MRS study of meningeal hemangiopericytoma and edema: a comparison with meningothelial meningioma

Influencing Factors and Nomogram for the Development of Epilepsy in Advanced Lung Cancer Patients With Brain Metastases

BACKGROUND

Epilepsy is a prevalent comorbidity in patients with brain metastases (BM) and could result in sudden and accidental damage, as well as increased disease burden due to its rapid onset. Foreseeing the potential for the development of epilepsy may permit timely and efficient measures. This study aimed to analyze the influencing factors of epilepsy in advanced lung cancer (ALC) patients with BM and construct a nomogram model to predict the likelihood of developing epilepsy.

METHODS

Socio-demographic and clinical data of ALC patients with BM were retrospectively collected from the First Affiliated Hospital of Zhejiang University School of Medicine between September 2019 and June 2021. Univariate and multivariate logistic regression analyses were applied to determine the influencing factors for epilepsy in ALC patients with BM. Based on the results of the logistic regression analysis, a nomogram was built to represent the contribution of each influencing factor in predicting the probability of epilepsy development in ALC patients with BM. The Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve were utilized to evaluate the goodness of fit and prediction performance of the model.

RESULTS

The incidence of epilepsy among 138 ALC patients with BM was 29.7%. On the multivariate analysis, having a higher number of supratentorial lesions (odds ratio [OR] = 1.727; p = 0.022), hemorrhagic foci (OR = 4.922; p = .021), and a high-grade of peritumoral edema (OR = 2.524; p < .001) were independent risk factors for developing epilepsy, while undergoing gamma knife radiosurgery (OR = .327; p = .019) was an independent protective factor. The p-value of the Hosmer-Lemeshow test was .535 and the area under the ROC curve (AUC) was .852 (95% CI: .807-.897), suggesting the model had a good fit and exhibited strong predictive accuracy.

CONCLUSION

The nomogram was constructed that can predict the probability of epilepsy development for ALC patients with BM, which is helpful for healthcare professionals to identify high-risk groups early and allows for individualized interventions.

Primary endodermal hemangiopericytoma/solitary fibrous tumor of the cervical spine: a case report and literature review

Background

Hemangiopericytoma (HPC), also known as solitary fibrous tumor (SFT), is a type of soft tissue sarcoma with a special aggressive behavior. The HPC/SFT is locally aggressive with possibility of late recurrence locally or distant extraneural metastasis. The most common location of this HPC/SFT is the lower extremities. The HPC/SFT in the central nervous system (CNS) is very rare, and compared with the brain, it is rarer in the spinal region. However, clinicians also lack an overall understanding of the diagnosis of HPC/SFT in the spinal cord.

Case presentation

In this study, we report a rare case of primary cervical spine HPC/SFT in a 53-year-old woman. Two to three weeks before admission, she experienced pain and numbness in her left upper extremity. After computerized tomography (CT) and magnetic resonance imaging (MRI), a gross total resection was performed. Obvious neurological improvement was observed postoperatively. The pain and numbness in the patient's left upper limb were relieved subsequently. We then reviewed the literature on HPC/SFT, such as its clinical presentation, imaging characteristics, treatment, and follow-up.

Conclusions

Diagnosis of HPC/SFT relies on magnetic resonance spectroscopy, enhanced CT, and MRI. Postoperative radiotherapy is strongly recommended to reduce the HPC/SFT recurrence. Immunohistochemical analysis can also help in the differential diagnosis. However; early and long-term follow-up is necessary for patients.

Liver metastasis and local recurrence of meningeal hemangiopericytoma: a case report

This report describes the clinical features, diagnostic and treatment modalities of a 62-year-old female patient with liver metastasis and local recurrence of meningeal hemangiopericytoma (HPC), who presented with the clinical manifestations of memory deterioration, visual reduction and abdominal mass for one month. Skull and abdominal computed tomography (CT), magnetic resonance imaging (MRI) and 18FFluorodeoxyglucose positron emission tomography (FDG-PET)-CT were used for pre-surgery identification. Lesions without FDG uptake and less tumoral viability was observed through FDG-PET-CT, which was characteristic features of HPC before operation. The intraoperative specimens from the liver resection and the calvarium were pathologically examined for further confirming the diagnosis. The patient underwent liver resection and bilateral frontal cerebral convex and parafalx resection as well as intracranial pressure sensor implantation for liver metastasis and local recurrence of HPC respectively. The patient recovered well and no recurrence or distant metastasis was found after 2-year follow-up. Early diagnosis and long-term follow-up are crucial for patients with hepatic metastasis or local recurrence of HPC, and FDG-PET-CT is recommended as an ideal imaging tool. Radical resection of HPC lesions is considered as an optimal treating approach.

Characterization of Brain Metabolism by Nuclear Magnetic Resonance

The noninvasive, quantitative ability of nuclear magnetic resonance (NMR) spectroscopy to characterize small molecule metabolites has long been recognized as a major strength of its application in biology. Numerous techniques exist for characterizing metabolism in living, excised, or extracted tissue, with a particular focus on 1 H-based methods due to the high sensitivity and natural abundance of protons. With the increasing use of high magnetic fields, the utility of in vivo 1 H magnetic resonance spectroscopy (MRS) has markedly improved for measuring specific metabolite concentrations in biological tissues. Higher fields, coupled with recent developments in hyperpolarization, also enable techniques for complimenting 1 H measurements with spectroscopy of other nuclei, such as 31 P and 13 C, and for combining measurements of metabolite pools with metabolic flux measurements. We compare ex vivo and in vivo methods for studying metabolism in the brain using NMR and highlight insights gained through using higher magnetic fields, the advent of dissolution dynamic nuclear polarization, and combining in vivo MRS and ex vivo NMR approaches.

Preoperative Prediction of Solitary Fibrous Tumor/Hemangiopericytoma and Angiomatous Meningioma Using Magnetic Resonance Imaging Texture Analysis

BACKGROUND

Solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is radiologically difficult to distinguish from meningioma, especially angiomatous meningioma. This study aimed to detect texture parameters to distinguish SFT/HPC from angiomatous meningioma using magnetic resonance imaging texture analysis with commercially available software.

METHODS

We retrospectively investigated textural parameters in 43 newly diagnosed SFTs/HPCs, angiomatous meningiomas, and other World Health Organization (WHO) grade I meningiomas treated at Keio University Hospital. For T1 contrast-enhanced, T2, and apparent diffusion coefficient (ADC) images, texture analyses were performed. Regions of interest were drawn manually with reference to the greater signal on contrast-enhanced T1-weighted images. ADC values and texture parameters, including kurtosis, skewness, and entropy, were evaluated and compared between these 3 groups.

RESULTS

The mean ADC value was significantly high in angiomatous meningioma, compared with SFT/HPC and other WHO grade I meningioma. ADC entropy was highest in SFT/HPC, followed by angiomatous and other WHO grade I meningioma. T2 skewness was significantly high in SFT/HPC, compared with angiomatous and other WHO grade I meningioma. T1 contrast-enhanced skewness was significantly low in angiomatous meningioma, compared with other WHO grade I meningioma. Mean ADC value distinguished SFT/HPC from angiomatous meningioma with a positive predictive value (PPV) of 62.5% and specificity of 62.5%. ADC entropy distinguished SFT/HPC from angiomatous meningioma with a PPV of 100% and specificity of 100%. ADC skewness distinguished SFT/HPC from angiomatous meningioma with a PPV of 66.7% and specificity of 71.4%.

CONCLUSIONS

This study demonstrated that magnetic resonance imaging texture analysis was useful for distinguishing SFT/HPC from meningioma, especially angiomatous meningioma.

Promises and pitfalls of untargeted metabolomics

Metabolomics is one of the newer omics fields, and has enabled researchers to complement genomic and protein level analysis of disease with both semi-quantitative and quantitative metabolite levels, which are the chemical mediators that constitute a given phenotype. Over more than a decade, methodologies have advanced for both targeted (quantification of specific analytes) as well as untargeted metabolomics (biomarker discovery and global metabolite profiling). Untargeted metabolomics is especially useful when there is no a priori metabolic hypothesis. Liquid chromatography coupled to mass spectrometry (LC-MS) has been the preferred choice for untargeted metabolomics, given the versatility in metabolite coverage and sensitivity of these instruments. Resolving and profiling many hundreds to thousands of metabolites with varying chemical properties in a biological sample presents unique challenges, or pitfalls. In this review, we address the various obstacles and corrective measures available in four major aspects associated with an untargeted metabolomics experiment: (1) experimental design, (2) pre-analytical (sample collection and preparation), (3) analytical (chromatography and detection), and (4) post-analytical (data processing).

Preoperative Assessment of Pathologic Subtypes of Meningioma and Solitary Fibrous Tumor/Hemangiopericytoma Using Dynamic Computed Tomography: A Clinical Research Study

BACKGROUND

Solitary fibrous tumors (SFTs)/hemangiopericytomas (HPCs) are highly vascularized tumors well known for malignant, invasive, and highly vascular features. To date, several studies have reported the preoperative imaging findings of SFTs/HPCs. In this study, computed tomography (CT) tumor values acquired from dynamic CT scan were selected to determine the tumor pathology of highly vascular tumors, such as SFTs/HPCs.

METHODS

We conducted a retrospective study on patients with pathologically diagnosed meningiomas and SFTs/HPCs who had undergone a dynamic contrast CT scan. We assessed and compared the CT values of these tumors according to the pathology.

RESULTS

From a total of 34 patients, 30 patients with meningiomas and 4 patients with HPCs were included. The mean CT values of SFTs/HPCs and angiomatous meningioma were statistically significantly higher than those of the other meningioma subtypes (P = 0.003). We also performed receiver operating characteristic curve analyses to detect an appropriate cutoff point for the CT value to differentiate tumor pathology, and the calculated threshold was 161 Hounsfield units (HU) (sensitivity, 100%; specificity, 75%; area under the curve, 0.87; 95%, CI 0.75-0.99).

CONCLUSIONS

This study showed that obtaining a CT value is useful in determining highly vascular tumor pathology preoperatively. When considering neurosurgical extra-axial tumor removal, and when the CT value of tumors is >161 HU, then highly vascular tumors such as SFTs/HPCs or angiomatous meningiomas are likely, and this should be considered prior to surgical intervention and for risk assessment.

Applications of high-resolution magic angle spinning MRS in biomedical studies II-Human diseases

High-resolution magic angle spinning (HRMAS) MRS is a powerful method for gaining insight into the physiological and pathological processes of cellular metabolism. Given its ability to obtain high-resolution spectra of non-liquid biological samples, while preserving tissue architecture for subsequent histopathological analysis, the technique has become invaluable for biochemical and biomedical studies. Using HRMAS MRS, alterations in measured metabolites, metabolic ratios, and metabolomic profiles present the possibility to improve identification and prognostication of various diseases and decipher the metabolomic impact of drug therapies. In this review, we evaluate HRMAS MRS results on human tissue specimens from malignancies and non-localized diseases reported in the literature since the inception of the technique in 1996. We present the diverse applications of the technique in understanding pathological processes of different anatomical origins, correlations with in vivo imaging, effectiveness of therapies, and progress in the HRMAS methodology.

Intracranial Hemangiopericytomas: Recurrence, Metastasis, and Radiotherapy

Background  Intracranial hemangiopericytomas (HPCs) are characterized by high recurrence rates and extracranial metastases. Radiotherapy provides an adjunct to surgery, but the timing of therapy and the patients most likely to benefit remain unclear. Methods  A retrospective review of 20 patients with HPC treated at the University of Texas Southwestern Medical Center between 1985 and 2014 was conducted. Recurrence and metastasis rates along with overall survival (OS) were characterized based on therapeutic approach and tumor pathology using Kaplan-Meier and Cox regression analyses. Results  The mean age was 45.6 years (range: 19-77). Gross total resection (GTR) was achieved in 13 patients, whereas 5 patients underwent subtotal resection. Median follow-up was 91.5 months (range: 8-357). The 5-, 10-, and 15-year recurrence-free survival (RFS) rates were 61, 41, and 20%, respectively. Six patients developed metastases at an average of 113 months (range: 42-231). OS at last follow-up was 80%. Importantly, immediate postoperative adjuvant radiotherapy (IRT) did not influence RFS compared with surgery alone or OS compared with delayed radiotherapy at the time of recurrence. Conclusion  HPCs have high recurrence rates necessitating close follow-up. Surgery remains an important first step, but the timing of radiotherapy for optimal control and OS remains uncertain.

Evaluation of Cancer Metabolomics Using ex vivo High Resolution Magic Angle Spinning (HRMAS) Magnetic Resonance Spectroscopy (MRS)

According to World Health Organization (WHO) estimates, cancer is responsible for more deaths than all coronary heart disease or stroke worldwide, serving as a major public health threat around the world. High resolution magic angle spinning (HRMAS) magnetic resonance spectroscopy (MRS) has demonstrated its usefulness in the identification of cancer metabolic markers with the potential to improve diagnosis and prognosis for the oncology clinic, due partially to its ability to preserve tissue architecture for subsequent histological and molecular pathology analysis. Capable of the quantification of individual metabolites, ratios of metabolites, and entire metabolomic profiles, HRMAS MRS is one of the major techniques now used in cancer metabolomic research. This article reviews and discusses literature reports of HRMAS MRS studies of cancer metabolomics published between 2010 and 2015 according to anatomical origins, including brain, breast, prostate, lung, gastrointestinal, and neuroendocrine cancers. These studies focused on improving diagnosis and understanding patient prognostication, monitoring treatment effects, as well as correlating with the use of in vivo MRS in cancer clinics.

High-resolution magic-angle-spinning NMR spectroscopy of intact tissue

High-resolution magic-angle-spinning (HR-MAS) NMR spectroscopy is a nondestructive technique that is used to obtain the metabolite profile of a tissue sample. This method requires minimal sample preparation. However, it is important to handle the sample with care and keep it frozen during preparation to minimize degradation. Here, we describe a typical protocol for HR-MAS analysis of intact tissue. We also include examples of typical pulse sequence programs and quantification methods that are used today.

Comparison of ADC values of intracranial hemangiopericytomas and angiomatous and anaplastic meningiomas

PURPOSE

This study aimed to determine whether the use of apparent diffusion coefficient (ADC) values can improve the diagnostic efficacy of magnetic resonance imaging (MRI) to differentiate hemangiopericytoma (HPC) from angiomatous and anaplastic meningioma.

MATERIALS AND METHODS

Preoperative diffusion-weighted imaging (DWI) studies of 38 patients with pathologically proven intracranial HPC (n = 12) and angiomatous (n = 13) or anaplastic meningioma (n = 13) were retrospectively reviewed. ADC values were measured in the tumor parenchyma and peritumoral edema, and used to obtain normalized ADC (NADC) ratios (ADC of tumor/ADC of normal white matter).

RESULTS

Mean ADC values were significantly different between HPC and anaplastic meningioma (1.17 ± 0.30 × 10(-3) mm(2)/s and 0.75 ± 0.11 × 10(-3) mm(2)/s, respectively). Mean NADC ratios were also significantly lower in the malignant cases (0.95 ± 0.13) compared with the benign HPCs (1.53 ± 0.39; P < 0.05). Mean ADC values and NADC ratios did not differ significantly between angiomatous meningioma and HPC (P > 0.05), whereas mean ADC values and NADC ratios were lower for anaplastic meningioma than for either angiomatous meningioma or HPC (P < 0.05). Mean ADC value in peritumoral edema in HPC (1.48 ± 0.11 × 10(-3) mm(2)/s) was lower than in either angiomatous (1.73 ± 0.28 × 10(-3) mm(2)/s) or anaplastic (1.72 ± 0.25 × 10(-3) mm(2)/s) meningioma (P < 0.05), and there was no significant difference between ADC values in anaplastic versus angiomatous meningioma (P > 0.05).

CONCLUSION

ADC values in tumor parenchyma and peritumoral edema can provide helpful information that is otherwise not available from conventional MRI to differentiate HPC from angiomatous and anaplastic meningioma.