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Cistaro A, Albano D, Alongi P, Laudicella R, Pizzuto DA, Formica G, Romagnolo C, Stracuzzi F, Frantellizzi V, Piccardo A, Quartuccio N. The Role of PET in Supratentorial and Infratentorial Pediatric Brain Tumors. Curr Oncol 2021; 28:2481-2495. [PMID: 34287265 PMCID: PMC8293135 DOI: 10.3390/curroncol28040226] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This review aims to provide a summary of the clinical indications and limitations of PET imaging with different radiotracers, including 18F-fluorodeoxyglucose (18F-FDG) and other radiopharmaceuticals, in pediatric neuro-oncology, discussing both supratentorial and infratentorial tumors, based on recent literature (from 2010 to present). METHODS A literature search of the PubMed/MEDLINE database was carried out searching for articles on the use of PET in pediatric brain tumors. The search was updated until December 2020 and limited to original studies published in English after 1 January 2010. RESULTS 18F-FDG PET continues to be successfully employed in different settings in pediatric neuro-oncology, including diagnosis, grading and delineation of the target for stereotactic biopsy, estimation of prognosis, evaluation of recurrence, treatment planning and assessment of treatment response. Nevertheless, non-18F-FDG tracers, especially amino acid analogues seem to show a better performance in each clinical setting. CONCLUSIONS PET imaging adds important information in the diagnostic work-up of pediatric brain tumors. International or national multicentric studies are encouraged in order to collect larger amount of data.
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Affiliation(s)
- Angelina Cistaro
- Nuclear Medicine Department, Ospedali Galliera, 16128 Genova, Italy; (A.C.); (A.P.)
- AIMN Pediatric Study Group, 20159 Milan, Italy;
| | - Domenico Albano
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia, 25123 Brescia, Italy;
| | - Pierpaolo Alongi
- Unit of Nuclear Medicine, Fondazione Istituto G. Giglio, 90015 Cefalù, Italy
- Correspondence:
| | - Riccardo Laudicella
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, A.O.U. Policlinico G. Martino, University of Messina, 98125 Messina, Italy; (R.L.); (G.F.); (F.S.)
| | | | - Giuseppe Formica
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, A.O.U. Policlinico G. Martino, University of Messina, 98125 Messina, Italy; (R.L.); (G.F.); (F.S.)
| | - Cinzia Romagnolo
- Nuclear Medicine Unit, Ospedali Riuniti, Torrette di Ancona, 60126 Ancona, Italy;
| | - Federica Stracuzzi
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, A.O.U. Policlinico G. Martino, University of Messina, 98125 Messina, Italy; (R.L.); (G.F.); (F.S.)
| | - Viviana Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, 00161 Rome, Italy;
| | - Arnoldo Piccardo
- Nuclear Medicine Department, Ospedali Galliera, 16128 Genova, Italy; (A.C.); (A.P.)
- AIMN Pediatric Study Group, 20159 Milan, Italy;
| | - Natale Quartuccio
- AIMN Pediatric Study Group, 20159 Milan, Italy;
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy
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2
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Applications of Hybrid PET/Magnetic Resonance Imaging in Central Nervous System Disorders. PET Clin 2020; 15:497-508. [DOI: 10.1016/j.cpet.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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3
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Graeter T, Eberhardt N, Shi R, Schmidberger J, Beer AJ, Beer M, Henne-Bruns D, Hillenbrand A, Barth TFE, Grimm J, Kratzer W, Gruener B. Hepatic alveolar echinococcosis: correlation between computed tomography morphology and inflammatory activity in positron emission tomography. Sci Rep 2020; 10:11808. [PMID: 32678174 PMCID: PMC7366930 DOI: 10.1038/s41598-020-68624-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 06/18/2020] [Indexed: 12/15/2022] Open
Abstract
Positron emission tomography-computed tomography (PET-CT) with 18F-fluorodesoxyglucose (FDG) is the imaging modality of choice for assessing inflammation surrounding hepatic alveolar echinococcosis (AE) lesions. This study is the first to evaluate FDG uptake in hepatic AE (n = 51) based on the standardized uptake value (SUV) and to correlate the SUVs with primary morphology and calcification patterns, based on the Echinococcus multilocularis Ulm Classification for Computed-Tomography (EMUC-CT). Our results show that the SUVs were increased for lesions with EMUC-CT types I-IV primary morphology, compared to the surrounding healthy liver tissue (SUV = 2.5 ± 0.4; p < 0.05). Type IV lesions included, by far, the highest number of PET-negative lesions. A comparison of lesions with different primary morphologies showed clear differences. The highest SUVs were found for types I and III, and the lowest was found for type IV. Type IV lesions (SUV, 3.8 ± 1.5) showed significantly lower uptake compared to type I (SUV, 6.9 ± 3.5; p = 0.030) and type III (SUV, 7.4 ± 3.9; p = 0.031) lesions. For type II lesions, the results showed only a statistical trend (SUV, 6.1 ± 3.1; p = 0.073). Due to the small number of cases, an evaluation of type V (n = 1) lesions was not possible. The different SUVs of lesions with different primary morphologies, particularly the lower FDG uptake observed in type IV lesions, suggested that these SUVs might reflect different stages of the disease.
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Affiliation(s)
- Tilmann Graeter
- Department of Diagnostic and Interventional Radiology, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Nina Eberhardt
- Department of Nuclear Medicine, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Rong Shi
- Department of Diagnostic and Interventional Radiology, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Julian Schmidberger
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Doris Henne-Bruns
- Department of General and Visceral Surgery, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Andreas Hillenbrand
- Department of General and Visceral Surgery, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Thomas F E Barth
- Institute of Pathology, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Johannes Grimm
- Institute of Pathology, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Beate Gruener
- Department of Internal Medicine III, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Quartuccio N, Laudicella R, Vento A, Pignata S, Mattoli MV, Filice R, Comis AD, Arnone A, Baldari S, Cabria M, Cistaro A. The Additional Value of 18F-FDG PET and MRI in Patients with Glioma: A Review of the Literature from 2015 to 2020. Diagnostics (Basel) 2020; 10:diagnostics10060357. [PMID: 32486075 PMCID: PMC7345880 DOI: 10.3390/diagnostics10060357] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
AIM Beyond brain computed tomography (CT) scan, Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) hold paramount importance in neuro-oncology. The aim of this narrative review is to discuss the literature from 2015 to 2020, showing advantages or complementary information of fluorine-18 fluorodeoxyglucose (18F-FDG) PET imaging to the anatomical and functional data offered by MRI in patients with glioma. METHODS A comprehensive Pubmed/MEDLINE literature search was performed to retrieve original studies, with a minimum of 10 glioma patients, published from 2015 until the end of April 2020, on the use of 18F-FDG PET in conjunction with MRI. RESULTS Twenty-two articles were selected. Combined use of the two modalities improves the accuracy in predicting prognosis, planning treatments, and evaluating recurrence. CONCLUSION According to the recent literature, 18F-FDG PET provides different and complementary information to MRI and may enhance performance in the whole management of gliomas. Therefore, integrated PET/MRI may be particularly useful in gliomas, since it could provide accurate morphological and metabolic information in one-shoot examination and improve the diagnostic value compared to each of procedures.
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Affiliation(s)
- Natale Quartuccio
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy; (N.Q.); (A.A.)
- Committee of AIMN Pediatric Study Group, 20159 Milan, Italy
| | - Riccardo Laudicella
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125 Messina, Italy; (R.L.); (A.V.); (S.P.); (R.F.); (A.D.C.); (S.B.)
- AIMN -Italian Association of Nuclear Medicine- Young Members Working Group, 20159 Milan, Italy
| | - Antonio Vento
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125 Messina, Italy; (R.L.); (A.V.); (S.P.); (R.F.); (A.D.C.); (S.B.)
| | - Salvatore Pignata
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125 Messina, Italy; (R.L.); (A.V.); (S.P.); (R.F.); (A.D.C.); (S.B.)
| | - Maria Vittoria Mattoli
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, 66100 Chieti, Italy;
| | - Rossella Filice
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125 Messina, Italy; (R.L.); (A.V.); (S.P.); (R.F.); (A.D.C.); (S.B.)
| | - Alessio Danilo Comis
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125 Messina, Italy; (R.L.); (A.V.); (S.P.); (R.F.); (A.D.C.); (S.B.)
| | - Annachiara Arnone
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy; (N.Q.); (A.A.)
| | - Sergio Baldari
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125 Messina, Italy; (R.L.); (A.V.); (S.P.); (R.F.); (A.D.C.); (S.B.)
| | - Manlio Cabria
- Nuclear Medicine Department, Ente Ospedaliero Ospedali Galliera, Italy, Mura delle Cappuccine, 14, 16128 Genova, Italy;
| | - Angelina Cistaro
- Nuclear Medicine Department, Ente Ospedaliero Ospedali Galliera, Italy, Mura delle Cappuccine, 14, 16128 Genova, Italy;
- Committee of AIMN Neuroimaging Study Group, 20159 Milan, Italy
- Coordinator of AIMN Paediatric Study Group, 20159 Milan, Italy
- Correspondence: ; Tel.: +39-22254881
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5
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Kong Z, Yan C, Zhu R, Wang J, Wang Y, Wang Y, Wang R, Feng F, Ma W. Imaging biomarkers guided anti-angiogenic therapy for malignant gliomas. NEUROIMAGE-CLINICAL 2018; 20:51-60. [PMID: 30069427 PMCID: PMC6067083 DOI: 10.1016/j.nicl.2018.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 12/24/2022]
Abstract
Antiangiogenic therapy is a universal approach to the treatment of malignant gliomas but fails to prolong the overall survival of newly diagnosed or recurrent glioblastoma patients. Imaging biomarkers are quantitative imaging parameters capable of objectively describing biological processes, pathological changes and treatment responses in some situations and have been utilized for outcome predictions of malignant gliomas in anti-angiogenic therapy. Advanced magnetic resonance imaging techniques (including perfusion-weighted imaging and diffusion-weighted imaging), positron emission computed tomography and magnetic resonance spectroscopy are imaging techniques that can be used to acquire imaging biomarkers, including the relative cerebral blood volume (rCBV), Ktrans, and the apparent diffusion coefficient (ADC). Imaging indicators for a better prognosis when treating malignant gliomas with antiangiogenic therapy include the following: a lower pre- or post-treatment rCBV, less change in rCBV during treatment, a lower pre-treatment Ktrans, a higher vascular normalization index during treatment, less change in arterio-venous overlap during treatment, lower pre-treatment ADC values for the lower peak, smaller ADC volume changes during treatment, and metabolic changes in glucose and phenylalanine. The investigation and utilization of these imaging markers may confront challenges, but may also promote further development of anti-angiogenic therapy. Despite considerable evidence, future prospective studies are critically needed to consolidate the current data and identify novel biomarkers. Anti-angiogenic therapy only benefits specific populations of glioma patients. Advanced imaging techniques can produce quantitative imaging biomarkers. Physiological and metabolic parameter can predict outcome for anti-angiogenic therapy. Larger prospective studies are needed to provide further evidence.
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Key Words
- 18F-FDOPA, 3,4-dihydroxy-6-[18F]-fluoro-l-phenylalanine
- 18F-FLT, [18F]-fluoro-3-deoxy-3-L-fluorothymidine
- ADC, apparent diffusion coefficient
- AVOL, arterio-venous overlap
- Anti-angiogenic
- BBB, blood brain barrier
- Biomarkers
- CBF, cerebral blood flow
- CBV, cerebral blood volume
- CNS, central nervous system
- CT, computed tomography
- D-2HG, D-2-hydroxypentanedioic acid
- DCE-MRI, dynamic contrast-enhanced magnetic resonance imaging
- DSC-MRI, dynamic susceptibility contrast magnetic resonance imaging
- DWI, diffusion-weighted imaging
- FDG, fluorodeoxyglucose
- FLAIR, fluid-attenuated inversion recovery
- FSE pcASL, fast spin echo pseudocontinuous artery spin labeling
- GBM, glioblastoma
- Glioma
- Imaging
- Ktrans, volume transfer constant between blood plasma and extravascular extracellular space
- MRI, magnetic resonance imaging
- MRS, magnetic resonance spectroscopy
- OS, overall survival
- PET, positron emission computed tomography
- PFS, progression-free survival
- PWI, perfusion-weighted imaging
- RANO, Response Assessment in Neuro-Oncology
- ROI, region of interest
- RSI, restriction spectrum imaging
- SUV, standardized uptake value
- TMZ, temozolomide
- Therapy
- VAI, vessel architectural imaging
- VEGF-A, vascular endothelial growth factor A
- VNI, vascular normalization index.
- fDMs, functional diffusion maps
- nGBM, newly diagnosed glioblastoma
- rCBF, relative cerebral blood flow
- rCBV, relative cerebral blood volume
- rGBM, recurrent glioblastoma
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Affiliation(s)
- Ziren Kong
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Chengrui Yan
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China; Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China
| | - Ruizhe Zhu
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Jiaru Wang
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Yaning Wang
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Yu Wang
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
| | - Renzhi Wang
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
| | - Feng Feng
- Department of Radiology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China..
| | - Wenbin Ma
- Department of Neurosurgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
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Vajapeyam S, Brown D, Johnston PR, Ricci KI, Kieran MW, Lidov HGW, Poussaint TY. Multiparametric Analysis of Permeability and ADC Histogram Metrics for Classification of Pediatric Brain Tumors by Tumor Grade. AJNR Am J Neuroradiol 2018; 39:552-557. [PMID: 29301780 DOI: 10.3174/ajnr.a5502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/30/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Accurate tumor grading is essential for treatment planning of pediatric brain tumors. We hypothesized that multiparametric analyses of a combination of permeability metrics and ADC histogram metrics would differentiate high- and low-grade tumors with high accuracy. MATERIALS AND METHODS DTI and dynamic contrast-enhanced MR imaging using T1-mapping with flip angles of 2°, 5°, 10°, and 15°, followed by a 0.1-mmol/kg body weight gadolinium-based bolus was performed on all patients in addition to standard MR imaging. Permeability data were processed and transfer constant from the blood plasma into the extracellular extravascular space, rate constant from the extracellular extravascular space back into blood plasma, extravascular extracellular volume fraction, and fractional blood plasma volume were calculated from 3D tumor volumes. Apparent diffusion coefficient histogram metrics were calculated for 3 separate tumor volumes derived from T2-FLAIR sequences, T1 contrast-enhanced sequences, and permeability maps, respectively. RESULTS Results from 41 patients (0.3-16.76 years of age; mean, 6.22 years) with newly diagnosed contrast-enhancing brain tumors (16 low-grade; 25 high-grade) were included in the institutional review board-approved retrospective analysis. Wilcoxon tests showed a higher transfer constant from blood plasma into extracellular extravascular space and rate constant from extracellular extravascular space back into blood plasma, and lower extracellular extravascular volume fraction (P < .001) in high-grade tumors. The mean ADCs of FLAIR and enhancing tumor volumes were significantly lower in high-grade tumors (P < .001). ROC analysis showed that a combination of extravascular volume fraction and mean ADC of FLAIR volume differentiated high- and low-grade tumors with high accuracy (area under receiver operating characteristic curve = 0.918). CONCLUSIONS ADC histogram metrics combined with permeability metrics differentiate low- and high-grade pediatric brain tumors with high accuracy.
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Affiliation(s)
- S Vajapeyam
- From the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.) .,Harvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts
| | - D Brown
- From the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.)
| | - P R Johnston
- From the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.)
| | - K I Ricci
- Cancer Center (K.I.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - M W Kieran
- Division of Pediatric Oncology (M.W.K.), Dana-Farber Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts
| | - H G W Lidov
- Pathology (H.G.W.L.), Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts
| | - T Y Poussaint
- From the Departments of Radiology (S.V., D.B., P.R.J., T.Y.P.).,Harvard Medical School (S.V., M.W.K., H.G.W.L., T.Y.P.), Boston, Massachusetts
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Grading and outcome prediction of pediatric diffuse astrocytic tumors with diffusion and arterial spin labeling perfusion MRI in comparison with 18F-DOPA PET. Eur J Nucl Med Mol Imaging 2017; 44:2084-2093. [PMID: 28752225 DOI: 10.1007/s00259-017-3777-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 07/10/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE The aim of this study was to investigate MRI-derived diffusion weighted imaging (DWI) and arterial spin labeling (ASL) perfusion imaging in comparison with 18F-dihydroxyphenylalanine (DOPA) PET with respect to diagnostic performance in tumor grading and outcome prediction in pediatric patients with diffuse astrocytic tumors (DAT). METHODS We retrospectively analyzed 26 children with histologically proven treatment naïve low and high grade DAT who underwent ASL and DWI performed within 2 weeks of 18F-DOPA PET. Relative ASL-derived cerebral blood flow max (rCBF max) and DWI-derived minimum apparent diffusion coefficient (rADC min) were compared with 18F-DOPA uptake tumor/normal tissue (T/N) and tumor/striatum (T/S) ratios, and correlated with World Health Organization (WHO) tumor grade and progression-free survival (PFS). Statistics included Pearson's chi-square and Mann-Whitney U tests, Spearman's rank correlation, receiver operating characteristic (ROC) analysis, discriminant function analysis (DFA), Kaplan-Meier survival curve, and Cox analysis. RESULTS A significant correlation was demonstrated between rCBF max, rADC min, and 18F-DOPA PET data (p < 0.001). Significant differences in terms of rCBF max, rADC min, and 18F-DOPA uptake were found between low- and high-grade DAT (p ≤ 0.001). ROC analysis and DFA demonstrated that T/S and T/N values were the best parameters for predicting tumor progression (AUC 0.93, p < 0.001). On univariate analysis, all diagnostic tools correlated with PFS (p ≤ 0.001); however, on multivariate analysis, only 18F-DOPA uptake remained significantly associated with outcome (p ≤ 0.03), while a trend emerged for rCBF max (p = 0.09) and rADC min (p = 0.08). The combination of MRI and PET data increased the predictive power for prognosticating tumor progression (AUC 0.97, p < 0.001). CONCLUSIONS DWI, ASL and 18F-DOPA PET provide useful complementary information for pediatric DAT grading. 18F-DOPA uptake better correlates with PFS prediction. Combining MRI and PET data provides the highest predictive power for prognosticating tumor progression suggesting a synergistic role of these diagnostic tools.
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Bevacizumab for malignant gliomas: current indications, mechanisms of action and resistance, and markers of response. Brain Tumor Pathol 2017; 34:62-77. [PMID: 28386777 DOI: 10.1007/s10014-017-0284-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/27/2017] [Indexed: 12/21/2022]
Abstract
Vascular endothelial growth factor (VEGF) is an attractive target of antiangiogenic therapy in glioblastomas. Bevacizumab (Bev), a humanized anti-VEGF antibody, is associated with the improvement of progression-free survival and performance status in patients with glioblastoma. However, randomized trials uniformly suggest that these favorable clinical effects of Bev do not translate into an overall survival benefit. The mechanisms of action of Bev appear to include the inhibition of tumor angiogenesis, as well as indirect effects such as the depletion of niches for glioma stem cells and stimulation of antitumor immunity. Although several molecules/pathways have been reported to mediate adaptation and resistance to Bev, including the activation of alternative pro-angiogenic pathways, the resistance mechanisms have not been fully elucidated; for example, the mechanism that reinduces tumor hypoxia remains unclarified. The identification of imaging characteristics or biomarkers predicting the response to Bev, as well as the better understanding of the mechanisms of action and resistance, is crucial to improve the overall clinical outcome and optimize individual therapy. In this article, the authors review the results of important clinical trials/studies, the current understanding of the mechanisms of action and resistance, and the knowledge of imaging characteristics and biomarkers predicting the response to Bev.
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9
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Infinger LK, Stevenson CB. Re-Examining the Need for Tissue Diagnosis in Pediatric Diffuse Intrinsic Pontine Gliomas: A Review. Curr Neuropharmacol 2017; 15:129-133. [PMID: 27109746 PMCID: PMC5327458 DOI: 10.2174/1570159x14666160425114024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/18/2014] [Accepted: 02/08/2016] [Indexed: 01/24/2023] Open
Abstract
Diffuse intrinsic pontine glioma (DIPG) is a malignant brain tumor of childhood that carries an extremely poor prognosis. There are ~200-300 new cases diagnosed each year, [1, 2] and little progress has been made in changing the prognosis and outcome of the tumor since it was first documented in the literature in 1926 [3]. The median overall survival is 8-11 months [4], with an overall survival rate of 30% at 1 year, and less than 10% at 2 years [4]. This review will provide background information on DIPGs, a historical look at the trends in caring for DIPG, and current trends in diagnosis and treatment. By changing the way we care for these terminal tumors, we can work towards having a better understanding of the underlying molecular biology, and attempt to develop better chemotherapeutic tools to combat the disease.
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Affiliation(s)
| | - Charles B. Stevenson
- Cincinnati Children’s Hospital Medical Center, Division of Pediatric Neurosurgery, USA
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10
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Vajapeyam S, Stamoulis C, Ricci K, Kieran M, Poussaint TY. Automated Processing of Dynamic Contrast-Enhanced MRI: Correlation of Advanced Pharmacokinetic Metrics with Tumor Grade in Pediatric Brain Tumors. AJNR Am J Neuroradiol 2016; 38:170-175. [PMID: 27633807 DOI: 10.3174/ajnr.a4949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/01/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Pharmacokinetic parameters from dynamic contrast-enhanced MR imaging have proved useful for differentiating brain tumor grades in adults. In this study, we retrospectively reviewed dynamic contrast-enhanced perfusion data from children with newly diagnosed brain tumors and analyzed the pharmacokinetic parameters correlating with tumor grade. MATERIALS AND METHODS Dynamic contrast-enhanced MR imaging data from 38 patients were analyzed by using commercially available software. Subjects were categorized into 2 groups based on pathologic analyses consisting of low-grade (World Health Organization I and II) and high-grade (World Health Organization III and IV) tumors. Pharmacokinetic parameters were compared between the 2 groups by using linear regression models. For parameters that were statistically distinct between the 2 groups, sensitivity and specificity were also estimated. RESULTS Eighteen tumors were classified as low-grade, and 20, as high-grade. Transfer constant from the blood plasma into the extracellular extravascular space (Ktrans), rate constant from extracellular extravascular space back into blood plasma (Kep), and extracellular extravascular volume fraction (Ve) were all significantly correlated with tumor grade; high-grade tumors showed higher Ktrans, higher Kep, and lower Ve. Although all 3 parameters had high specificity (range, 82%-100%), Kep had the highest specificity for both grades. Optimal sensitivity was achieved for Ve, with a combined sensitivity of 76% (compared with 71% for Ktrans and Kep). CONCLUSIONS Pharmacokinetic parameters derived from dynamic contrast-enhanced MR imaging can effectively discriminate low- and high-grade pediatric brain tumors.
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Affiliation(s)
- S Vajapeyam
- From the Departments of Radiology (S.V., C.S., T.Y.P.) .,Harvard Medical School (S.V., C.S., M.K., T.Y.P.), Boston, Massachusetts
| | - C Stamoulis
- From the Departments of Radiology (S.V., C.S., T.Y.P.).,Neurology (C.S.), Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School (S.V., C.S., M.K., T.Y.P.), Boston, Massachusetts
| | - K Ricci
- Cancer Center (K.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - M Kieran
- Department of Pediatric Oncology (M.K.), Dana-Farber Cancer Center, Boston, Massachusetts.,Harvard Medical School (S.V., C.S., M.K., T.Y.P.), Boston, Massachusetts
| | - T Young Poussaint
- From the Departments of Radiology (S.V., C.S., T.Y.P.).,Harvard Medical School (S.V., C.S., M.K., T.Y.P.), Boston, Massachusetts
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Perfusion MRI as the predictive/prognostic and pharmacodynamic biomarkers in recurrent malignant glioma treated with bevacizumab: a systematic review and a time-to-event meta-analysis. J Neurooncol 2016; 128:185-94. [PMID: 27108275 DOI: 10.1007/s11060-016-2102-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/04/2016] [Indexed: 12/15/2022]
Abstract
This study aims to evaluate the value of perfusion MRI as a predictive/prognostic biomarker and a pharmacodynamic biomarker in patients with recurrent glioma treated with a bevacizumab-based regimen. We identified thirteen literature reports that investigated dynamic susceptibility-contrast (DSC) MRI or dynamic contrast-enhanced (DCE) MRI for predicting the patient outcome and analyzing the anti-angiogenic effect of bevacizumab by performing a systematic search of MEDLINE and EMBASE. The relative cerebral volume (rCBV) of DSC-MRI is currently the most common perfusion MRI parameter used as a predictive/prognostic biomarker. Pooled hazard ratios between responders and non-responders, as determined by rCBV, were 0.46 (95 % CI 0.28-0.76) for progression-free survival from five articles with a total 226 patients and 0.47 (95 % CI 0.29-0.76) for overall survival from six articles with a total 247 patients, and thus indicating that rCBV is helpful for predicting disease progression and the eventual outcome after treatment. Regarding the pharmacodynamic value of perfusion MRI parameters derived from either DSC-MRI or DCE-MRI, most perfusion MRI parameters (rCBV, Ktrans, CBVmax, Kpsmax, fpv, Ve and Kep) demonstrated a consistent decrease on the follow-up MRI after treatment, indicating that perfusion MRI may be helpful for evaluating the anti-angiogenic effect of a bevacizumab-based treatment regimen. However, the lack of standardization of imaging acquisition and analysis techniques for various perfusion MRI parameters needs to be resolved in the future. Despite these unsolved issues, the current evidence favoring the use of perfusion MRI as a predictive/prognostic or pharmacodynamic biomarker should be considered in patients with glioma treated using a bevacizumab-based regimen.
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12
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Concurrent functional and metabolic assessment of brain tumors using hybrid PET/MR imaging. J Neurooncol 2016; 127:287-93. [DOI: 10.1007/s11060-015-2032-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 12/25/2015] [Indexed: 01/15/2023]
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13
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A phase I trial and PK study of cediranib (AZD2171), an orally bioavailable pan-VEGFR inhibitor, in children with recurrent or refractory primary CNS tumors. Childs Nerv Syst 2015; 31:1433-45. [PMID: 26188774 PMCID: PMC4561207 DOI: 10.1007/s00381-015-2812-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 07/03/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cediranib (AZD2171), an oral pan-vascular endothelial growth factor (VEGF) inhibitor, was evaluated in this phase I study to determine its toxicity profile, dose-limiting toxicities (DLTs), maximum-tolerated dose (MTD), pharmacokinetics, and pharmacodynamics in children and adolescents with recurrent or refractory primary central nervous system (CNS) tumors. METHODS Children and adolescents <22 years were enrolled into one of two strata: stratum I—those not receiving enzyme-inducing anticonvulsant drugs (EIACD) and stratum II—those receiving EIACDs. Dose-level selection was based on the continual reassessment method (CRM). RESULTS Thirty-six eligible patients with median age of 12.7 years (range, 5.4-21.7 years) in stratum I (24 males) and 12 patients (7 males) in stratum II with median age of 13.4 years (range, 8.9-19.5 years) were initially assessed over a 4-week DLT evaluation period, modified to 6 weeks during the study. An MTD of 32 mg/m(2)/day was declared; however, excessive toxicities (transaminitis, proteinuria, diarrhea, hemorrhage, palmer-planter syndrome, reversible posterior leukoencephalopathy) in the expansion cohort treated at this dose suggested that it might not be tolerated over a longer time period. An expansion cohort at 20 mg/m(2)/day also demonstrated poor longer-term tolerability. Diffusion and perfusion MRI and PET imaging variables as well as biomarker analysis were performed and correlated with outcome. At 20 mg/m(2)/day, the median plasma area under the concentration-time curve at steady state was lower than that observed in adults at similar dosages. CONCLUSIONS While the MTD of once daily oral cediranib in children with recurrent or progressive CNS tumors was initially defined as 32 mg/m(2)/day, this dose and 20 mg/m(2)/day were not considered tolerable over a protracted time period.
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Zukotynski K, Fahey F, Kocak M, Kun L, Boyett J, Fouladi M, Vajapeyam S, Treves T, Poussaint TY. 18F-FDG PET and MR imaging associations across a spectrum of pediatric brain tumors: a report from the pediatric brain tumor consortium. J Nucl Med 2014; 55:1473-80. [PMID: 25071098 DOI: 10.2967/jnumed.114.139626] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The purpose of this study was to describe (18)F-FDG uptake across a spectrum of pediatric brain tumors and correlate (18)F-FDG PET with MR imaging variables, progression-free survival (PFS), and overall survival (OS). METHODS A retrospective analysis was conducted of children enrolled in phase I/II clinical trials through the Pediatric Brain Tumor Consortium from August 2000 to June 2010. PET variables were summarized within diagnostic categories using descriptive statistics. Associations of PET with MR imaging variables and PFS and OS by tumor types were evaluated. RESULTS Baseline (18)F-FDG PET was available in 203 children; 66 had newly diagnosed brain tumors, and 137 had recurrent/refractory brain tumors before enrolling in a Pediatric Brain Tumor Consortium trial. MR imaging was performed within 2 wk of PET and before therapy in all cases. The (18)F-FDG uptake pattern and MR imaging contrast enhancement (CE) varied by tumor type. On average, glioblastoma multiforme and medulloblastoma had uniform, intense uptake throughout the tumor, whereas brain stem gliomas (BSGs) had low uptake in less than 50% of the tumor and ependymoma had low uptake throughout the tumor. For newly diagnosed BSG, correlation of (18)F-FDG uptake with CE portended reduced OS (P = 0.032); in refractory/recurrent BSG, lack of correlation between (18)F-FDG uptake and CE suggested decreased PFS (P = 0.023). In newly diagnosed BSG for which more than 50% of the tumor had (18)F-FDG uptake, there was a suggestion of lower apparent diffusion coefficient (P = 0.061) and decreased PFS (P = 0.065). CONCLUSION (18)F-FDG PET and MR imaging showed a spectrum of patterns depending on tumor type. In newly diagnosed BSG, the correlation of (18)F-FDG uptake and CE suggested decreased OS, likely related to more aggressive disease. When more than 50% of the tumor had (18)F-FDG uptake, the apparent diffusion coefficient was lower, consistent with increased cellularity. In refractory/recurrent BSG, poor correlation between (18)F-FDG uptake and CE was associated with decreased PFS, which may reflect concurrent tissue breakdown at sites of treated disease and development of new sites of (18)F-FDG-avid malignancy.
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Affiliation(s)
- Katherine Zukotynski
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Frederic Fahey
- Department of Radiology, Harvard Medical School, Boston, Massachusetts Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Larry Kun
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - James Boyett
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee; and
| | - Maryam Fouladi
- Department of Hematology/Oncology, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Sridhar Vajapeyam
- Department of Radiology, Harvard Medical School, Boston, Massachusetts Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Ted Treves
- Department of Radiology, Harvard Medical School, Boston, Massachusetts Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Tina Y Poussaint
- Department of Radiology, Harvard Medical School, Boston, Massachusetts Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
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Morana G, Piccardo A, Milanaccio C, Puntoni M, Nozza P, Cama A, Zefiro D, Cabria M, Rossi A, Garrè ML. Value of 18F-3,4-Dihydroxyphenylalanine PET/MR Image Fusion in Pediatric Supratentorial Infiltrative Astrocytomas: A Prospective Pilot Study. J Nucl Med 2014; 55:718-23. [DOI: 10.2967/jnumed.113.125500] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Goda JS, Dutta D, Raut N, Juvekar SL, Purandare N, Rangarajan V, Arora B, Gupta T, Kurkure P, Jalali R. Can multiparametric MRI and FDG-PET predict outcome in diffuse brainstem glioma? A report from a prospective phase-II study. Pediatr Neurosurg 2013; 49:274-81. [PMID: 25277867 DOI: 10.1159/000366167] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/20/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To study the impact of multiparametric MRI and (18)F-FDG-PET on the outcome of children with diffuse intrinsic pontine gliomas (DIPG). MATERIALS AND METHODS Imaging data from a phase-II prospective therapeutic study in children with newly diagnosed DIPG were considered for evaluation. They included baseline MRI with contrast enhancement before treatment. Functional imaging included MR spectroscopy, MR perfusion and FDG-PET studies. All patients (n = 20) had baseline MRI and 11 patients had FDG-PET. Response was assessed by MRI and PET 4 weeks after therapy. Baseline imaging findings were correlated with survival. Presence or absence of adverse parameters on MRI (heterogeneous contrast enhancement, hyperperfusion or increased choline:NAA ratio) was used to develop a cumulative radiological prognostic index (RPI). Sensitivity and specificity of each imaging modality in tumour grading was estimated. RESULTS The cumulative RPI was able to classify the patients into different grades and was predictive of overall survival (p = 0.02). MR perfusion also predicted survival (p = 0.039). Sensitivity and specificity of MRI and FDG-PET to detect low-grade gliomas were low to moderate (33-66%), but moderate to high in detecting high-grade gliomas (50-100%). Baseline FDG uptake on PET scan did not correlate with survival (p = 0.7). CONCLUSIONS Cumulative RPI was able to classify tumours into different grades and predicted clinical outcome. At baseline, MR hyperperfusion indicated a shorter survival for DIPG patients. Sensitivity and specificity of imaging modalities to detect low-grade gliomas were poor.
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Affiliation(s)
- Jayant S Goda
- Department of Radiation Oncology, Neuro-Oncology Disease Management Group, Tata Memorial Centre, Mumbai, India
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