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Moriconi S, Rodríguez-Núñez O, Gros R, Felger LA, Maragkou T, Hewer E, Pierangelo A, Novikova T, Schucht P, McKinley R. Near-real-time Mueller polarimetric image processing for neurosurgical intervention. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03090-6. [PMID: 38503943 DOI: 10.1007/s11548-024-03090-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Wide-field imaging Mueller polarimetry is a revolutionary, label-free, and non-invasive modality for computer-aided intervention; in neurosurgery, it aims to provide visual feedback of white matter fibre bundle orientation from derived parameters. Conventionally, robust polarimetric parameters are estimated after averaging multiple measurements of intensity for each pair of probing and detected polarised light. Long multi-shot averaging, however, is not compatible with real-time in vivo imaging, and the current performance of polarimetric data processing hinders the translation to clinical practice. METHODS A learning-based denoising framework is tailored for fast, single-shot, noisy acquisitions of polarimetric intensities. Also, performance-optimised image processing tools are devised for the derivation of clinically relevant parameters. The combination recovers accurate polarimetric parameters from fast acquisitions with near-real-time performance, under the assumption of pseudo-Gaussian polarimetric acquisition noise. RESULTS The denoising framework is trained, validated, and tested on experimental data comprising tumour-free and diseased human brain samples in different conditions. Accuracy and image quality indices showed significant ( p < 0.05 ) improvements on testing data for a fast single-pass denoising versus the state-of-the-art and high polarimetric image quality standards. The computational time is reported for the end-to-end processing. CONCLUSION The end-to-end image processing achieved real-time performance for a localised field of view ( ≈ 6.5 mm 2 ). The denoised polarimetric intensities produced visibly clear directional patterns of neuronal fibre tracts in line with reference polarimetric image quality standards; directional disruption was kept in case of neoplastic lesions. The presented advances pave the way towards feasible oncological neurosurgical translations of novel, label-free, interventional feedback.
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Affiliation(s)
- Stefano Moriconi
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Omar Rodríguez-Núñez
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Romain Gros
- Institute of Tissue Medicine and Pathology, University of Bern, 3008, Bern, Switzerland
| | - Leonard A Felger
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Theoni Maragkou
- Institute of Tissue Medicine and Pathology, University of Bern, 3008, Bern, Switzerland
| | - Ekkehard Hewer
- Institute of Pathology, Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Angelo Pierangelo
- LPICM, CNRS, Ecole Polytechnique, IP Paris, 91120, Palaiseau, France
| | - Tatiana Novikova
- LPICM, CNRS, Ecole Polytechnique, IP Paris, 91120, Palaiseau, France
| | - Philippe Schucht
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Richard McKinley
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
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Xu Y, Mathis AM, Pollo B, Schlegel J, Maragkou T, Seidel K, Schucht P, Smith KA, Porter RW, Raabe A, Little AS, Sanai N, Agbanyim DC, Martirosyan NL, Eschbacher JM, Quint K, Preul MC, Hewer E. Intraoperative in vivo confocal laser endomicroscopy imaging at glioma margins: can we detect tumor infiltration? J Neurosurg 2024; 140:357-366. [PMID: 37542440 DOI: 10.3171/2023.5.jns23546] [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: 03/09/2023] [Accepted: 05/19/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Confocal laser endomicroscopy (CLE) is a US Food and Drug Administration-cleared intraoperative real-time fluorescence-based cellular resolution imaging technology that has been shown to image brain tumor histoarchitecture rapidly in vivo during neuro-oncological surgical procedures. An important goal for successful intraoperative implementation is in vivo use at the margins of infiltrating gliomas. However, CLE use at glioma margins has not been well studied. METHODS Matching in vivo CLE images and tissue biopsies acquired at glioma margin regions of interest (ROIs) were collected from 2 institutions. All images were reviewed by 4 neuropathologists experienced in CLE. A scoring system based on the pathological features was implemented to score CLE and H&E images from each ROI on a scale from 0 to 5. Based on the H&E scores, all ROIs were divided into a low tumor probability (LTP) group (scores 0-2) and a high tumor probability (HTP) group (scores 3-5). The concordance between CLE and H&E scores regarding tumor probability was determined. The intraclass correlation coefficient (ICC) and diagnostic performance were calculated. RESULTS Fifty-six glioma margin ROIs were included for analysis. Interrater reliability of the scoring system was excellent when used for H&E images (ICC [95% CI] 0.91 [0.86-0.94]) and moderate when used for CLE images (ICC [95% CI] 0.69 [0.40-0.83]). The ICCs (95% CIs) of the LTP group (0.68 [0.40-0.83]) and HTP group (0.68 [0.39-0.83]) did not differ significantly. The concordance between CLE and H&E scores was 61.6%. The sensitivity and specificity values of the scoring system were 79% and 37%. The positive predictive value (PPV) and negative predictive value were 65% and 53%, respectively. Concordance, sensitivity, and PPV were greater in the HTP group than in the LTP group. Specificity was higher in the newly diagnosed group than in the recurrent group. CONCLUSIONS CLE may detect tumor infiltration at glioma margins. However, it is not currently dependable, especially in scenarios where low probability of tumor infiltration is expected. The proposed scoring system has excellent intrinsic interrater reliability, but its interrater reliability is only moderate when used with CLE images. These results suggest that this technology requires further exploration as a method for consistent actionable intraoperative guidance with high dependability across the range of tumor margin scenarios. Specific-binding and/or tumor-specific fluorophores, a CLE image atlas, and a consensus guideline for image interpretation may help with the translational utility of CLE.
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Affiliation(s)
- Yuan Xu
- 1Department of Neurosurgery, The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Andrea M Mathis
- 2Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Bianca Pollo
- 3Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Jürgen Schlegel
- 4Department of Neuropathology, Institute of Pathology, TUM School of Medicine, Technical University Munich, Germany
| | - Theoni Maragkou
- 5Institute of Tissue Medicine and Pathology, University of Bern, Switzerland
| | - Kathleen Seidel
- 2Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Philippe Schucht
- 2Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Kris A Smith
- 1Department of Neurosurgery, The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Randall W Porter
- 1Department of Neurosurgery, The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Andreas Raabe
- 2Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Andrew S Little
- 1Department of Neurosurgery, The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Nader Sanai
- 1Department of Neurosurgery, The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Dennis C Agbanyim
- 2Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Nikolay L Martirosyan
- 1Department of Neurosurgery, The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jennifer M Eschbacher
- 6Department of Neuropathology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - Mark C Preul
- 1Department of Neurosurgery, The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Ekkehard Hewer
- 8Institute of Pathology, Lausanne University Hospital, University of Lausanne, Switzerland
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3
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Ivanov D, Si L, Felger L, Maragkou T, Schucht P, Schanne-Klein MC, Ma H, Ossikovski R, Novikova T. Impact of corpus callosum fiber tract crossing on polarimetric images of human brain histological sections: ex vivo studies in transmission configuration. J Biomed Opt 2023; 28:102908. [PMID: 37705930 PMCID: PMC10496857 DOI: 10.1117/1.jbo.28.10.102908] [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] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/20/2023] [Accepted: 08/17/2023] [Indexed: 09/15/2023]
Abstract
Significance Imaging Mueller polarimetry is capable to trace in-plane orientation of brain fiber tracts by detecting the optical anisotropy of white matter of healthy brain. Brain tumor cells grow chaotically and destroy this anisotropy. Hence, the drop in scalar retardance values and randomization of the azimuth of the optical axis could serve as the optical marker for brain tumor zone delineation. Aim The presence of underlying crossing fibers can also affect the values of scalar retardance and the azimuth of the optical axis. We studied and analyzed the impact of fiber crossing on the polarimetric images of thin histological sections of brain corpus callosum. Approach We used the transmission Mueller microscope for imaging of two-layered stacks of thin sections of corpus callosum tissue to mimic the overlapping brain fiber tracts with different fiber orientations. The decomposition of the measured Mueller matrices was performed with differential and Lu-Chipman algorithms and completed by the statistical analysis of the maps of scalar retardance, azimuth of the optical axis, and depolarization. Results Our results indicate the sensitivity of Mueller polarimetry to different spatial arrangement of brain fiber tracts as seen in the maps of scalar retardance and azimuth of optical axis of two-layered stacks of corpus callosum sections The depolarization varies slightly (< 15 % ) with the orientation of the optical axes in both corpus callosum stripes, but its value increases by 2.5 to 3 times with the stack thickness. Conclusions The crossing brain fiber tracts measured in transmission induce the drop in values of scalar retardance and randomization of the azimuth of the optical axis at optical path length of 15 μ m . It suggests that the presence of nerve fibers crossing within the depth of few microns will be also detected in polarimetric maps of brain white matter measured in reflection configuration.
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Affiliation(s)
- Deyan Ivanov
- Institut Polytechnique de Paris, École Polytechnique, CNRS, LPICM, Palaiseau, France
| | - Lu Si
- Tsinghua University, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, China
| | - Leonard Felger
- Bern University Hospital, University of Bern, Inselspital, Department of Neurosurgery, Bern, Switzerland
| | - Theoni Maragkou
- University of Bern, Institute of Tissue Medicine and Pathology, Bern, Switzerland
| | - Philippe Schucht
- Bern University Hospital, University of Bern, Inselspital, Department of Neurosurgery, Bern, Switzerland
| | | | - Hui Ma
- Tsinghua University, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, China
- Tsinghua University, Department of Physics, Beijing, China
| | - Razvigor Ossikovski
- Institut Polytechnique de Paris, École Polytechnique, CNRS, LPICM, Palaiseau, France
| | - Tatiana Novikova
- Institut Polytechnique de Paris, École Polytechnique, CNRS, LPICM, Palaiseau, France
- Florida International University, Department of Biomedical Engineering, Miami, Florida, United States
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4
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Träger M, Schweizer L, Pérez E, Schmid S, Hain EG, Dittmayer C, Onken J, Fukuoka K, Ichimura K, Schüller U, Dührsen L, Müther M, Paulus W, Thomas C, Gutt-Will M, Schucht P, Maragkou T, Schittenhelm J, Eckert F, Niyazi M, Fleischmann DF, Dorostkar MM, Feyer P, May SA, Moskopp D, Badakhshi H, Radke C, Walter J, Ehret F, Capper D, Kaul D. Adult intracranial ependymoma-relevance of DNA methylation profiling for diagnosis, prognosis, and treatment. Neuro Oncol 2023; 25:1286-1298. [PMID: 36734226 PMCID: PMC10326475 DOI: 10.1093/neuonc/noad030] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A methylation-based classification of ependymoma has recently found broad application. However, the diagnostic advantage and implications for treatment decisions remain unclear. Here, we retrospectively evaluate the impact of surgery and radiotherapy on outcome after molecular reclassification of adult intracranial ependymomas. METHODS Tumors diagnosed as intracranial ependymomas from 170 adult patients collected from 8 diagnostic institutions were subjected to DNA methylation profiling. Molecular classes, patient characteristics, and treatment were correlated with progression-free survival (PFS). RESULTS The classifier indicated an ependymal tumor in 73.5%, a different tumor entity in 10.6%, and non-classifiable tumors in 15.9% of cases, respectively. The most prevalent molecular classes were posterior fossa ependymoma group B (EPN-PFB, 32.9%), posterior fossa subependymoma (PF-SE, 25.9%), and supratentorial ZFTA fusion-positive ependymoma (EPN-ZFTA, 11.2%). With a median follow-up of 60.0 months, the 5- and 10-year-PFS rates were 64.5% and 41.8% for EPN-PFB, 67.4% and 45.2% for PF-SE, and 60.3% and 60.3% for EPN-ZFTA. In EPN-PFB, but not in other molecular classes, gross total resection (GTR) (P = .009) and postoperative radiotherapy (P = .007) were significantly associated with improved PFS in multivariable analysis. Histological tumor grading (WHO 2 vs. 3) was not a predictor of the prognosis within molecularly defined ependymoma classes. CONCLUSIONS DNA methylation profiling improves diagnostic accuracy and risk stratification in adult intracranial ependymoma. The molecular class of PF-SE is unexpectedly prevalent among adult tumors with ependymoma histology and relapsed as frequently as EPN-PFB, despite the supposed benign nature. GTR and radiotherapy may represent key factors in determining the outcome of EPN-PFB patients.
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Affiliation(s)
- Malte Träger
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Leonille Schweizer
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Edinger Institute, Institute of Neurology, University of Frankfurt am Main, Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany
| | - Eilís Pérez
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Simone Schmid
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisabeth G Hain
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Carsten Dittmayer
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia Onken
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kohei Fukuoka
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
- Department of Brain Disease Translational Research, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ulrich Schüller
- Institute of Neuropathology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center Hamburg, Hamburg, Germany
| | - Lasse Dührsen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Müther
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Christian Thomas
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Marielena Gutt-Will
- Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Philippe Schucht
- Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Theoni Maragkou
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Jens Schittenhelm
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Franziska Eckert
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
- Department of Radiation Oncology, Medical University Vienna, AKH, Comprehensive Cancer Center, Vienna, Austria
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- German Cancer Consortium (DKTK) partner site Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Daniel F Fleischmann
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- German Cancer Consortium (DKTK) partner site Munich, Munich, Germany
| | - Mario M Dorostkar
- Center for Neuropathology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Petra Feyer
- Department of Radiation Oncology, Vivantes Hospital Neukölln, Berlin, Germany
| | - Sven-Axel May
- Department of Neurosurgery, Klinikum Chemnitz, Chemnitz, Germany
| | - Dag Moskopp
- Department of Neurosurgery, Vivantes Klinikum Im Friedrichshain, Berlin, Germany
| | - Harun Badakhshi
- Department of Clinical Radiation Oncology, Ernst Von Bergmann Medical Center Potsdam, Potsdam, Germany
| | - Cornelia Radke
- Department of Pathology, Ernst Von Bergmann Medical Center Potsdam, Potsdam, Germany
| | - Jan Walter
- Department of Neurosurgery, Jena University Hospital, Jena, Germany
- Department of Neurosurgery, Medical Center Saarbrücken, Saarbrücken, Germany
| | - Felix Ehret
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Capper
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Felger L, Rodríguez-Núñez O, Gros R, Maragkou T, McKinley R, Moriconi S, Murek M, Zubak I, Novikova T, Pierangelo A, Schucht P. Robustness of the wide-field imaging Mueller polarimetry for brain tissue differentiation and white matter fiber tract identification in a surgery-like environment: an ex vivo study. Biomed Opt Express 2023; 14:2400-2415. [PMID: 37206128 PMCID: PMC10191649 DOI: 10.1364/boe.486438] [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] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 05/21/2023]
Abstract
During neurooncological surgery, the visual differentiation of healthy and diseased tissue is often challenging. Wide-field imaging Muller polarimetry (IMP) is a promising technique for tissue discrimination and in-plane brain fiber tracking in an interventional setup. However, the intraoperative implementation of IMP requires realizing imaging in the presence of remanent blood, and complex surface topography resulting from the use of an ultrasonic cavitation device. We report on the impact of both factors on the quality of polarimetric images of the surgical resection cavities reproduced in fresh animal cadaveric brains. The robustness of IMP is observed under adverse experimental conditions, suggesting a feasible translation of IMP for in vivo neurosurgical applications.
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Affiliation(s)
- Leonard Felger
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Omar Rodríguez-Núñez
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Romain Gros
- Institute of Tissue Medicine and Pathology, University of Bern, 3010 Bern, Switzerland
| | - Theoni Maragkou
- Institute of Tissue Medicine and Pathology, University of Bern, 3010 Bern, Switzerland
| | - Richard McKinley
- SCAN, University Institute of Diagnostic and Interventional Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Stefano Moriconi
- SCAN, University Institute of Diagnostic and Interventional Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Michael Murek
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Irena Zubak
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Tatiana Novikova
- LPICM, CNRS, Ecole polytechnique, IP Paris, 91128 Palaiseau, France
| | | | - Philippe Schucht
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
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6
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Gros R, Rodríguez-Núñez O, Felger L, Moriconi S, McKinley R, Pierangelo A, Novikova T, Vassella E, Schucht P, Hewer E, Maragkou T. Effects of formalin fixation on polarimetric properties of brain tissue: fresh or fixed? Neurophotonics 2023; 10:025009. [PMID: 37234458 PMCID: PMC10207713 DOI: 10.1117/1.nph.10.2.025009] [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] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/16/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023]
Abstract
Significance Imaging Mueller polarimetry (IMP) appears as a promising technique for real-time delineation of healthy and neoplastic tissue during neurosurgery. The training of machine learning algorithms used for the image post-processing requires large data sets typically derived from the measurements of formalin-fixed brain sections. However, the success of the transfer of such algorithms from fixed to fresh brain tissue depends on the degree of alterations of polarimetric properties induced by formalin fixation (FF). Aim Comprehensive studies were performed on the FF induced changes in fresh pig brain tissue polarimetric properties. Approach Polarimetric properties of pig brain were assessed in 30 coronal thick sections before and after FF using a wide-field IMP system. The width of the uncertainty region between gray and white matter was also estimated. Results The depolarization increased by 5% in gray matter and remained constant in white matter following FF, whereas the linear retardance decreased by 27% in gray matter and by 28% in white matter after FF. The visual contrast between gray and white matter and fiber tracking remained preserved after FF. Tissue shrinkage induced by FF did not have a significant effect on the uncertainty region width. Conclusions Similar polarimetric properties were observed in both fresh and fixed brain tissues, indicating a high potential for transfer learning.
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Affiliation(s)
- Romain Gros
- University of Bern, Institute of Tissue Medicine and Pathology, Bern, Switzerland
- University of Bern, Graduate School for Cellular and Biomedical Sciences, Bern, Switzerland
| | - Omar Rodríguez-Núñez
- Bern University Hospital, University of Bern, Department of Neurosurgery, Inselspital, Bern, Switzerland
| | - Leonard Felger
- Bern University Hospital, University of Bern, Department of Neurosurgery, Inselspital, Bern, Switzerland
| | - Stefano Moriconi
- University of Bern, Inselspital, Bern University Hospital, University Institute of Diagnostic and Interventional Radiology, Support Center for Advanced Neuroimaging, Bern, Switzerland
| | - Richard McKinley
- University of Bern, Inselspital, Bern University Hospital, University Institute of Diagnostic and Interventional Radiology, Support Center for Advanced Neuroimaging, Bern, Switzerland
| | | | | | - Erik Vassella
- University of Bern, Institute of Tissue Medicine and Pathology, Bern, Switzerland
| | - Philippe Schucht
- Bern University Hospital, University of Bern, Department of Neurosurgery, Inselspital, Bern, Switzerland
| | - Ekkehard Hewer
- Lausanne University Hospital and University of Lausanne, Institute of Pathology, Lausanne, Switzerland
| | - Theoni Maragkou
- University of Bern, Institute of Tissue Medicine and Pathology, Bern, Switzerland
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7
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Weng G, Ermiş E, Maragkou T, Krcek R, Reinhardt P, Zubak I, Schucht P, Wiest R, Slotboom J, Radojewski P. Accurate prediction of isocitrate dehydrogenase -mutation status of gliomas using SLOW-editing magnetic resonance spectroscopic imaging at 7 T MR. Neurooncol Adv 2023; 5:vdad001. [PMID: 36875625 PMCID: PMC9977233 DOI: 10.1093/noajnl/vdad001] [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] [Indexed: 01/05/2023] Open
Abstract
Background 2-hydroxy-glutarate (2HG) is a metabolite that accumulates in isocitrate dehydrogenase (IDH)-mutated gliomas and can be detected noninvasively using MR spectroscopy. However, due to the low concentration of 2HG, established magnetic resonance spectroscopic imaging (MRSI) techniques at the low field have limitations with respect to signal-to-noise and to the spatial resolution that can be obtained within clinically acceptable measurement times. Recently a tailored editing method for 2HG detection at 7 Tesla (7 T) named SLOW-EPSI was developed. The underlying prospective study aimed to compare SLOW-EPSI to established techniques at 7 T and 3 T for IDH-mutation status determination. Methods The applied sequences were MEGA-SVS and MEGA-CSI at both field strengths and SLOW-EPSI at 7 T only. Measurements were performed on a MAGNETOM-Terra 7 T MR-scanner in clinical mode using a Nova 1Tx32Rx head coil and on a 3 T MAGNETOM-Prisma scanner with a standard 32-channel head coil. Results Fourteen patients with suspected glioma were enrolled. Histopathological confirmation was available in 12 patients. IDH mutation was confirmed in 9 out of 12 cases and 3 cases were characterized as IDH wildtype. SLOW-EPSI at 7 T showed the highest accuracy for IDH-status prediction (91.7% accuracy, 11 of the 12 predictions correct with 1 false negative case). At 7 T, MEGA-CSI had an accuracy of 58.3% and MEGA-SVS had an accuracy of 75%. At 3 T, MEGA-CSI showed an accuracy of 63.6% and MEGA-SVS of 33.3%. The co-edited cystathionine was detected in 2 out of 3 oligodendroglioma cases with 1p/19q codeletion. Conclusions Depending on the pulse sequence, spectral editing can be a powerful tool for the noninvasive determination of the IDH status. SLOW-editing EPSI sequence is the preferable pulse sequence when used at 7 T for IDH-status characterization.
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Affiliation(s)
- Guodong Weng
- Institute for Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging (SCAN), University of Bern, Bern, Switzerland.,Translational Imaging Center, sitem-insel, Bern, Switzerland
| | - Ekin Ermiş
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Theoni Maragkou
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Reinhardt Krcek
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Philipp Reinhardt
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Irena Zubak
- Department of Neurosurgery, Inselspital Bern and University Hospital, Bern, Switzerland
| | - Philippe Schucht
- Department of Neurosurgery, Inselspital Bern and University Hospital, Bern, Switzerland
| | - Roland Wiest
- Institute for Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging (SCAN), University of Bern, Bern, Switzerland.,Translational Imaging Center, sitem-insel, Bern, Switzerland
| | - Johannes Slotboom
- Institute for Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging (SCAN), University of Bern, Bern, Switzerland.,Translational Imaging Center, sitem-insel, Bern, Switzerland
| | - Piotr Radojewski
- Institute for Diagnostic and Interventional Neuroradiology, Support Center for Advanced Neuroimaging (SCAN), University of Bern, Bern, Switzerland.,Translational Imaging Center, sitem-insel, Bern, Switzerland
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8
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Renz P, Schoeberlein A, Haesler V, Maragkou T, Surbek D, Brosius Lutz A. A Novel Murine Multi-Hit Model of Perinatal Acute Diffuse White Matter Injury Recapitulates Major Features of Human Disease. Biomedicines 2022; 10:biomedicines10112810. [PMID: 36359331 PMCID: PMC9687579 DOI: 10.3390/biomedicines10112810] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
The selection of an appropriate animal model is key to the production of results with optimal relevance to human disease. Particularly in the case of perinatal brain injury, a dearth of affected human neonatal tissue available for research purposes increases the reliance on animal models for insight into disease mechanisms. Improvements in obstetric and neonatal care in the past 20 years have caused the pathologic hallmarks of perinatal white matter injury (WMI) to evolve away from cystic necrotic lesions and toward diffuse regions of reactive gliosis and persistent myelin disruption. Therefore, updated animal models are needed that recapitulate the key features of contemporary disease. Here, we report a murine model of acute diffuse perinatal WMI induced through a two-hit inflammatory–hypoxic injury paradigm. Consistent with diffuse human perinatal white matter injury (dWMI), our model did not show the formation of cystic lesions. Corresponding to cellular outcomes of dWMI, our injury protocol produced reactive microgliosis and astrogliosis, disrupted oligodendrocyte maturation, and disrupted myelination.. Functionally, we observed sensorimotor and cognitive deficits in affected mice. In conclusion, we report a novel murine model of dWMI that induces a pattern of brain injury mirroring multiple key aspects of the contemporary human clinical disease scenario.
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Affiliation(s)
- Patricia Renz
- Department for BioMedical Research, University of Bern and Switzerland, 3010 Bern, Switzerland
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Andreina Schoeberlein
- Department for BioMedical Research, University of Bern and Switzerland, 3010 Bern, Switzerland
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Valérie Haesler
- Department for BioMedical Research, University of Bern and Switzerland, 3010 Bern, Switzerland
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Theoni Maragkou
- Institute of Pathology, University of Bern, 3010 Bern, Switzerland
| | - Daniel Surbek
- Department for BioMedical Research, University of Bern and Switzerland, 3010 Bern, Switzerland
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Amanda Brosius Lutz
- Department for BioMedical Research, University of Bern and Switzerland, 3010 Bern, Switzerland
- Department of Obstetrics and Gynecology, Division of Feto-Maternal Medicine University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence:
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9
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Kashani E, Schnidrig D, Hashemi Gheinani A, Ninck MS, Zens P, Maragkou T, Baumgartner U, Schucht P, Rätsch G, Rubin MA, Berezowska S, Ng CKY, Vassella E. Integrated longitudinal analysis of adult grade 4 diffuse gliomas with long-term relapse interval revealed upregulation of TGF-β signaling in recurrent tumors. Neuro Oncol 2022; 25:662-673. [PMID: 36124685 PMCID: PMC10076939 DOI: 10.1093/neuonc/noac220] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adult-type diffuse gliomas, CNS WHO grade 4 are the most aggressive primary brain tumors and represent a particular challenge of therapeutic intervention. METHODS In a single-center retrospective study of matched pairs of initial and post-therapeutic glioma cases with a recurrence period greater than one year, we performed whole exome sequencing combined with mRNA and microRNA expression profiling to identify processes that are altered in recurrent gliomas. RESULTS Mutational analysis of recurrent gliomas revealed early branching evolution in seventy-five percent of patients. High plasticity was confirmed at the mRNA and miRNA levels. SBS1 signature was reduced and SBS11 was elevated, demonstrating the effect of alkylating agent therapy on the mutational landscape. There was no evidence for secondary genomic alterations driving therapy resistance. ALK7/ACVR1C and LTBP1 were upregulated, whereas LEFTY2 was downregulated, pointing towards enhanced Tumor Growth Factor β (TGF-β) signaling in recurrent gliomas. Consistently, altered microRNA expression profiles pointed towards enhanced Nuclear Factor Kappa B and Wnt signaling that, cooperatively with TGF-β, induces epithelial to mesenchymal transition (EMT), migration and stemness. TGF-β-induced expression of pro-apoptotic proteins and repression of anti-apoptotic proteins were uncoupled in the recurrent tumor. CONCLUSIONS Our results suggest an important role of TGF-β signaling in recurrent gliomas. This may have clinical implication, since TGF-β inhibitors have entered clinical phase studies and may potentially be used in combination therapy to interfere with chemoradiation resistance. Recurrent gliomas show high incidence of early branching evolution. High tumor plasticity is confirmed at the level of microRNA and mRNA expression profiles.
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Affiliation(s)
- Elham Kashani
- Institute of Pathology, University of Bern, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Désirée Schnidrig
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.,Department for BioMedical Research, University of Bern, Bern, Switzerland.,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Ali Hashemi Gheinani
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Philipp Zens
- Institute of Pathology, University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Theoni Maragkou
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Ulrich Baumgartner
- Cell and Molecular Biology Department, QIMR Berghofer Medical Research Institute, Sid Faithfull Brain Cancer Laboratory, Brisbane, Australia.,School of Biomedical Sciences, the University of Queensland, Brisbane, Australia
| | - Philippe Schucht
- School of Biomedical Sciences, the University of Queensland, Brisbane, Australia.,Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
| | - Gunnar Rätsch
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland.,ETH Zurich, Zurich, Switzerland
| | - Mark A Rubin
- Department for BioMedical Research, University of Bern, Bern, Switzerland.,Bern Center for Precision Medicine, Bern, Switzerland
| | - Sabina Berezowska
- Institute of Pathology, University of Bern, Bern, Switzerland.,Institute of Pathology, Lausanne University, Hospital and University of Lausanne, Lausanne, Switzerland
| | - Charlotte K Y Ng
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.,Department for BioMedical Research, University of Bern, Bern, Switzerland.,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Bern Center for Precision Medicine, Bern, Switzerland
| | - Erik Vassella
- Institute of Pathology, University of Bern, Bern, Switzerland
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10
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Maragkou T, Quint K, Pollo B, Hewer E. P15.08.B Intraoperative confocal laser endomicroscopy of brain tumors - potential and challenges from a neuropathological perspective. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.298] [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: 11/12/2022] Open
Abstract
Abstract
Background
Intraoperative consultation, usually in the form of a frozen section, is an integral part of current neuropathology practice. Typical indications include determination of specimen adequacy, intraoperative diagnosis and distinction between tumoral and non-tumoral tissue in diffusely infiltrating gliomas in tumor periphery. The latter is currently limited by the fact that typically not all potential regions of interest can be sampled for frozen sections and the turnaround times of frozen sections usually do not permit multiple repetitive assessments. The commercial availability of a clinical-grade in vivo laser endomicroscope for neurosurgical applications may have the potential to change this and to permit a microscopic analysis in near-real time, which in turn may have a significant impact on resection strategies for brain tumors. In this work, we investigate the potential role of CLE in neurosurgery and the transferability of histological criteria to confocal imaging.
Material and Methods
The potential role of CLE in neurosurgery in comparison to other techniques for intraoperative tumor assessment was determined by analyzing common intraoperative neuropathological workflows and identifying unaddressed opportunities. The transferability of the histological criteria from standard histology to confocal imaging was achieved by analyzing matched image pairs (standard histology and CLE) from several common tumor entities.
Results
We identified the time gap between specimen resection and the availability of the frozen section results as an important application for intraoperative CLE imaging in neurosurgery. Importantly, neuropathologists could assess tissue in near real time in an unlimited number of digital biopsies prior to resection, which adds a potent new tool to the neurosurgical armamentarium. CLE images revealed features similar to already known tissue architecture/morphology seen in standard histology, which correlated well in matched histological images. Unique aspects of individual cells and other surrounding tumor tissue elements were observed in vivo while the CLE probe acquired images throughout its focal-depth range.
Conclusion
Widespread application of CLE may have a major impact on neuropathologists' role in intraoperative diagnosis and bring along both opportunities and challenges. For broad clinical adoption, strategies for histological criteria validation as well as for determination of diagnostic accuracy need to be developed.
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Affiliation(s)
- T Maragkou
- Institute of Pathology, University of Bern , Bern , Switzerland
| | - K Quint
- Quint Healthcare , Fürth , Germany
| | - B Pollo
- Fondazione IRCCS Istituto Neurologico Carlo Besta , Milano , Italy
| | - E Hewer
- Institut Universitaire de Pathologie , Lausanne , Switzerland
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11
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Hewer E, Panitz G, Elsner J, Swamy von Zastrow F, Quint K, Eschbacher J, Sadeghi D, Ikeliani IU, Brunner M, Maragkou T, Abramov I, Xu Y, Belykh E, Mignucci-Jimenez G, Preul MC, Schlegel J. P13.05.A Image annotation guideline for invivo confocal laser endomicroscopy, interrater reliability and how to learn from medical consensus for machine learning algorithms. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.285] [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: 11/14/2022] Open
Abstract
Abstract
Background
Intraoperative confocal laser endomicroscopy (CLE) is an in vivo imaging technique increasingly studied in neurosurgery and neuropathology. It can be affected by artifacts introduced by the CLE device or related to the intraoperative setting. We developed and evaluated an image annotation guideline (AGL) to detect and eliminate images bearing no valuable information as a result of such artifacts. Images ware classified into good and bad quality, based on defined technical criteria, which are also considered relevant by clinical experts.
Material and Methods
Datasets were created from intraoperative CLE in vivo specimens of patients resected for brain tumors. The process from data collection to development of the ML algorithm followed 7 steps: data quality specification, image and metadata collection, AGL development, annotation, data allocation for clinical validation, clinical validation, and, optionally, algorithm development. Final diagnoses were obtained by pathological analysis. Artifacts were grouped into three categories: diminished signal-to-noise-ratio (dSNR), optical distortions (movement/perturbations), and contrast/brightness artifacts. Images were annotated by 4 medical data annotators (T4). For clinical validation, 500 images were excluded from the training data and additionally annotated by 3 board certified neuropathologists (NPs 1-3) with experience in CLE imaging, to determine the medical consensus on good and bad images. All raters (NPs) were compared against each other and against T4; T4 was also compared against the medical consensus. Cohen’s Kappa and overall percentage agreement (OPA) were used to evaluate inter-rater reliability. Positive percent agreement (PPA) and negative percentage agreement (NPA) were also used to evaluate agreement between medical consensus and T4.
Results
21,616 CLE images and corresponding clinical metadata were collected from 94 patients and annotated. For each case between 27 and 815 CLE images were acquired over the course of the surgery (mean=175 images per case, SD=170.6). 11% and 13% of images were labeled as dSNR and distortion, respectively, and 34% as class contrast. 42% of the images represented the good quality images. Interrater agreement between the 3 NPs ranged between 0.30 and 0.59. Agreement between T4 and the medical consensus was substantial (Cohen’s Kappa >=0.61). OPA between T4 and the medical consensus was 80.60%, PPA 72.34% and NPA 87.92%.
Conclusion
Annotations according to a well-structured and expertly curated AGL show higher values for Cohen’s Kappa and Overall Percent Agreement (OPA) with the medical consensus, than that of individual experts among one another. Such an AGL can be considered appropriate and produces on par results with annotations by a group of experts in the field and can be further employed for training machine learning (ML) algorithms.
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Affiliation(s)
- E Hewer
- Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
| | - G Panitz
- Carl Zeiss Meditec AG , Oberkochen , Germany
| | - J Elsner
- M3i Industrie-in-Klinik-Plattform GmbH , Munich , Germany
| | | | - K Quint
- Quint Healthcare , Fürth , Germany
| | - J Eschbacher
- Barrow Neurological Institute , Phoenix, AZ , United States
| | - D Sadeghi
- M3i Industrie-in-Klinik-Plattform GmbH , Munich , Germany
| | - I U Ikeliani
- M3i Industrie-in-Klinik-Plattform GmbH , Munich , Germany
| | - M Brunner
- M3i Industrie-in-Klinik-Plattform GmbH , Munich , Germany
| | - T Maragkou
- Institute of Pathology, Inselspital Bern , Bern , Switzerland
| | - I Abramov
- Department of Neurosurgery, Barrow Neurological Institute , Phoenix, AZ , United States
| | - Y Xu
- Department of Neurosurgery, Barrow Neurological Institute , Phoenix, AZ , United States
| | - E Belykh
- Department of Neurosurgery, Barrow Neurological Institute , Phoenix, AZ , United States
| | - G Mignucci-Jimenez
- Department of Neurosurgery, Barrow Neurological Institute , Phoenix, AZ , United States
| | - M C Preul
- Department of Neurosurgery, Barrow Neurological Institute , Phoenix, AZ , United States
| | - J Schlegel
- Institute of Neuropathology, TUM School of Medicine , Munich , Germany
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12
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Engelhardt S, Dislich B, Zubler C, Maragkou T, Wartenberg M, Tzankov A. Myositis als postakute Folge einer COVID-19-Erkrankung? Pathologie 2022; 43:377-380. [PMID: 35376988 PMCID: PMC8978168 DOI: 10.1007/s00292-022-01063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Abstract
Es wird über eine an COVID-19 erkrankte Patientin mit Verdacht auf eine Myositis als Folge einer SARS-CoV-2-Infektion berichtet. Initial führte wenig Information über die Krankengeschichte zur erschwerten histopathologischen Interpretation. Im Verlauf konnten weitere Details eruiert und die Diagnose einer infektassoziierten thrombotischen Mikroangiopathie im Rahmen einer Morganella-morganii-Myositis gestellt werden. Der Fall zeigt, dass auch in Zeiten der allgegenwärtigen Pandemie und selbst bei positivem COVID-19-Test Differentialdiagnosen sowie der integrative klinisch-pathologische Ansatz bei der Befundung von Muskelbiopsien nicht außer Acht gelassen werden sollten.
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Affiliation(s)
- S Engelhardt
- Institut für Medizinische Genetik und Pathologie, Universitätsspital Basel, Schönbeinstrasse 40, 4031, Basel, Schweiz.
| | - B Dislich
- Institut für Pathologie, Universität Bern, Bern, Schweiz
| | - C Zubler
- Departement für Plastische- und Handchirurgie, Inselspital Universitätsspital Bern, Bern, Schweiz
| | - T Maragkou
- Institut für Pathologie, Universität Bern, Bern, Schweiz
| | - M Wartenberg
- Institut für Pathologie, Universität Bern, Bern, Schweiz
| | - A Tzankov
- Institut für Medizinische Genetik und Pathologie, Universitätsspital Basel, Schönbeinstrasse 40, 4031, Basel, Schweiz
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13
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Maragkou T, Quint K, Pollo B, Hewer E. Intraoperative confocal laser endomicroscopy for brain tumors - potential and challenges from a neuropathological perspective. Free Neuropathol 2022; 3:3-24. [PMID: 37284159 PMCID: PMC10209910 DOI: 10.17879/freeneuropathology-2022-4369] [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] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/21/2022] [Indexed: 06/08/2023]
Abstract
Confocal laser endomicroscopy (CLE) represents a new non-invasive in vivo imaging technique that holds considerable promise in neurosurgery and neuropathology. CLE is based on the principle of optical sectioning which uses pinholes placed in the light path to selectively image photons of a specific focal plane by filtering out photons above and below the focal plane. Potential indications of CLE in neurosurgery and neuropathology include intraoperative tumor diagnosis and staging as well as assessment of tumor resection margins notably in the case of diffusely infiltrating gliomas. CLE-based tumor analysis in near-real time may also have a significant impact on future tumor resection strategies. We here discuss the technical features of CLE, its potential for wide-field imaging, its role in comparison to established histological techniques for intraoperative tumor assessment and its position in digital pathology and telepathology. Based on our group's experience with a commercially available confocal laser endomicroscope (ZEISS CONVIVO), we critically address the current state of intraoperative CLE in brain tumor surgery, the applicability of classical histological criteria and the strategies required to further improve the diagnostic accuracy of CLE. We finally discuss how a widespread use of CLE in neurosurgery may modify the role of neuropathologists in intraoperative consultation, generating both new opportunities and new challenges.
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Affiliation(s)
- Theoni Maragkou
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | | - Bianca Pollo
- Unit of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Ekkehard Hewer
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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14
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Kube J, Maragkou T, Psychogios MN. Supratentorielles intraaxiales Schwannom. ROFO-FORTSCHR RONTG 2018; 191:231-233. [PMID: 30081423 DOI: 10.1055/a-0657-4061] [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: 10/28/2022]
Affiliation(s)
- Julia Kube
- Neuroradiology, University Medical Center Goettingen
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