The use of CT and MRI in the characterization of intracranial mass lesions

Interventions to reduce the time to diagnosis of brain tumours

BACKGROUND

Brain tumours are recognised as one of the most difficult cancers to diagnose because presenting symptoms, such as headache, cognitive symptoms, and seizures, may be more commonly attributable to other, more benign conditions. Interventions to reduce the time to diagnosis of brain tumours include national awareness initiatives, expedited pathways, and protocols to diagnose brain tumours, based on a person's presenting symptoms and signs; and interventions to reduce waiting times for brain imaging pathways. If such interventions reduce the time to diagnosis, it may make it less likely that people experience clinical deterioration, and different treatment options may be available.

OBJECTIVES

To systematically evaluate evidence on the effectiveness of interventions that may influence: symptomatic participants to present early (shortening the patient interval), thresholds for primary care referral (shortening the primary care interval), and time to imaging diagnosis (shortening the secondary care interval and diagnostic interval). To produce a brief economic commentary, summarising the economic evaluations relevant to these interventions.

SEARCH METHODS

For evidence on effectiveness, we searched CENTRAL, MEDLINE, and Embase from January 2000 to January 2020; Clinicaltrials.gov to May 2020, and conference proceedings from 2014 to 2018. For economic evidence, we searched the UK National Health Services Economic Evaluation Database from 2000 to December 2014.

SELECTION CRITERIA

We planned to include studies evaluating any active intervention that may influence the diagnostic pathway, e.g. clinical guidelines, direct access imaging, public health campaigns, educational initiatives, and other interventions that might lead to early identification of primary brain tumours. We planned to include randomised and non-randomised comparative studies. Included studies would include people of any age, with a presentation that might suggest a brain tumour.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed titles identified by the search strategy, and the full texts of potentially eligible studies. We resolved discrepancies through discussion or, if required, by consulting another review author.

MAIN RESULTS

We did not identify any studies for inclusion in this review. We excluded 115 studies. The main reason for exclusion of potentially eligible intervention studies was their study design, due to a lack of control groups. We found no economic evidence to inform a brief economic commentary on this topic.

AUTHORS' CONCLUSIONS

In this version of the review, we did not identify any studies that met the review inclusion criteria for either effectiveness or cost-effectiveness. Therefore, there is no evidence from good quality studies on the best strategies to reduce the time to diagnosis of brain tumours, despite the prioritisation of research on early diagnosis by the James Lind Alliance in 2015. This review highlights the need for research in this area.

Agreement between low-field MRI and CT for the detection of suspected intracranial lesions in dogs and cats

OBJECTIVE

To assess the agreement between CT and MRI for enabling detection of intracranial lesions in cats and dogs.

DESIGN

Evaluation study.

ANIMALS

51 dogs and 7 cats with suspected intracranial lesions.

PROCEDURES

During a 2-year-period, dogs and cats with suspected intracranial pathological changes underwent MRI and CT (single slice) of the head. Radiologists evaluated images produced with both techniques without awareness of subject identity. Agreement between methods was assessed for allowing detection of solitary or multiple lesions, selected lesion characteristics (via the Cohen κ statistic), and lesion dimensions (via Bland-Altman plots).

RESULTS

CT and MRI had substantial agreement for allowing detection of lesions and identification of whether the lesions were solitary or multiple. The techniques agreed almost perfectly for allowing identification of a mass effect and contrast medium enhancement, which were considered principal diagnostic imaging signs. A lower degree of agreement was attained for allowing identification of enhancement patterns and aspects of lesion margins. Agreement was substantial to almost perfect for lesion visualization in most anatomic brain regions but poor for identification of lesion dimensions.

CONCLUSIONS AND CLINICAL RELEVANCE

Degrees of agreement between CT and MRI for allowing the detection and characterization of intracranial lesions ranged from poor to almost perfect, depending on the variable assessed. More investigation is needed into the relative analytic sensitivity and possible complementarities of CT and MRI in the detection of suspected intracranial lesions in dogs and cats.

Specific chemotaxis of magnetically labeled mesenchymal stem cells: implications for MRI of glioma

PURPOSE

Glioblastoma multiforme (GBM) is a lethal disease marked by infiltration of cancerous cells into the surrounding normal brain. The dire outcome of GBM patients stems in part from the limitations of current neuroimaging methods. Notably, early cancer detection methodologies are lacking, without the ability to identify aggressive, metastatic tumor cells. We propose a novel approach for tumor detection using magnetic resonance imaging (MRI) based on imaging specific tumor tropism of mesenchymal stem cells (MSCs) labeled with micron-sized iron oxide particles (MPIOs).

PROCEDURES

MPIO labeled and unlabeled MSCs were compared for viability, multi-lineage differentiation, and migration, where both chemotactic and chemokinetic movement were assessed in the presence of serum-free medium, serum-containing medium, and glioma-conditioned medium. MRI was performed on agarose samples, consisting of MPIO-labeled single MSCs, to confirm the capability to detect single cells.

RESULTS

We determined that MPIO-labeled MSCs exhibit specific and significant chemotactic migration towards glioma-conditioned medium in vitro. Confocal fluorescence microscopy confirmed that MPIOs are internalized and do not impact important cell processes of MSCs. Lastly, MPIO-labeled MSCs appear as single distinct, dark spots on T(2)*-weighted MRI, supporting the robustness of this contrast agent for cell tracking.

CONCLUSIONS

This is the first study to show that MPIO-labeled MSCs exhibit specific tropism toward tumor-secreted factors in vitro. The potential for detecting single MPIO-labeled MSCs provides rationale for in vivo extension of this methodology to visualize GBM in animal models.