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Jena A, Taneja S, Khan AA, Sogani SK. Recurrent Glioma: Does Qualitative Simultaneous 18F-DOPA PET/mp-MRI Improve Diagnostic Workup? An Initial Experience. Clin Nucl Med 2021; 46:703-709. [PMID: 34374678 DOI: 10.1097/rlu.0000000000003728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
RATIONALE OF THE STUDY Neuroimaging modalities such as contrast-enhanced MRI and PET provide significant insight in the evaluation of gliomas. However, their reliability in successfully differentiating the tumor recurrence with treatment-related changes is still technologically challenging. The current study aims to qualitatively investigate the potential of the hybrid PET/multiparametric MRI modality to noninvasively distinguish between these 2 outcomes of brain tumor diagnostics for optimum and early patient management. PATIENTS AND METHODS A cohort of 26 suspected recurrent glioma cases proved on histology and/or clinicoradiological outcome forms the part of this study. A 3-point visual analytical scale was used to qualify lesions as recurrent or posttreatment radiation effects on PET, conventional MRI, dynamic susceptibility contrast-perfusion-weighted imaging, apparent diffusion coefficient, and the MR spectroscopy according to their level of suspicion. RESULTS Of the 26 patients, 21 patients were classified as recurrence and 5 as radiation necrosis. Advanced MRI parameters (perfusion, diffusion, and spectroscopy) integrated with 18F-DOPA PET imaging resulted in superior diagnostic performance obtained on visual assessment with an accuracy of 95%, sensitivity of 96%, and specificity approaching up to 100% over individual modalities. CONCLUSIONS The combination of multiple MR parameters evaluated together with 18F-DOPA PET offers an attractive approach to noninvasively distinguish true recurrence from radiation necrosis. However, further prospective studies with larger cohorts are warranted with additional neuropathological validations.
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Affiliation(s)
- Amarnath Jena
- From the PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals and House of Diagnostics
| | - Sangeeta Taneja
- From the PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals and House of Diagnostics
| | - Anna Ara Khan
- From the PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals and House of Diagnostics
| | - Shanti K Sogani
- Department of Neurosurgery, Institute of Neuro Sciences, Indraprastha Apollo Hospitals, New Delhi, India
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Sogani SK, Jena A, Taneja S, Gambhir A, Mishra AK, D'Souza MM, Verma SM, Hazari PP, Negi P, Jadhav GKR. Potential for differentiation of glioma recurrence from radionecrosis using integrated 18F-fluoroethyl-L-tyrosine (FET) positron emission tomography/magnetic resonance imaging: A prospective evaluation. Neurol India 2019; 65:293-301. [PMID: 28290392 DOI: 10.4103/neuroindia.ni_101_16] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE To assess the utility of 18F-fluoroethyl-L-tyrosine (FET) positron emission tomography/magnetic resonance imaging (PET/MRI) in distinguishing recurrence from radionecrosis. MATERIALS AND METHODS Thirty-two patients (25 males, 7 females) of glioma who had already undergone surgery/chemoradiotherapy and had enhancing brain lesions suspicious of recurrence were evaluated using integrated 18F-FET PET/MRI, and followed up with histopathology or clinical follow-up and/or MRI/PET/MRI imaging. Manually drawn regions of interest over areas of maximal enhancement or FET uptake were used to calculate tumor to background ratios [TBRmax, TBRmean], choline: creatine ratio [Cho: Cr ratio], normalized relative cerebral blood volume [N rCBVmean] and apparent diffusion coefficient [ADCmean]. Correlations were evaluated using Pearson's coefficient. Accuracy of each parameter was calculated using independent t-test and receiver operator curve (ROC) analysis while utility of all four parameters together using multivariate analysis of variance (MANOVA) for differentiating recurrence vs. radionecrosis was evaluated. Positive histopathology and imaging/clinical follow up served as the gold standard. RESULTS Twenty-four of the 32 patients were diagnosed with recurrent disease and 8 with radiation necrosis. Significant correlations were observed between TBRmaxand N rCBVmean (ρ =0.503; P = 0.003), TBRmean, and N rCBVmean (ρ =0.414; P = 0.018), TBRmaxand ADCmean (ρ = -0.52; P = 0.002), and TBRmeanand ADCmean(ρ = -0.518; P = 0.002). TBRmax, TBRmean, ADCmean, Cho: Cr ratios, and N rCBVmeanwere significant in differentiating recurrence from radiation necrosis with an accuracy of 94.1%, 88.2%, 80.4%, 96.4%, and 89.9%, respectively. MANOVA indicated that combination of all parameters demonstrated better evaluation of recurrence vs. necrosis than any single parameter. The diagnostic accuracy, sensitivity, and specificity using all MRI parameters were 93.75%, 96%, and 85.7%, and using all FET PET/MRI parameters was 96.87%, 100%, and 85.7%, respectively. CONCLUSIONS Synergetic effect of multiple MR parameters evaluated together in addition to FET PET uptake highlights the fact that integrated 18F-FET PET/MRI might have the potential to impact management of patients with glioma by timely and conclusive recognition of true recurrence from radiation necrosis.
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Affiliation(s)
- Shanti K Sogani
- Department of Neurosurgery, Institute of Neuro Sciences, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Amarnath Jena
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Sangeeta Taneja
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Aashish Gambhir
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Anil K Mishra
- Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Brig. SK Mazumdar Road, Timarpur, Delhi, India
| | - Maria M D'Souza
- Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Brig. SK Mazumdar Road, Timarpur, Delhi, India
| | - Sapna M Verma
- Institute of Radiation Oncology, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Puja P Hazari
- Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Brig. SK Mazumdar Road, Timarpur, Delhi, India
| | - Pradeep Negi
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Ganesh K R Jadhav
- Institute of Radiation Oncology, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
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Jena A, Taneja S, Jha A, Damesha NK, Negi P, Jadhav GK, Verma SM, Sogani SK. Multiparametric Evaluation in Differentiating Glioma Recurrence from Treatment-Induced Necrosis Using Simultaneous 18F-FDG-PET/MRI: A Single-Institution Retrospective Study. AJNR Am J Neuroradiol 2017; 38:899-907. [PMID: 28341716 DOI: 10.3174/ajnr.a5124] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 12/21/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating glioma recurrence from treatment-induced necrosis can be a challenge on conventional imaging. This study aimed to assess the diagnostic performance of each functional MR imaging and PET parameter derived by using simultaneous FDG-PET/MR imaging individually and in combination in the evaluation of suspected glioma recurrence. MATERIALS AND METHODS Thirty-five treated glioma patients with 41 enhancing lesions (World Health Organization grade II = 9, III = 13, IV = 19) on MR imaging after an operation followed by radiation therapy and/or chemotherapy formed part of this study. Using PET/MR imaging, we calculated the normalized mean relative CBV, mean ADC, Cho/Cr, and maximum and mean target-to-background ratios. Statistical analysis was performed to determine the diagnostic performance of each parameter by receiver operating characteristic analysis individually and in combination with multivariate receiver operating characteristic analysis for the detection of glioma recurrence. Histopathology or clinicoradiologic follow-up was considered the criterion standard. RESULTS Of 35 patients, 25 (30 lesions) were classified as having a recurrence and 10 (11 lesions) patients as having treatment-induced necrosis. Parameters like rCBVmean (mean relative CBV), ADCmean, Cho/Cr, and maximum and mean target-to-background ratios were statistically significant in the detection of recurrent lesions with an accuracy of 77.5%, 78.0%, 90.9%, 87.8%, and 87.8%, respectively. On multivariate receiver operating characteristic analysis, the combination of all 3 MR imaging parameters resulted in an area under the curve of 0.913 ± 0.053. Furthermore, an area under the curve of 0.935 ± 0.046 was obtained when MR imaging parameters (ADCmean and Cho/Cr) were combined with the PET parameter (mean target-to-background ratio), demonstrating an increase in diagnostic accuracy. CONCLUSIONS Simultaneous PET/MR imaging with FDG offers correlative and synergistic multiparametric assessment of glioma recurrence with increased accuracy and clinical utility.
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Affiliation(s)
- A Jena
- From the PET SUITE (A. Jena, S.T., A. Jha, P.N.)
| | - S Taneja
- From the PET SUITE (A. Jena, S.T., A. Jha, P.N.)
| | - A Jha
- From the PET SUITE (A. Jena, S.T., A. Jha, P.N.)
| | - N K Damesha
- Neurosurgery (N.K.D., S.K.S.), Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - P Negi
- From the PET SUITE (A. Jena, S.T., A. Jha, P.N.)
| | - G K Jadhav
- Departments of Molecular Imaging and Nuclear Medicine, Radiation Oncology (G.K.J., S.M.V.)
| | - S M Verma
- Departments of Molecular Imaging and Nuclear Medicine, Radiation Oncology (G.K.J., S.M.V.)
| | - S K Sogani
- Neurosurgery (N.K.D., S.K.S.), Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
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Suri V, Mittapalli V, Kulshrestha M, Premlani K, Sogani SK, Suri K. Primary intraventricular central nervous system lymphoma in an immunocompetent patient. J Pediatr Neurosci 2016; 10:393-5. [PMID: 26962354 PMCID: PMC4770660 DOI: 10.4103/1817-1745.174433] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report a young 15-year-old boy with 6 months history of headache, vomiting, and seizure. He underwent septostomy followed by right ventriculoperitoneal shunt for obstructive hydrocephalus and was managed with empirical antituberculosis treatment. Magnetic resonance imaging (MRI) revealed solid, nodular, enhancing masses in bilateral lateral ventricles and 4th ventricle. Surgical biopsy from 4th ventricular lesion confirmed a B-cell lymphoma. Staging evaluation with MRI positron emission tomography and bone marrow biopsy were normal suggesting an intraventricular primary central nervous system lymphoma.
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Affiliation(s)
- Vinit Suri
- Department of Neurology Sciences, Indraprastha Apollo Hospital, New Delhi, India
| | - Venkatesh Mittapalli
- Department of Neurology Sciences, Indraprastha Apollo Hospital, New Delhi, India
| | - Manish Kulshrestha
- Department of Neurology Sciences, Indraprastha Apollo Hospital, New Delhi, India
| | - Kaushal Premlani
- Department of Neurology Sciences, Indraprastha Apollo Hospital, New Delhi, India
| | - S K Sogani
- Department of Neurology Sciences, Indraprastha Apollo Hospital, New Delhi, India
| | - Kunal Suri
- Department of Neurology Sciences, Indraprastha Apollo Hospital, New Delhi, India
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Abstract
Anti-N Methyl D Aspartate Receptor encephalitis (anti-NMDARE) is a recently defined disease, which is probably more under-recognized than rare. We report a case of anti-NMDARE in a 13-years-old girl, who presented with intractable seizures. To the best of our knowledge, this is the second case of pediatric anti-NMDARE being reported from India. The need for a greater awareness of this disease and the subtle differences in clinical presentation between pediatric and adult patients are highlighted.
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Affiliation(s)
- Vinit Suri
- Department of Neurology, Indraprastha Apollo Hospital, New Delhi, India
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Sahni T, Jain M, Prasad R, Sogani SK, Singh VP. Use of hyperbaric oxygen in traumatic brain injury: retrospective analysis of data of 20 patients treated at a tertiary care centre. Br J Neurosurg 2011; 26:202-7. [PMID: 22085249 DOI: 10.3109/02688697.2011.626879] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Traumatic brain injury (TBI) related impact results in a permanent need for help in performing daily activities. Standard treatment consists of removing the cause, restore perfusion, support metabolic requirement and limit inflammatory and oxidative damage. Hyperbaric oxygen therapy (HBOT) is one such newer promising treatment that enhances neurological recovery to some extent. HBOT is intermittent inhalation of 100% oxygen at greater than normal atmospheric pressure and is internationally accepted for its role in well-defined indications. It is hypothesised that HBO has a role in reviving 'idling neurons', also called the ischemic penumbra defined as area of reduced cerebral blood flow, abolished synaptic activity but preserved structural integrity. We carried out a retrospective analysis of medical records of 20 patients of TBI who had been treated with HBOT in addition to standard management. These were placed in Group A (test group) and received at least 30 sessions of HBO along with standard treatment. The patients were assessed along the Disability Rating Scale (DRS), Glasgow coma scale (GCS) and Rancho Los Amigos Scale (RLAS). Another 20 patients of TBI, matched in age and severity of brain injury, who received standard treatment but not HBOT, were selected as the control group (Group B). Assessment on the DRS showed maximum improvement in patients with scores of 22-24 (vegetative state).The percentage of patients in the test group fell from 45% to 5% whereas only 20% patients in Group B had similar progress. After the treatment, a significantly higher proportion of HBOT treated subjects showed a good response in cognitive functions, as measured by RLA. In group A, 90% patients had a score of ≤ 3 and in Group B 95% had a similar score, which improved to ≥ 3 in 60% patients versus 30% patients respectively. In both groups maximum patients are in 1-6 months post-injury category and within the groups this category showed the greatest recovery, with a greater improvement in the test group as compared to control group.
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Affiliation(s)
- Tarun Sahni
- Department of Hyperbaric Oxygen Therapy, Indraprastha Apollo Hospital, Sarita Vihar, Delhi-Mathura Road, New Delhi, India.
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