1
|
Dong W, Wang N, Qi Z. Advances in the application of neuroinflammatory molecular imaging in brain malignancies. Front Immunol 2023; 14:1211900. [PMID: 37533851 PMCID: PMC10390727 DOI: 10.3389/fimmu.2023.1211900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
The prevalence of brain cancer has been increasing in recent decades, posing significant healthcare challenges. The introduction of immunotherapies has brought forth notable diagnostic imaging challenges for brain tumors. The tumor microenvironment undergoes substantial changes in induced immunosuppression and immune responses following the development of primary brain tumor and brain metastasis, affecting the progression and metastasis of brain tumors. Consequently, effective and accurate neuroimaging techniques are necessary for clinical practice and monitoring. However, patients with brain tumors might experience radiation-induced necrosis or other neuroinflammation. Currently, positron emission tomography and various magnetic resonance imaging techniques play a crucial role in diagnosing and evaluating brain tumors. Nevertheless, differentiating between brain tumors and necrotic lesions or inflamed tissues remains a significant challenge in the clinical diagnosis of the advancements in immunotherapeutics and precision oncology have underscored the importance of clinically applicable imaging measures for diagnosing and monitoring neuroinflammation. This review summarizes recent advances in neuroimaging methods aimed at enhancing the specificity of brain tumor diagnosis and evaluating inflamed lesions.
Collapse
Affiliation(s)
- Wenxia Dong
- Department of Radiology, The First People’s Hospital of Linping District, Hangzhou, China
| | - Ning Wang
- Department of Medical Imaging, Jining Third People’s Hospital, Jining, Shandong, China
| | - Zhe Qi
- Department of Radiology, Zibo Central Hospital, Zibo, Shandong, China
| |
Collapse
|
2
|
Beniamin M, Elhefnawy S, Abdelsamad A, Hassan H. Role of MRI modalities in assessment of cystic brain Lesions: a prospective study. УКРАЇНСЬКИЙ РАДІОЛОГІЧНИЙ ТА ОНКОЛОГІЧНИЙ ЖУРНАЛ 2022. [DOI: 10.46879/ukroj.4.2022.9-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background. Intracranial cystic lesions are unnatural cavities in which the continuity of the brain parenchyma is disrupted because of different pathologies such as infections and tumors containing proteinaceous fluid and/or cellular/necrotic materials.
Purpose – to investigate the value of some MRI modalities, mostly DWI and MR spectroscopy, in differentiation of the common intracranial intra-axial cystic brain lesions to help these patients benefit from the best medical management and treatment.
Materials and Methods. This is a prospective study, conducted from April 2019 till April 2021. It involved forty adult patients of both sexes with a cystic/necrotic intra-axial brain lesion with variable perifocal edema and rim enhancement on post-contrast study at MRI unit, radiology department, Ain Shams University (ASU) Hospital. All examinations were carried out after signing of the informed consent by the patients themselves or their guardian if the patient was incapacitated by any means.
Results. The ADC values in the center of lesions were not uniform. We found the lowest ADC value in the center of the lesion at the abscess 0.4x10–3 mm2 /s, and the highest ADC value 3.2x10–3 mm2 /s was in cystic neoplastic lesion. There was a significant difference in the ADC values in the center of neoplastic necrotic lesions; mean ADC value was (1.95±1.08) x10–3 mm2 /s and (1.15±0.65) x10–3 mm2 /s in abscess lesions, with a cut-off value, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy value of: 1.55%, 92.9%, 91.7%, 96.3%, 84.6% and 92.5% respectively. MRS was performed in 40 cases, and the Cho/Cr, Cho/NAA and NAA/Cr mean ratios were calculated. These ratios were compared between the different categories. Statistically significant differences were found in the Cho/Cr, Cho/NAA ratios between both groups (p values<0.001**), while no statistically significant difference was found in the NAA/Cr ratio.
Conclusion. Diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) are useful as additional diagnostic modalities for differentiating brain abscesses from cystic or necrotic brain tumors. Furthermore, the following MR techniques may be helpful for discriminating brain abscess from cystic or necrotic tumors: diffusion tensor imaging (DTI), perfusion weighted imaging as well as positron emission tomography computed tomography (PET-CT). This will help to improve the accuracy of MR in differentiating brain abscess from cystic or necrotic tumors.
Collapse
|
3
|
Ciernikova S, Sevcikova A, Stevurkova V, Mego M. Tumor microbiome - an integral part of the tumor microenvironment. Front Oncol 2022; 12:1063100. [PMID: 36505811 PMCID: PMC9730887 DOI: 10.3389/fonc.2022.1063100] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
The tumor microenvironment (TME) plays a significant role in tumor progression and cancer cell survival. Besides malignant cells and non-malignant components, including immune cells, elements of the extracellular matrix, stromal cells, and endothelial cells, the tumor microbiome is considered to be an integral part of the TME. Mounting evidence from preclinical and clinical studies evaluated the presence of tumor type-specific intratumoral bacteria. Differences in microbiome composition between cancerous tissues and benign controls suggest the importance of the microbiome-based approach. Complex host-microbiota crosstalk within the TME affects tumor cell biology via the regulation of oncogenic pathways, immune response modulation, and interaction with microbiota-derived metabolites. Significantly, the involvement of tumor-associated microbiota in cancer drug metabolism highlights the therapeutic implications. This review aims to summarize current knowledge about the emerging role of tumor microbiome in various types of solid malignancies. The clinical utility of tumor microbiome in cancer progression and treatment is also discussed. Moreover, we provide an overview of clinical trials evaluating the role of tumor microbiome in cancer patients. The research focusing on the communication between the gut and tumor microbiomes may bring new opportunities for targeting the microbiome to increase the efficacy of cancer treatment and improve patient outcomes.
Collapse
Affiliation(s)
- Sona Ciernikova
- Department of Genetics, Cancer Research Institute, Biomedical Research Center of Slovak Academy of Sciences, Bratislava, Slovakia,*Correspondence: Sona Ciernikova,
| | - Aneta Sevcikova
- Department of Genetics, Cancer Research Institute, Biomedical Research Center of Slovak Academy of Sciences, Bratislava, Slovakia
| | - Viola Stevurkova
- Department of Genetics, Cancer Research Institute, Biomedical Research Center of Slovak Academy of Sciences, Bratislava, Slovakia
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Bratislava and National Cancer Institute, Bratislava, Slovakia
| |
Collapse
|
4
|
Roesler R, Dini SA, Isolan GR. Neuroinflammation and immunoregulation in glioblastoma and brain metastases: Recent developments in imaging approaches. Clin Exp Immunol 2021; 206:314-324. [PMID: 34591980 DOI: 10.1111/cei.13668] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 01/12/2023] Open
Abstract
Brain tumors and brain metastases induce changes in brain tissue remodeling that lead to immunosuppression and trigger an inflammatory response within the tumor microenvironment. These immune and inflammatory changes can influence invasion and metastasis. Other neuroinflammatory and necrotic lesions may occur in patients with brain cancer or brain metastases as sequelae from treatment with radiotherapy. Glioblastoma (GBM) is the most aggressive primary malignant brain cancer in adults. Imaging methods such as positron emission tomography (PET) and different magnetic resonance imaging (MRI) techniques are highly valuable for the diagnosis and therapeutic evaluation of GBM and other malignant brain tumors. However, differentiating between tumor tissue and inflamed brain tissue with imaging protocols remains a challenge. Here, we review recent advances in imaging methods that have helped to improve the specificity of primary tumor diagnosis versus evaluation of inflamed and necrotic brain lesions. We also comment on advances in differentiating metastasis from neuroinflammation processes. Recent advances include the radiosynthesis of 18 F-FIMP, an L-type amino acid transporter 1 (LAT1)-specific PET probe that allows clearer differentiation between tumor tissue and inflammation compared to previous probes, and the combination of different advanced imaging protocols with the inclusion of radiomics and machine learning algorithms.
Collapse
Affiliation(s)
- Rafael Roesler
- Department of Pharmacology, Institute for Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.,Cancer and Neurobiology Laboratory, Experimental Research Center, Clinical Hospital (CPE-HCPA), Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Simone Afonso Dini
- The Center for Advanced Neurology and Neurosurgery (CEANNE)-Brazil, Porto Alegre, RS, Brazil
| | - Gustavo R Isolan
- The Center for Advanced Neurology and Neurosurgery (CEANNE)-Brazil, Porto Alegre, RS, Brazil.,Mackenzie Evangelical University of Paraná (FEMPAR), Curitiba, PR, Brazil
| |
Collapse
|
5
|
Matsusue E, Inoue C, Tabuchi S, Yoshioka H, Nagao Y, Matsumoto K, Nakamura K, Fujii S. Utility of 3T single-voxel proton MR spectroscopy for differentiating intracranial meningiomas from intracranial enhanced mass lesions. Acta Radiol Open 2021; 10:20584601211009472. [PMID: 34211737 PMCID: PMC8215334 DOI: 10.1177/20584601211009472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 02/03/2023] Open
Abstract
Background Proton magnetic resonance spectroscopy (MRS) provides structural and
metabolic information that is useful for the diagnosis of meningiomas with
atypical radiological appearance. However, the metabolite that should be
prioritized for the diagnosis of meningiomas has not been established. Purpose To evaluate the differences between the metabolic peaks of meningiomas and
other intracranial enhanced mass lesions (non-meningiomas) using MR
spectroscopy in short echo time (TE) spectra and the most useful metabolic
peak for discriminating between the groups. Material and Methods The study involved 9 meningiomas, 22 non-meningiomas, intracranial enhancing
tumors and abscesses, and 15 normal controls. The ranking of the peak at
3.8 ppm, peak at 3.8 ppm/Creatine (Cr), β-γ Glutamine-Glutamate (bgGlx)/Cr,
N-acetyl compounds (NACs)/Cr, choline (Cho)/Cr, lipid and/or lactate
(Lip-Lac) at 1.3 ppm/Cr, and the presence of alanine (Ala) were derived. The
metabolic peaks were compared using the Mann-Whitney U test. ROC analysis
was used to determine the cut-off values for differentiating meningiomas
from non-meningiomas using statistically significant metabolic peaks. Results The ranking of the peak at 3.8 ppm among all the peaks, peak at 3.8 ppm/Cr,
bgGlx/Cr, Lip-Lac/Cr, and the presence of Ala discriminated meningiomas from
non-meningiomas with moderate to high accuracy. The highest accuracy was
96.9% at a threshold value of 3 for the rank of the peak at 3.8 ppm. Conclusion A distinct elevated peak at 3.8 ppm, ranked among the top three highest
peaks, allowed the detection of meningiomas.
Collapse
Affiliation(s)
- Eiji Matsusue
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Chie Inoue
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Sadaharu Tabuchi
- Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Hiroki Yoshioka
- Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Yuichiro Nagao
- Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kensuke Matsumoto
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kazuhiko Nakamura
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Tottori University, Tottori, Japan
| |
Collapse
|
6
|
Kweh BTS, Lee HQ, Tee JW. Intracranial peripherally enhancing lesions in cardiac transplant recipients: A rare case series and literature review. J Clin Neurosci 2020; 78:284-290. [PMID: 32331940 DOI: 10.1016/j.jocn.2020.04.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/05/2020] [Indexed: 12/26/2022]
Abstract
Intracranial peripherally enhancing lesions in immunosuppressed solid organ transplant recipients represent a unique diagnostic and management dilemma due to the vast array of differentials that demand consideration. Diagnosis of the underlying pathology is often guided by the use of magnetic resonance imaging (MRI). We present the first published case series of three cardiac transplant recipients with significantly atypical neuroradiological findings contrary to the tenets of contemporary literature. Our rare case series consists of: (1) A sterile Mycobacterium pyogenic abscess mimicking glioblastoma multiforme due to an immunosuppressed state (2) Epstein Barr Virus encephalitis masquerading as Central Nervous System Post-Transplant Lymphoproliferative Disorder (3) An unusual case of partially treated disseminated Nocardiosis warning of the need to consider the immunosuppressed state and partial treatment response obfuscating classical MRI appearances. We utilise these unprecedented cases as the basis of a literature review to understand the pathophysiology behind the peculiar imaging findings in this rarefied cohort of transplant recipients, and rationalise why the MRI findings in each instance contradicts the accepted imaging patterns. In the setting of potential unreliability of neuroradiology in this immunosuppressed unique subgroup, we hope to impart to clinicians that definitive diagnosis obtained by emergent neurosurgical intervention may be necessary to accurately and expediently guide further medical management.
Collapse
Affiliation(s)
- Barry Ting Sheen Kweh
- National Trauma Research Institute, Melbourne, Victoria 3004, Australia; Department of Neurosurgery, Level 1, Old Baker Building, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Hui Qing Lee
- National Trauma Research Institute, Melbourne, Victoria 3004, Australia; Department of Neurosurgery, Level 1, Old Baker Building, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Jin Wee Tee
- National Trauma Research Institute, Melbourne, Victoria 3004, Australia; Department of Neurosurgery, Level 1, Old Baker Building, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
| |
Collapse
|
7
|
Mahammedi A, Bachir S, Purdy J, Larvie M, Buehler M. Pyogenic brain abscess, ventriculitis and diffuse meningitis with fatal outcome in an adult: Radiologic-pathologic correlation ☆,. Radiol Case Rep 2018; 13:1063-1068. [PMID: 30228844 PMCID: PMC6137902 DOI: 10.1016/j.radcr.2018.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 10/25/2022] Open
Abstract
Rupture of brain abscesses with evolution into ventriculitis with meningitis may result in sudden and dramatic worsening of the clinical situation. We present a 57-year-old man with such an event and fatal outcome. Multiple imaging modalities including computed tomography and advanced magnetic resonance imaging were correlated with gross specimen and histologic images. The differential diagnosis of multiple lesions with ring enhancement and prominent perifocal edema includes mainly infectious and neoplastic processes, such as brain abscess, metastasis, and multicentric glioblastoma. Pyogenic ventriculitis is an uncommon manifestation of severe intracranial infection that might be clinically obscure. We discuss the characteristic magnetic resonance findings of brain abscess and its complications, including meningitis and ventriculitis with emphasis on the role of diffusion-weighted and fluid-attenuated inversion recovery imaging.
Collapse
Affiliation(s)
- Abdelkader Mahammedi
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Suha Bachir
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Jenna Purdy
- University of Toledo, Department of Pathology and Neuroradiology, Toledo, OH, USA
| | - Mykol Larvie
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Mark Buehler
- University of Toledo, Department of Pathology and Neuroradiology, Toledo, OH, USA
| |
Collapse
|
8
|
|
9
|
Morris SA, Esquenazi Y, Tandon N. Pyogenic cerebral abscesses demonstrating facilitated diffusion. Clin Neurol Neurosurg 2016; 144:77-81. [PMID: 26999529 DOI: 10.1016/j.clineuro.2016.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Pyogenic cerebral abscesses are associated with high morbidity and mortality when treatment is delayed. Benign clinical presentation, as well as absence of restricted diffusion on MRI may contribute to missed diagnoses and delays. The authors sought to elucidate characteristics associated with facilitated diffusion on the MRIs of patients with pyogenic abscesses. PATIENTS AND METHODS The authors performed a 10-year retrospective review of prospectively attained data for patients undergoing mass resection by a single surgeon. RESULTS Our findings show that 3/33 (9%) patients with microbiological diagnoses of cerebral abscesses with a thin ring of contrast enhancement but minimal or no restricted diffusion MRI imaging. All causative organisms were hemolytic streptococci and none of the subjects received antibiotic therapy prior to specimen collection. A trend in these patients was the presence of diabetes and in conjunction with other studies that cite incomplete treatment as being associated with facilitated diffusion, we conjecture that impaired inflammatory responses in some patients may be associated with the absence of restricted diffusion. CONCLUSION With this in mind, clinicians must maintain a high index of suspicion when assessing patients with cystic, contrast enhancing masses. A prospective multicenter study to compile imaging along with other patient characteristics may help refine the non-invasive diagnostic criteria for brain abscesses.
Collapse
Affiliation(s)
- Saint-Aaron Morris
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA.
| |
Collapse
|
10
|
Villanueva-Meyer JE, Cha S. From Shades of Gray to Microbiologic Imaging: A Historical Review of Brain Abscess Imaging:RSNA Centennial Article. Radiographics 2015. [DOI: 10.1148/rg.2015140297] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
11
|
Magnetic resonance spectroscopy and imaging on fresh human brain tumor biopsies at microscopic resolution. Anal Bioanal Chem 2015; 407:6771-80. [PMID: 26123440 DOI: 10.1007/s00216-015-8847-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/04/2015] [Accepted: 06/10/2015] [Indexed: 12/16/2022]
Abstract
The metabolic composition and concentration knowledge provided by magnetic resonance spectroscopy (MRS) liquid and high-resolution magic angle spinning spectroscopy (HR-MAS) has a relevant impact in clinical practice during magnetic resonance imaging (MRI) monitoring of human tumors. In addition, the combination of morphological and chemical information by MRI and MRS has been particularly useful for diagnosis and prognosis of tumor evolution. MRI spatial resolution reachable in human beings is limited for safety reasons and the demanding necessary conditions are only applicable on experimental model animals. Nevertheless, MRS and MRI can be performed on human biopsies at high spatial resolution, enough to allow a direct correlation between the chemical information and the histological features observed in such biopsies. Although HR-MAS is nowadays a well-established technique for spectroscopic analysis of tumor biopsies, with this approach just a mean metabolic profile of the whole sample can be obtained and thus the high histological heterogeneity of some important tumors is mostly neglected. The value of metabolic HR-MAS data strongly depends on a wide statistical analysis and usually the microanatomical rationale for the correlation between histology and spectroscopy is lost. We present here a different approach for the combined use of MRI and MRS on fresh human brain tumor biopsies with native contrast. This approach has been designed to achieve high spatial (18 × 18 × 50 μm) and spectral (0.031 μL) resolution in order to obtain as much spatially detailed morphological and metabolical information as possible without any previous treatment that can alter the sample. The preservation of native tissue conditions can provide information that can be translated to in vivo studies and additionally opens the possibility of performing other techniques to obtain complementary information from the same sample.
Collapse
|
12
|
Fu JH, Chuang TC, Chung HW, Chang HC, Lin HS, Hsu SS, Wang PC, Hsu SH, Pan HB, Lai PH. Discriminating pyogenic brain abscesses, necrotic glioblastomas, and necrotic metastatic brain tumors by means of susceptibility-weighted imaging. Eur Radiol 2014; 25:1413-20. [DOI: 10.1007/s00330-014-3518-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 11/06/2014] [Accepted: 11/18/2014] [Indexed: 01/14/2023]
|
13
|
Rangarajan K, Das CJ, Kumar A, Gupta AK. MRI in central nervous system infections: A simplified patterned approach. World J Radiol 2014; 6:716-725. [PMID: 25276314 PMCID: PMC4176788 DOI: 10.4329/wjr.v6.i9.716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/23/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Recognition and characterization of central nervous system infections poses a formidable challenge to the neuro-radiologist. Imaging plays a vital role, the lesions typically being relatively inaccessible to tisue sampling. The results of an accurate diagnosis are endlessly rewarding, given the availability of excellent pharmacological regimen. The availability of numerous magnetic resonance (MR) sequences which provide functional and molecular information is a powerful tool in the hands of the radiologist. However, the plethora of sequences and the possibilities on each sequence is also intimidating, and often confusing as well as time consuming. While a large number of reviews have already described in detail the possible imaging findings in each infection, we intend to classify infections based on their imaging characteristics. In this review we describe an algorithm for first classifying the imaging findings into patterns based on basic MR sequences (T1, T2 and enhancement pattern with Gadolinium), and then sub-classify them based on more advanced molecular and functional sequences (Diffusion, Perfusion, Susceptibility imaging, MR Spectroscopy). This patterned approach is intended as a guide to radiologists in-training and in-practice for quickly narrowing their list of differentials when faced with a clinical challenge. The entire content of the article has also been summarised in the form of flow-charts for the purpose of quick reference.
Collapse
|
14
|
ABO-Sheisha DM, Amin MA, Soliman AY. Role of diffusion weighted imaging and proton magnetic resonance spectroscopy in ring enhancing brain lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
15
|
Elshafey R, Hassanein O, Shakal A, Mokbel E. 1H proton MR spectroscopy and diffusion-weighted imaging in discrimination between pyogenic brain abscesses and necrotic brain tumors. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
16
|
Warrington CD, Feeney DA, Ober CP, Jessen CR, Steward SM, Armién AG, Fletcher TF. Relative metabolite concentrations and ratios determined by use of 3-T region-specific proton magnetic resonance spectroscopy of the brain of healthy Beagles. Am J Vet Res 2014; 74:1291-303. [PMID: 24066913 DOI: 10.2460/ajvr.74.10.1291] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine relative concentrations of selected major brain tissue metabolites and their ratios and lobar variations by use of 3-T proton (hydrogen 1 [(1)H]) magnetic resonance spectroscopy (MRS) of the brain of healthy dogs. ANIMALS 10 healthy Beagles. PROCEDURES 3-T (1)H MRS at echo times of 144 and 35 milliseconds was performed on 5 transverse slices and 1 sagittal slice of representative brain lobe regions. Intravoxel parenchyma was classified as white matter, gray matter, or mixed (gray and white) and analyzed for relative concentrations (in arbitrary units) of N-acetylaspartate (NAA), choline, and creatine (ie, height at position of peak on MRS graph) as well as their ratios (NAA-to-choline, NAA-to-creatine, and choline-to-creatine ratios). Peak heights for metabolites were compared between echo times. Peak heights for metabolites and their ratios were correlated and evaluated among matter types. Yield was calculated as interpretable voxels divided by available lobar voxels. RESULTS Reference ranges of the metabolite concentration ratios were determined at an echo time of 35 milliseconds (NAA-to-choline ratio, 1.055 to 2.224; NAA-to-creatine ratio, 1.103 to 2.161; choline-to-creatine ratio, 0.759 to 1.332) and 144 milliseconds (NAA-to-choline ratio, 0.687 to 1.788; NAA-to-creatine ratio, 0.984 to 2.044; choline-to-creatine ratio, 0.828 to 1.853). Metabolite concentration ratios were greater in white matter than in gray matter. Voxel yields ranged from 43% for the temporal lobe to 100% for the thalamus. CONCLUSIONS AND CLINICAL RELEVANCE Metabolite concentrations and concentration ratios determined with 3-T (1)H MRS were not identical to those in humans and were determined for clinical and research investigations of canine brain disease.
Collapse
Affiliation(s)
- Christopher D Warrington
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108
| | | | | | | | | | | | | |
Collapse
|
17
|
Hsu SH, Chou MC, Ko CW, Hsu SS, Lin HS, Fu JH, Wang PC, Pan HB, Lai PH. Proton MR spectroscopy in patients with pyogenic brain abscess: MR spectroscopic imaging versus single-voxel spectroscopy. Eur J Radiol 2013; 82:1299-307. [PMID: 23453705 DOI: 10.1016/j.ejrad.2013.01.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Single-voxel spectroscopy (SVS) has been the gold standard technique to diagnose the pyogenic abssess. Two-dimensional magnetic resonance spectroscopic imaging (MRSI) is able to provide spatial distribution of metabolic concentration, and is potentially more suitable for differential diagnosis between abscess and necrotic tumors. Therefore, the purpose of this study was to evaluate the equivalence of MRSI and SVS in the detection of the metabolites in pyogenic brain abscesses. MATERIALS AND METHODS Forty-two patients with pyogenic abscesses were studied by using both SVS and MRSI methods. Two neuroradiologists reviewed the MRS data independently. A κ value was calculated to express inter-reader agreement of the abscesses metabolites, and a correlation coefficient was calculated to show the similarity of two spectra. After consensus judgment of two readers, the binary value of metabolites of pyogenic abscesses (presence or absence) was compared between SVS and MRSI. RESULTS The consistency of spectral interpretation of the two readers was very good (κ ranged from 0.95 to 1), and the similarity of two spectra was also very high (cc=0.9±0.05). After consensus judgment of two readers, the sensitivities of MRSI ranged from 91% (acetate) to 100% (amino acids, succinate, lactate, lipid), and the specificities of MRSI were 100% for detecting all metabolites with SVS as reference. CONCLUSION SVS and MRSI provide similar metabolites in the cavity of pyogenic brain abscess. With additional metabolic information of cavity wall and contralateral normal-appearing brain tissue, MRSI would be a more suitable technique to differentiate abscesses from necrotic tumors.
Collapse
Affiliation(s)
- Shuo-Hsiu Hsu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Bertholdo D, Watcharakorn A, Castillo M. Brain proton magnetic resonance spectroscopy: introduction and overview. Neuroimaging Clin N Am 2013; 23:359-80. [PMID: 23928194 DOI: 10.1016/j.nic.2012.10.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Magnetic resonance (MR) spectroscopy offers a noninvasive means of assessing in vivo brain metabolites that shed light on cellular concentrations, cell function and dysfunction, cellular energetics, presence of ischemia, and presence of necrosis, among others. Studies obtained at higher field strengths are evolving toward sampling of smaller tissue volumes, greater signal-to-noise ratio, and higher metabolic spatial resolution. This article discusses the usefulness, from the clinical standpoint, of MR spectroscopy in various disorders. However, to be valid and significant the results of MR spectroscopy should always be correlated with their imaging counterparts.
Collapse
Affiliation(s)
- Débora Bertholdo
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | | |
Collapse
|
19
|
Wei L, Hong S, Yoon Y, Hwang SN, Park JC, Zhang Z, Olson JJ, Hu XP, Shim H. Early prediction of response to Vorinostat in an orthotopic rat glioma model. NMR IN BIOMEDICINE 2012; 25:1104-11. [PMID: 22302519 PMCID: PMC3356508 DOI: 10.1002/nbm.2776] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/13/2011] [Accepted: 12/13/2011] [Indexed: 05/22/2023]
Abstract
Glioblastoma is the most common primary brain tumor and is uniformly fatal despite aggressive surgical and adjuvant therapy. As survival is short, it is critical to determine the value of therapy early on in treatment. Improved early predictive assessment would allow neuro-oncologists to personalize and adjust or change treatment sooner to maximize the use of efficacious therapy. During carcinogenesis, tumor suppressor genes can be silenced by aberrant histone deacetylation. This epigenetic modification has become an important target for tumor therapy. Suberoylanilide hydroxamic acid (SAHA, Vorinostat, Zolinza) is an orally active, potent inhibitor of histone deacetylase (HDAC) activity. A major shortcoming of the use of HDAC inhibitors in the treatment of patients with brain tumors is the lack of reliable biomarkers to predict and determine response. Histological evaluation may reflect tumor viability following treatment, but is an invasive procedure and impractical for glioblastoma. Another problem is that response to SAHA therapy is associated with tumor redifferentiation and cytostasis rather than tumor size reduction, thus limiting the use of traditional imaging methods. A noninvasive method to assess drug delivery and efficacy is needed. Here, we investigated whether changes in (1)H MRS metabolites could render reliable biomarkers for an early response to SAHA treatment in an orthotopic animal model for glioma. Untreated tumors exhibited significantly elevated alanine and lactate levels and reduced inositol, N-acetylaspartate and creatine levels, typical changes reported in glioblastoma relative to normal brain tissues. The (1)H MRS-detectable metabolites of SAHA-treated tumors were restored to those of normal-like brain tissues. In addition, reduced inositol and N-acetylaspartate were found to be potential biomarkers for mood alteration and depression, which may also be alleviated with SAHA treatment. Our study suggests that (1)H MRS can provide reliable metabolic biomarkers at the earliest stage of SAHA treatment to predict the therapeutic response.
Collapse
Affiliation(s)
- Li Wei
- Department of Biomedical Engineering, Emory University, Atlanta, Georgia 30322, USA
| | - Samuel Hong
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia 30322, USA
| | - Younghyoun Yoon
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia 30322, USA
| | - Scott N. Hwang
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia 30322, USA
| | - Jaekeun C. Park
- Department of Biomedical Engineering, Emory University, Atlanta, Georgia 30322, USA
| | - Zhaobin Zhang
- Department of Neurosurgery, Emory University, Atlanta, Georgia 30322, USA
| | - Jeffrey J. Olson
- Department of Neurosurgery, Emory University, Atlanta, Georgia 30322, USA
| | - Xiaoping P. Hu
- Department of Biomedical Engineering, Emory University, Atlanta, Georgia 30322, USA
| | - Hyunsuk Shim
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia 30322, USA
- Winship Cancer Institute, Emory University, Atlanta, Georgia 30322, USA
- Correspondence to: H. Shim, Department of Radiology and Imaging Sciences, Winship Cancer Institute, Emory University, 1701 Uppergate Drive, C5018, Atlanta, GA 30322, Tel: 404-778-4564, Fax: 404-712-5813,
| |
Collapse
|
20
|
Tu PH, Liu ZH, Chuang CC, Yang TC, Wu CT, Lee ST. Postoperative midline shift as secondary screening for the long-term outcomes of surgical decompression of malignant middle cerebral artery infarcts. J Clin Neurosci 2012; 19:661-4. [DOI: 10.1016/j.jocn.2011.07.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 07/01/2011] [Accepted: 07/06/2011] [Indexed: 11/15/2022]
|
21
|
The metabolic features of normal pancreas and pancreatic adenocarcinoma: preliminary result of in vivo proton magnetic resonance spectroscopy at 3.0 T. J Comput Assist Tomogr 2011; 35:539-43. [PMID: 21926845 DOI: 10.1097/rct.0b013e318227a545] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of the study was to analyze the metabolic features and distribution of normal pancreas and pancreatic adenocarcinoma while determining the biomarker of pancreatic cancerous process. METHODS Twenty-seven control and 29 pancreatic adenocarcinoma patients underwent breath-hold 3-T proton magnetic resonance spectroscopy. The ratios of lipid (lipid/InW), choline-containing compounds (CCCs/InW), and fatty acids (FAs/InW) to nonsaturated internal water (InW) of the normal pancreas head and body-tail region, with cancerous and noncancerous regions in pancreatic adenocarcinoma, were calculated. RESULTS In normal pancreas, there were no statistical difference in the ratios of FAs to InW and lipid to InW of different regions, but CCCs/InW of body-tail area was greater than that of head (7.28 × 10⁻⁴ vs 3.23 × 10⁻⁴). In pancreatic cancer, FAs/InW and lipid/InW between cancerous and noncancerous region were different (3.44 × 10⁻⁴ vs 16.3 × 10⁻⁴ and 7.78 × 10⁻⁴ vs 36.3 × 10⁻⁴, respectively). Choline-containing compounds/InW in cancerous region was smaller than that in noncancerous region of pancreatic head cancer (1.62 × 10⁻⁴ vs 5.69 × 10⁻⁴) but similar to such region in body-tail cancer. Lipid/InW dropped in noncancerous regions (from 0.67 to 0.36), whereas there were no differences in FAs/InW and CCCs/InW between normal pancreas regions and noncancerous regions in pancreatic cancer. CONCLUSIONS In normal pancreas, CCCs of body-tail region was greater than that of head. Whereas in pancreatic adenocarcinoma, CCCs, FAs, and lipid were all decreased in cancerous region, lipid in the noncancerous region was also decreased compared with normal pancreas. Lipid may be the potential sensitive biomarker for pancreatic cancer.
Collapse
|
22
|
Quintana LM. Brain Abscess Associated with Brain Tumors. World Neurosurg 2011. [DOI: 10.1016/j.wneu.2010.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
23
|
Why Doesn't … ? World Neurosurg 2011. [DOI: 10.1016/j.wneu.2010.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
24
|
Jho DH, Spiliopoulos K, Stein TD, Williams Z. Concomitant Presentation of a Glioblastoma Multiforme With Superimposed Abscess. World Neurosurg 2011; 75:126-31; discussion 50-3. [DOI: 10.1016/j.wneu.2010.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 09/13/2010] [Indexed: 11/15/2022]
|
25
|
Characterization of intracranial space-occupying lesions by 99mTc-Tetrofosmin SPECT. J Neurooncol 2010; 101:83-9. [DOI: 10.1007/s11060-010-0230-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 05/11/2010] [Indexed: 11/26/2022]
|