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Hage S, Kinkade S, Girard R, Flemming KD, Kim H, Torbey MT, Huang J, Huston J, Shu Y, Selwyn RG, Hart BL, Mabray MC, Feghali J, Sair HI, Narvid J, Lupo JM, Lee J, Stadnik A, Alcazar-Felix RJ, Shenkar R, Hobson N, DeBiasse D, Lane K, McBee NA, Treine K, Ostapkovich N, Wang Y, Thompson RE, Koenig JI, Carroll T, Hanley DF, Awad IA. Trial Readiness of Cavernous Malformations With Symptomatic Hemorrhage, Part II: Biomarkers and Trial Modeling. Stroke 2024; 55:31-39. [PMID: 38134265 PMCID: PMC10752356 DOI: 10.1161/strokeaha.123.044083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/12/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Quantitative susceptibility mapping (QSM) and dynamic contrast-enhanced quantitative perfusion (DCEQP) magnetic resonance imaging sequences assessing iron deposition and vascular permeability were previously correlated with new hemorrhage in cerebral cavernous malformations. We assessed their prospective changes in a multisite trial-readiness project. METHODS Patients with cavernous malformation and symptomatic hemorrhage (SH) in the prior year, without prior or planned lesion resection or irradiation were enrolled. Mean QSM and DCEQP of the SH lesion were acquired at baseline and at 1- and 2-year follow-ups. Sensitivity and specificity of biomarker changes were analyzed in relation to predefined criteria for recurrent SH or asymptomatic change. Sample size calculations for hypothesized therapeutic effects were conducted. RESULTS We logged 143 QSM and 130 DCEQP paired annual assessments. Annual QSM change was greater in cases with SH than in cases without SH (P=0.019). Annual QSM increase by ≥6% occurred in 7 of 7 cases (100%) with recurrent SH and in 7 of 10 cases (70%) with asymptomatic change during the same epoch and 3.82× more frequently than clinical events. DCEQP change had lower sensitivity for SH and asymptomatic change than QSM change and greater variance. A trial with the smallest sample size would detect a 30% difference in QSM annual change during 2 years of follow-up in 34 or 42 subjects (1 and 2 tailed, respectively); power, 0.8, α=0.05. CONCLUSIONS Assessment of QSM change is feasible and sensitive to recurrent bleeding in cavernous malformations. Evaluation of an intervention on QSM percent change may be used as a time-averaged difference between 2 arms using a repeated measures analysis. DCEQP change is associated with lesser sensitivity and higher variability than QSM. These results are the basis of an application for certification by the US Food and Drug Administration of QSM as a biomarker of drug effect on bleeding in cavernous malformations. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03652181.
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Affiliation(s)
- Stephanie Hage
- Neurovascular Surgery Program, Department of Neurological Surgery (S.H., S.K., R.G., J.L., A.S., R.J.A.-F., R.S., N.H., D.D., I.A.A.), University of Chicago Medicine and Biological Sciences, IL
| | - Serena Kinkade
- Neurovascular Surgery Program, Department of Neurological Surgery (S.H., S.K., R.G., J.L., A.S., R.J.A.-F., R.S., N.H., D.D., I.A.A.), University of Chicago Medicine and Biological Sciences, IL
| | - Romuald Girard
- Neurovascular Surgery Program, Department of Neurological Surgery (S.H., S.K., R.G., J.L., A.S., R.J.A.-F., R.S., N.H., D.D., I.A.A.), University of Chicago Medicine and Biological Sciences, IL
| | | | - Helen Kim
- Department of Anesthesiology and Perioperative Care, Center for Cerebrovascular Research (H.K.), University of California, San Francisco
| | - Michel T Torbey
- Department of Neurology (M.T.T.), University of New Mexico, Albuquerque
| | | | - John Huston
- Radiology (J. Huston, Y.S.), Mayo Clinic, Rochester, MN
| | - Yunhong Shu
- Radiology (J. Huston, Y.S.), Mayo Clinic, Rochester, MN
| | - Reed G Selwyn
- Department of Diagnostic Radiology (R.G.S., B.L.H.), University of New Mexico, Albuquerque
| | - Blaine L Hart
- Department of Diagnostic Radiology (R.G.S., B.L.H.), University of New Mexico, Albuquerque
| | - Marc C Mabray
- Department of Radiology (M.C.M.), University of New Mexico, Albuquerque
| | | | - Haris I Sair
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD (H.I.S.)
| | - Jared Narvid
- Department of Radiology and Biomedical Imaging (J.N., J.M.L.), University of California, San Francisco
| | - Janine M Lupo
- Department of Radiology and Biomedical Imaging (J.N., J.M.L.), University of California, San Francisco
| | - Justine Lee
- Neurovascular Surgery Program, Department of Neurological Surgery (S.H., S.K., R.G., J.L., A.S., R.J.A.-F., R.S., N.H., D.D., I.A.A.), University of Chicago Medicine and Biological Sciences, IL
| | - Agnieszka Stadnik
- Neurovascular Surgery Program, Department of Neurological Surgery (S.H., S.K., R.G., J.L., A.S., R.J.A.-F., R.S., N.H., D.D., I.A.A.), University of Chicago Medicine and Biological Sciences, IL
| | - Roberto J Alcazar-Felix
- Neurovascular Surgery Program, Department of Neurological Surgery (S.H., S.K., R.G., J.L., A.S., R.J.A.-F., R.S., N.H., D.D., I.A.A.), University of Chicago Medicine and Biological Sciences, IL
| | - Robert Shenkar
- Neurovascular Surgery Program, Department of Neurological Surgery (S.H., S.K., R.G., J.L., A.S., R.J.A.-F., R.S., N.H., D.D., I.A.A.), University of Chicago Medicine and Biological Sciences, IL
| | - Nicholas Hobson
- Neurovascular Surgery Program, Department of Neurological Surgery (S.H., S.K., R.G., J.L., A.S., R.J.A.-F., R.S., N.H., D.D., I.A.A.), University of Chicago Medicine and Biological Sciences, IL
| | - Dorothy DeBiasse
- Neurovascular Surgery Program, Department of Neurological Surgery (S.H., S.K., R.G., J.L., A.S., R.J.A.-F., R.S., N.H., D.D., I.A.A.), University of Chicago Medicine and Biological Sciences, IL
| | - Karen Lane
- Brain Injury Outcomes Unit, Department of Neurology (K.L., N.A.M., K.T., N.O., Y.W., R.E.T., D.F.H.), Johns Hopkins University Medical Institutions, Baltimore, MD
| | - Nichole A McBee
- Brain Injury Outcomes Unit, Department of Neurology (K.L., N.A.M., K.T., N.O., Y.W., R.E.T., D.F.H.), Johns Hopkins University Medical Institutions, Baltimore, MD
| | - Kevin Treine
- Brain Injury Outcomes Unit, Department of Neurology (K.L., N.A.M., K.T., N.O., Y.W., R.E.T., D.F.H.), Johns Hopkins University Medical Institutions, Baltimore, MD
| | - Noeleen Ostapkovich
- Brain Injury Outcomes Unit, Department of Neurology (K.L., N.A.M., K.T., N.O., Y.W., R.E.T., D.F.H.), Johns Hopkins University Medical Institutions, Baltimore, MD
| | - Ying Wang
- Brain Injury Outcomes Unit, Department of Neurology (K.L., N.A.M., K.T., N.O., Y.W., R.E.T., D.F.H.), Johns Hopkins University Medical Institutions, Baltimore, MD
| | - Richard E Thompson
- Brain Injury Outcomes Unit, Department of Neurology (K.L., N.A.M., K.T., N.O., Y.W., R.E.T., D.F.H.), Johns Hopkins University Medical Institutions, Baltimore, MD
| | - James I Koenig
- National Institute of Neurological Disorders and Stroke, Bethesda, MD (J.K.)
| | - Timothy Carroll
- Department of Diagnostic Radiology (T.C.), University of Chicago Medicine and Biological Sciences, IL
| | - Daniel F Hanley
- Brain Injury Outcomes Unit, Department of Neurology (K.L., N.A.M., K.T., N.O., Y.W., R.E.T., D.F.H.), Johns Hopkins University Medical Institutions, Baltimore, MD
| | - Issam A Awad
- Neurovascular Surgery Program, Department of Neurological Surgery (S.H., S.K., R.G., J.L., A.S., R.J.A.-F., R.S., N.H., D.D., I.A.A.), University of Chicago Medicine and Biological Sciences, IL
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Ren Z, Easley TO, Pineda FD, Guo X, Barber RF, Karczmar GS. Pharmacokinetic Analysis of Enhancement-Constrained Acceleration (ECA) reconstruction-based high temporal resolution breast DCE-MRI. PLoS One 2023; 18:e0286123. [PMID: 37319275 PMCID: PMC10270582 DOI: 10.1371/journal.pone.0286123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
The high spatial and temporal resolution of dynamic contrast-enhanced MRI (DCE-MRI) can improve the diagnostic accuracy of breast cancer screening in patients who have dense breasts or are at high risk of breast cancer. However, the spatiotemporal resolution of DCE-MRI is limited by technical issues in clinical practice. Our earlier work demonstrated the use of image reconstruction with enhancement-constrained acceleration (ECA) to increase temporal resolution. ECA exploits the correlation in k-space between successive image acquisitions. Because of this correlation, and due to the very sparse enhancement at early times after contrast media injection, we can reconstruct images from highly under-sampled k-space data. Our previous results showed that ECA reconstruction at 0.25 seconds per image (4 Hz) can estimate bolus arrival time (BAT) and initial enhancement slope (iSlope) more accurately than a standard inverse fast Fourier transform (IFFT) when k-space data is sampled following a Cartesian based sampling trajectory with adequate signal-to-noise ratio (SNR). In this follow-up study, we investigated the effect of different Cartesian based sampling trajectories, SNRs and acceleration rates on the performance of ECA reconstruction in estimating contrast media kinetics in lesions (BAT, iSlope and Ktrans) and in arteries (Peak signal intensity of first pass, time to peak, and BAT). We further validated ECA reconstruction with a flow phantom experiment. Our results show that ECA reconstruction of k-space data acquired with 'Under-sampling with Repeated Advancing Phase' (UnWRAP) trajectories with an acceleration factor of 14, and temporal resolution of 0.5 s/image and high SNR (SNR ≥ 30 dB, noise standard deviation (std) < 3%) ensures minor errors (5% or 1 s error) in lesion kinetics. Medium SNR (SNR ≥ 20 dB, noise std ≤ 10%) was needed to accurately measure arterial enhancement kinetics. Our results also suggest that accelerated temporal resolution with ECA with 0.5 s/image is practical.
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Affiliation(s)
- Zhen Ren
- Department of Radiology, The University of Chicago, Chicago, Illinois, United States of America
| | - Ty O. Easley
- McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Federico D. Pineda
- Department of Radiology, The University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Xiaodong Guo
- Department of Radiology, The University of Chicago, Chicago, Illinois, United States of America
| | - Rina F. Barber
- Department of Statistics, The University of Chicago, Chicago, Illinois, United States of America
| | - Gregory S. Karczmar
- Department of Radiology, The University of Chicago, Chicago, Illinois, United States of America
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Hage S, Kinkade S, Girard R, Flemming KD, Kim H, Torbey MT, Huang J, Huston J, Shu Y, Selwyn RG, Hart BL, Mabray MC, Feghali J, Sair HI, Narvid J, Lupo JM, Lee J, Stadnik A, Alcazar R, Shenkar R, Hobson N, DeBiasse D, Lane K, McBee N, Treine K, Ostapkovich N, Wang Y, Thompson RE, Mendoza-Puccini C, Koenig J, Carroll T, Hanley DF, Awad IA. Cavernous Angioma Symptomatic Hemorrhage (CASH) Trial Readiness II: Imaging Biomarkers and Trial Modeling. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.01.23290854. [PMID: 37333396 PMCID: PMC10275015 DOI: 10.1101/2023.06.01.23290854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background Quantitative susceptibility mapping (QSM) and dynamic contrast enhanced quantitative perfusion (DCEQP) MRI sequences assessing iron deposition and vascular permeability were previously correlated with new hemorrhage in cavernous angiomas. We assessed their prospective changes in cavernous angiomas with symptomatic hemorrhage (CASH) in a multisite trial readiness project ( clinicaltrials.gov NCT03652181 ). Methods Patients with CASH in the prior year, without prior or planned lesion resection or irradiation were enrolled. Mean QSM and DCEQP of CASH lesion were acquired at baseline, and at 1- and 2-year follow-ups. Sensitivity and specificity of biomarker changes were analyzed in relation to predefined lesional symptomatic hemorrhage (SH) or asymptomatic change (AC). Sample size calculations for hypothesized therapeutic effects were conducted. Results We logged 143 QSM and 130 DCEQP paired annual assessments. Annual QSM change was greater in cases with SH than in cases without SH (p= 0.019). Annual QSM increase by ≥ 6% occurred in 7 of 7 cases (100%) with recurrent SH and in 7 of 10 cases (70%) with AC during the same epoch, and 3.82 times more frequently than clinical events. DCEQP change had lower sensitivity for SH and AC than QSM change, and greater variance. A trial with smallest sample size would detect a 30% difference in QSM annual change in 34 or 42 subjects (one and two-tailed, respectively), power 0.8, alpha 0.05. Conclusions Assessment of QSM change is feasible and sensitive to recurrent bleeding in CASH. Evaluation of an intervention on QSM percent change may be used as a time-averaged difference between 2 arms using a repeated measures analysis. DCEQP change is associated with lesser sensitivity and higher variability than QSM. These results are the basis of an application for certification by the U.S. F.D.A. of QSM as a biomarker of drug effect in CASH.
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Quantitative Susceptibility Mapping: Translating an Investigative Research Tool into High Volume Clinical Diagnostic Imaging. Diagnostics (Basel) 2022; 12:diagnostics12122962. [PMID: 36552969 PMCID: PMC9776933 DOI: 10.3390/diagnostics12122962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Quantitative susceptibility mapping (QSM) is an MRI-based technique for iron quantification of targeted tissue. QSM provides information relevant to clinicians in a broad range of diagnostic contexts, including sickle cell disease, inflammatory/demyelinating processes, and neoplasms. However, major MRI vendors do not offer QSM post-processing in a form ready for general use. This work describes a vendor-agnostic approach for scaling QSM analysis from a research technique to a routine diagnostic test. We provide the details needed to seamlessly integrate hardware, software, and clinical systems to provide QSM processing for a busy clinical radiology workflow. This approach can be generalized to other advanced MRI acquisitions and analyses with proven diagnostic utility, yet without crucial MR vendor support.
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Dimov AV, Nguyen TD, Gillen KM, Marcille M, Spincemaille P, Pitt D, Gauthier SA, Wang Y. Susceptibility source separation from gradient echo data using magnitude decay modeling. J Neuroimaging 2022; 32:852-859. [PMID: 35668022 DOI: 10.1111/jon.13014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE The objective is to demonstrate feasibility of separating magnetic sources in quantitative susceptibility mapping (QSM) by incorporating magnitude decay rates R 2 ∗ $R_2^{\rm{*}}$ in gradient echo (GRE) MRI. METHODS Magnetic susceptibility source separation was developed using R 2 ∗ $R_2^{\rm{*}}$ and compared with a prior method using R 2 ' = R 2 ∗ - R 2 ${R^{\prime}_2} = R_2^* - {R_2}$ that required an additional sequence to measure the transverse relaxation rate R2 . Both susceptibility separation methods were compared in multiple sclerosis (MS) patients (n = 17). Susceptibility values of negative sources estimated with R 2 ∗ $R_2^{\rm{*}}$ -based source separation in a set of enhancing MS lesions (n = 44) were correlated against longitudinal myelin water fraction (MWF) changes. RESULTS In in vivo data, linear regression of the estimated χ + ${\chi}^{+}$ and χ - ${\chi}^{-}$ susceptibility values between the R 2 ∗ $R_2^*$ - and the R 2 ' ${R^{\prime}_2}$ -based separation methods performed across 182 segmented lesions revealed correlation coefficient r = .96 and slope close .99. Correlation analysis in enhancing lesions revealed a significant positive association between the χ - ${\chi}^{-}$ increase at 1-year post-onset relative to 0 year and the MWF increase at 1 year relative to 0 year (β = -0.144, 95% confidence interval: [-0.199, -0.1], p = .0008) and good agreement between R 2 ' ${R^{\prime}_2}$ and R 2 ∗ $R_2^*$ methods (r = .79, slope = .95). CONCLUSIONS Separation of magnetic sources based solely on GRE complex data is feasible by combining magnitude decay rate modeling and phase-based QSM and χ - ${\chi}^{-}$ change may serve as a biomarker for myelin recovery or damage in acute MS lesions.
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Affiliation(s)
- Alexey V Dimov
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Kelly M Gillen
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Melanie Marcille
- Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | | | - David Pitt
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Susan A Gauthier
- Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Yi Wang
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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Sone JY, Hobson N, Srinath A, Romanos SG, Li Y, Carrión-Penagos J, Shkoukani A, Stadnik A, Piedad K, Lightle R, Moore T, DeBiasse D, Bi D, Shenkar R, Carroll T, Ji Y, Girard R, Awad IA. Perfusion and Permeability MRI Predicts Future Cavernous Angioma Hemorrhage and Growth. J Magn Reson Imaging 2021; 55:1440-1449. [PMID: 34558140 PMCID: PMC8942875 DOI: 10.1002/jmri.27935] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cerebral cavernous angioma (CA) is a capillary vasculopathy affecting more than a million Americans with a small fraction of cases demonstrating lesional bleed or growth with major clinical sequelae. Perfusion and permeability are fundamental features of CA pathophysiology, but their role as prognostic biomarkers is unclear. PURPOSE To investigate whether perfusion or permeability lesional descriptors derived from dynamic contrast-enhanced quantitative perfusion (DCEQP) magnetic resonance imaging (MRI) can predict subsequent lesional bleed/growth in the year following imaging. STUDY TYPE Single-site case-controlled study. SUBJECTS Two hundred and five consecutively enrolled patients (63.4% female). FIELD STRENGTH/SEQUENCE Three-Tesla/T1 -mapping with contrast-enhanced dynamic two-dimensional (2D) spoiled gradient recalled acquisition (SPGR) sequences. ASSESSMENT Prognostic associations with bleed/growth (present or absent) in the following year were assessed in 745 CA lesions evaluated by DCEQP in the 205 patients in relation to lesional descriptors calculated from permeability and perfusion maps. A subgroup of 30 cases also underwent peripheral blood collection at the time of DCEQP scans and assays of plasma levels of soluble CD14, IL-1β, VEGF, and soluble ROBO4 proteins, whose weighted combination had been previously reported in association with future CA bleeding. STATISTICAL TESTS Mann-Whitney U-test for univariate analyses. Logistic regression models minimizing the Bayesian information criterion (BIC), testing sensitivity and specificity (receiver operating characteristic curves) of weighted combinations of parameters. RESULTS The best prognostic biomarker for lesional bleed or growth included brainstem lesion location, mean lesional permeability, and low-value perfusion cluster mean (BIC = 201.5, sensitivity = 77%, specificity = 72%, P < 0.05). Adding a previously published prognostic plasma protein biomarker improved the performance of the imaging model (sensitivity = 100%, specificity = 88%, P < 0.05). DATA CONCLUSION A combination of MRI-based descriptors reflecting higher lesional permeability and lower perfusion cluster may potentially predict future bleed/growth in CAs. The sensitivity and specificity of the prognostic imaging biomarker can be enhanced when combined with brainstem lesion location and a plasma protein biomarker of CA hemorrhage. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Je Yeong Sone
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Nicholas Hobson
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Abhinav Srinath
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Sharbel G Romanos
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Ying Li
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Julián Carrión-Penagos
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Abdallah Shkoukani
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Agnieszka Stadnik
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Kristina Piedad
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Rhonda Lightle
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Thomas Moore
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Dorothy DeBiasse
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Dehua Bi
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA.,Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Robert Shenkar
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Timothy Carroll
- Department of Diagnostic Radiology, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Yuan Ji
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Romuald Girard
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Issam A Awad
- Neurovascular Surgery Program, Department of Neurosurgery, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
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Kim H, Flemming KD, Nelson JA, Lui A, Majersik JJ, Cruz MD, Zabramski J, Trevizo O, Lanzino G, Zafar A, Torbey M, Mabray MC, Robinson M, Narvid J, Lupo J, Thompson RE, Hanley DF, McBee N, Treine K, Ostapkovich N, Stadnik A, Piedad K, Hobson N, Carroll T, Shkoukani A, Carrión-Penagos J, Mendoza-Puccini C, Koenig JI, Awad I. Baseline Characteristics of Patients With Cavernous Angiomas With Symptomatic Hemorrhage in Multisite Trial Readiness Project. Stroke 2021; 52:3829-3838. [PMID: 34525838 DOI: 10.1161/strokeaha.120.033487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Brain cavernous angiomas with symptomatic hemorrhage (CASH) have a high risk of neurological disability from recurrent bleeding. Systematic assessment of baseline features and multisite validation of novel magnetic resonance imaging biomarkers are needed to optimize clinical trial design aimed at novel pharmacotherapies in CASH. METHODS This prospective, multicenter, observational cohort study included adults with unresected, adjudicated brain CASH within the prior year. Six US sites screened and enrolled patients starting August 2018. Baseline demographics, clinical and imaging features, functional status (modified Rankin Scale and National Institutes of Health Stroke Scale), and patient quality of life outcomes (Patient-Reported Outcomes Measurement Information System-29 and EuroQol-5D) were summarized using descriptive statistics. Patient-Reported Outcomes Measurement Information System-29 scores were standardized against a reference population (mean 50, SD 10), and one-sample t test was performed for each domain. A subgroup underwent harmonized magnetic resonance imaging assessment of lesional iron content with quantitative susceptibility mapping and vascular permeability with dynamic contrast-enhanced quantitative perfusion. RESULTS As of May 2020, 849 patients were screened and 110 CASH cases enrolled (13% prevalence of trial eligible cases). The average age at consent was 46±16 years, 53% were female, 41% were familial, and 43% were brainstem lesions. At enrollment, ≥90% of the cohort had independent functional outcome (modified Rankin Scale score ≤2 and National Institutes of Health Stroke Scale score <5). However, perceived health problems affecting quality of life were reported in >30% of patients (EuroQol-5D). Patients had significantly worse Patient-Reported Outcomes Measurement Information System-29 scores for anxiety (P=0.007), but better depression (P=0.002) and social satisfaction scores (P=0.012) compared with the general reference population. Mean baseline quantitative susceptibility mapping and permeability of CASH lesion were 0.45±0.17 ppm and 0.39±0.31 mL/100 g per minute, respectively, which were similar to historical CASH cases and consistent across sites. CONCLUSIONS These baseline features will aid investigators in patient stratification and determining the most appropriate outcome measures for clinical trials of emerging pharmacotherapies in CASH.
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Affiliation(s)
- Helen Kim
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco. (H.K., J.A.N., A.L.).,Department of Epidemiology and Biostatistics, University of California, San Francisco. (H.K.)
| | | | - Jeffrey A Nelson
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco. (H.K., J.A.N., A.L.)
| | - Avery Lui
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco. (H.K., J.A.N., A.L.)
| | - Jennifer J Majersik
- Department of Neurology, University of Utah, Salt Lake City (J.J.M., M.D.C.)
| | - Michael Dela Cruz
- Department of Neurology, University of Utah, Salt Lake City (J.J.M., M.D.C.)
| | - Joseph Zabramski
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (J.Z., O.T.)
| | - Odilette Trevizo
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (J.Z., O.T.)
| | | | - Atif Zafar
- Department of Neurology, University of Toronto, Canada (A.Z.)
| | - Michel Torbey
- Department of Neurology, University of New Mexico, Albuquerque. (M.T.)
| | - Marc C Mabray
- Department of Radiology, University of New Mexico, Albuquerque. (M.C.M.)
| | - Myranda Robinson
- Department of Neurosurgery, University of New Mexico, Albuquerque. (M.R.)
| | - Jared Narvid
- Department of Radiology and Biomedical Imaging, University of California, San Francisco. (J.N., J.L.)
| | - Janine Lupo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco. (J.N., J.L.)
| | - Richard E Thompson
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD. (R.E.T.)
| | - Daniel F Hanley
- Brain Injury Outcomes, Department of Neurology, Johns Hopkins University, Baltimore, MD. (D.F.H., N.M., K.T., N.O.)
| | - Nichol McBee
- Brain Injury Outcomes, Department of Neurology, Johns Hopkins University, Baltimore, MD. (D.F.H., N.M., K.T., N.O.)
| | - Kevin Treine
- Brain Injury Outcomes, Department of Neurology, Johns Hopkins University, Baltimore, MD. (D.F.H., N.M., K.T., N.O.)
| | - Noeleen Ostapkovich
- Brain Injury Outcomes, Department of Neurology, Johns Hopkins University, Baltimore, MD. (D.F.H., N.M., K.T., N.O.)
| | - Agnieszka Stadnik
- Department of Neurosurgery, University of Chicago, IL. (A. Stadnik, K.P., N.H., A. Shkoukani, J.C.-P., I.A.)
| | - Kristina Piedad
- Department of Neurosurgery, University of Chicago, IL. (A. Stadnik, K.P., N.H., A. Shkoukani, J.C.-P., I.A.)
| | - Nicholas Hobson
- Department of Neurosurgery, University of Chicago, IL. (A. Stadnik, K.P., N.H., A. Shkoukani, J.C.-P., I.A.)
| | - Timothy Carroll
- Department of Diagnostic Radiology, University of Chicago, IL. (T.C.)
| | - Abdallah Shkoukani
- Department of Neurosurgery, University of Chicago, IL. (A. Stadnik, K.P., N.H., A. Shkoukani, J.C.-P., I.A.)
| | - Julián Carrión-Penagos
- Department of Neurosurgery, University of Chicago, IL. (A. Stadnik, K.P., N.H., A. Shkoukani, J.C.-P., I.A.)
| | - Carolina Mendoza-Puccini
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD. (C.M.-P.)
| | - James I Koenig
- Division of Neuroscience, National Institute of Neurological Disorders and Stroke, Bethesda, MD. (J.I.K.)
| | - Issam Awad
- Department of Neurosurgery, University of Chicago, IL. (A. Stadnik, K.P., N.H., A. Shkoukani, J.C.-P., I.A.)
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Salvatore C, Castiglioni I, Cerasa A. Radiomics approach in the neurodegenerative brain. Aging Clin Exp Res 2021; 33:1709-1711. [PMID: 31428998 DOI: 10.1007/s40520-019-01299-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/29/2019] [Indexed: 12/27/2022]
Abstract
As claimed by Robert Gilles et al., "Images are more than pictures, they are data". This statement refers to the power of imaging to provide large amounts of quantitative features for improving diagnosis, prognosis and therapy response. The conversion of digital medical images into high-dimensional mineable data is called radiomics. Radiomics analysis is based on data-characterisation algorithms which have the potential to uncover disease heterogeneity characteristics that might escape from the expert evaluation. This method has been widely applied in oncology and genetic fields, while the literature on neurodegenerative disorders is in its relative infancy. Here, we provide a preliminary evaluation of the main results reached applying radiomics analyses on well-established MRI features of patients with Alzheimer's Disease and Parkinson's disease.
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Affiliation(s)
- Christian Salvatore
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Milan, Italy
| | - Isabella Castiglioni
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Milan, Italy.
| | - Antonio Cerasa
- Research in Advanced Neurorehabilitation, S. Anna Institute, Crotone, Italy.
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Catanzaro, Italy.
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9
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Li J, Zhang Q, Che Y, Zhang N, Guo L. Iron Deposition Characteristics of Deep Gray Matter in Elderly Individuals in the Community Revealed by Quantitative Susceptibility Mapping and Multiple Factor Analysis. Front Aging Neurosci 2021; 13:611891. [PMID: 33935681 PMCID: PMC8079745 DOI: 10.3389/fnagi.2021.611891] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose The objective of this study was to determine which factors influence brain iron concentrations in deep gray matter in elderly individuals and how these factors influence regional brain iron concentrations. Methods A total of 105 elderly individuals were enrolled in this study. All participants underwent detailed magnetic resonance imaging (MRI) examinations from October 2018 to August 2019. Among them, 44 individuals had undergone a previous MRI examination from July 2010 to August 2011. Quantitative susceptibility mapping (QSM) was utilized as an indirect quantitative marker of brain iron, and the susceptibility values of deep gray matter structures were obtained. Univariate analysis and multiple linear regression analysis were used to investigate 11 possible determinants for cerebral iron deposition. Results Our results showed no sex- or hemisphere-related differences in susceptibility values in any of the regions studied. Aging was significantly correlated with increased insusceptibility values in almost all analyzed brain regions (except for the thalamus) when we compared the susceptibility values at the two time points. In a cross-sectional analysis, the relationship between gray matter nucleus susceptibility values and age was conducted using Pearson’s linear regression. Aging was significantly correlated with the susceptibility values of the globus pallidus (GP), putamen (Put), and caudate nucleus (CN), with the Put having the strongest correlations. In multiple linear regression models, associations with increased susceptibility values were found in the CN, Put, red nucleus, and dentate nucleus for individuals with a history of type 2 diabetes mellitus (T2DM). However, the patients with hypertension showed significantly reduced susceptibility values in the red nucleus and dentate nucleus. Our data suggested that smokers had increased susceptibility values in the thalamus. No significant associations were found for individuals with a history of hypercholesterolemia and Apolipoprotein E4 carrier status. Conclusion Our data revealed that aging, T2DM, and smoking could increase iron deposition in some deep gray matter structures. However, hypertension had the opposite effects in the red nuclei and dentate nuclei. Brain iron metabolism could be influenced by many factors in different modes. In future studies, we should strictly control for confounding factors.
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Affiliation(s)
- Jing Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qihao Zhang
- Department of Radiology, Weill Cornell Medical College, Cornell University, New York City, NY, United States
| | - Yena Che
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Nan Zhang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Lingfei Guo
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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