3D GRASE pulsed arterial spin labeling at multiple inflow times in patients with long arterial transit times: comparison with dynamic susceptibility-weighted contrast-enhanced MRI at 3 Tesla. J Cereb Blood Flow Metab 2015; 35:392-401. [PMID: 25407272 PMCID: PMC4348376 DOI: 10.1038/jcbfm.2014.200] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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] [Received: 06/26/2014] [Revised: 09/26/2014] [Accepted: 10/22/2014] [Indexed: 11/09/2022]
Abstract
Pulsed arterial spin labeling (PASL) at multiple inflow times (multi-TIs) is advantageous for the measurement of brain perfusion in patients with long arterial transit times (ATTs) as in steno-occlusive disease, because bolus-arrival-time can be measured and blood flow measurements can be corrected accordingly. Owing to its increased signal-to-noise ratio, a combination with a three-dimensional gradient and spin echo (GRASE) readout allows acquiring a sufficient number of multi-TIs within a clinically feasible acquisition time of 5 minutes. We compared this technique with the clinical standard dynamic susceptibility-weighted contrast-enhanced imaging-magnetic resonance imaging in patients with unilateral stenosis >70% of the internal carotid or middle cerebral artery (MCA) at 3 Tesla. We performed qualitative (assessment by three expert raters) and quantitative (region of interest (ROI)/volume of interest (VOI) based) comparisons. In 43 patients, multi-TI PASL-GRASE showed perfusion alterations with moderate accuracy in the qualitative analysis. Quantitatively, moderate correlation coefficients were found for the MCA territory (ROI based: r=0.52, VOI based: r=0.48). In the anterior cerebral artery (ACA) territory, a readout related right-sided susceptibility artifact impaired correlation (ROI based: r=0.29, VOI based: r=0.34). Arterial transit delay artifacts were found only in 12% of patients. In conclusion, multi-TI PASL-GRASE can correct for arterial transit delay in patients with long ATTs. These results are promising for the transfer of ASL to the clinical practice.
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Affiliation(s)
- Steve Z Martin
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
| | - Vince I Madai
- 1] Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany [2] Department of Neurology, Charité-Universtitätsmedizin, Berlin, Germany
| | - Federico C von Samson-Himmelstjerna
- 1] Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany [2] Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | - Matthias A Mutke
- 1] Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany [2] Department of Neurology, Charité-Universtitätsmedizin, Berlin, Germany
| | - Miriam Bauer
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
| | - Cornelius X Herzig
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
| | - Stefan Hetzer
- Berlin Center for Advanced Neuroimaging (BCAN), Berlin, Germany
| | - Matthias Günther
- 1] Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany [2] Faculty of Physics and Electronics, University of Bremen, Bremen, Germany [3] mediri GmbH, Heidelberg, Germany
| | - Jan Sobesky
- 1] Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany [2] Department of Neurology, Charité-Universtitätsmedizin, Berlin, Germany
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10
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Madai VI, Galinovic I, Grittner U, Zaro-Weber O, Schneider A, Martin SZ, Samson-Himmelstjerna FCV, Stengl KL, Mutke MA, Moeller-Hartmann W, Ebinger M, Fiebach JB, Sobesky J. DWI intensity values predict FLAIR lesions in acute ischemic stroke. PLoS One 2014; 9:e92295. [PMID: 24658092 PMCID: PMC3962388 DOI: 10.1371/journal.pone.0092295] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 02/21/2014] [Indexed: 12/03/2022] Open
Abstract
Background and Purpose In acute stroke, the DWI-FLAIR mismatch allows for the allocation of patients to the thrombolysis window (<4.5 hours). FLAIR-lesions, however, may be challenging to assess. In comparison, DWI may be a useful bio-marker owing to high lesion contrast. We investigated the performance of a relative DWI signal intensity (rSI) threshold to predict the presence of FLAIR-lesions in acute stroke and analyzed its association with time-from-stroke-onset. Methods In a retrospective, dual-center MR-imaging study we included patients with acute stroke and time-from-stroke-onset ≤12 hours (group A: n = 49, 1.5T; group B: n = 48, 3T). DW- and FLAIR-images were coregistered. The largest lesion extent in DWI defined the slice for further analysis. FLAIR-lesions were identified by 3 raters, delineated as regions-of-interest (ROIs) and copied on the DW-images. Circular ROIs were placed within the DWI-lesion and labeled according to the FLAIR-pattern (FLAIR+ or FLAIR−). ROI-values were normalized to the unaffected hemisphere. Adjusted and nonadjusted receiver-operating-characteristics (ROC) curve analysis on patient level was performed to analyze the ability of a DWI- and ADC-rSI threshold to predict the presence of FLAIR-lesions. Spearman correlation and adjusted linear regression analysis was performed to assess the relationship between DWI-intensity and time-from-stroke-onset. Results DWI-rSI performed well in predicting lesions in FLAIR-imaging (mean area under the curve (AUC): group A: 0.84; group B: 0.85). An optimal mean DWI-rSI threshold was identified (A: 162%; B: 161%). ADC-maps performed worse (mean AUC: A: 0.58; B: 0.77). Adjusted regression models confirmed the superior performance of DWI-rSI. Correlation coefficents and linear regression showed a good association with time-from-stroke-onset for DWI-rSI, but not for ADC-rSI. Conclusion An easily assessable DWI-rSI threshold identifies the presence of lesions in FLAIR-imaging with good accuracy and is associated with time-from-stroke-onset in acute stroke. This finding underlines the potential of a DWI-rSI threshold as a marker of lesion age.
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Affiliation(s)
- Vince I. Madai
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
- Department of Neurology, Charité-Universtitätsmedizin, Berlin, Germany
| | - Ivana Galinovic
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
| | - Ulrike Grittner
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
- Department for Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Olivier Zaro-Weber
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
- Max-Planck-Institute for Neurological Research, Cologne, Germany
| | - Alice Schneider
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
- Department for Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Steve Z. Martin
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
| | | | - Katharina L. Stengl
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
- Department of Neurology, Charité-Universtitätsmedizin, Berlin, Germany
| | - Matthias A. Mutke
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
- Department of Neurology, Charité-Universtitätsmedizin, Berlin, Germany
| | | | - Martin Ebinger
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
- Department of Neurology, Charité-Universtitätsmedizin, Berlin, Germany
| | - Jochen B. Fiebach
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
| | - Jan Sobesky
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
- Department of Neurology, Charité-Universtitätsmedizin, Berlin, Germany
- * E-mail:
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