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Alirezaei Z, Amouheidari A, Iraji S, Hassanpour M, Hejazi SH, Davanian F, Nami MT, Rastaghi S, Shokrani P, Tsien CI, Nazem-Zadeh MR. Prediction of Normal Tissue Complication Probability (NTCP) After Radiation Therapy Using Imaging and Molecular Biomarkers and Multivariate Modelling. J Mol Neurosci 2023; 73:587-597. [PMID: 37462853 DOI: 10.1007/s12031-023-02136-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/12/2023] [Indexed: 09/24/2023]
Abstract
The aim of this study was to design a predictive radiobiological model of normal brain tissue in low-grade glioma following radiotherapy based on imaging and molecular biomarkers. Fifteen patients with primary brain tumors prospectively participated in this study and underwent radiation therapy. Magnetic resonance imaging (MRI) was obtained from the patients, including T1- and T2-weighted imaging and diffusion tensor imaging (DTI), and a generalized equivalent dose (gEUD) was calculated. The radiobiological model of the normal tissue complication probability (NTCP) was performed using the variables gEUD; axial diffusivity (AD) and radial diffusivity (RD) of the corpus callosum; and serum protein S100B by univariate and multivariate logistic regression XLIIIrd Sir Peter Freyer Memorial Lecture and Surgical Symposium (2018). Changes in AD, RD, and S100B from baseline up to the 6 months after treatment had an increasing trend and were significant in some time points (P-value < 0.05). The model resulting from RD changes in the 6 months after treatment was significantly more predictable of necrosis than other univariate models. The bivariate model combining RD changes in Gy40 dose-volume and gEUD, as well as the trivariate model obtained using gEUD, RD, and S100B, had a higher predictive value among multivariate models at the sixth month of the treatment. Changes in RD diffusion indices and in serum protein S100B value were used in the early-delayed stage as reliable biomarkers for predicting late-delayed damage (necrosis) caused by radiation in the corpus callosum. Current findings could pave the way for intervention therapies to delay the severity of damage to white matter structures, minimize cognitive impairment, and improve the quality of life of patients with low-grade glioma.
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Affiliation(s)
- Zahra Alirezaei
- Medical Physics Department, Isfahan University of Medical Science, Isfahan, Iran
| | - Alireza Amouheidari
- Research & Education, Department of Radiation Oncology, Isfahan Milad Hospital, Isfahan, Iran
| | - Sajjad Iraji
- Medical Physics and Biomedical Engineering Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Hassanpour
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hosein Hejazi
- Skin Diseases and Leishmaniosis Research Center, Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Fariba Davanian
- Radiology Department, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | | | - Sedighe Rastaghi
- Biostatistics Department, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parvaneh Shokrani
- Medical Physics Department, Isfahan University of Medical Science, Isfahan, Iran
| | - Christina I Tsien
- Radiation Oncology Department, Washington University, St. Louis, MO, USA
| | - Mohammad-Reza Nazem-Zadeh
- Medical Physics and Biomedical Engineering Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran.
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Mohan S, Wang S, Chawla S, Abdullah K, Desai A, Maloney E, Brem S. Multiparametric MRI assessment of response to convection-enhanced intratumoral delivery of MDNA55, an interleukin-4 receptor targeted immunotherapy, for recurrent glioblastoma. Surg Neurol Int 2021; 12:337. [PMID: 34345478 PMCID: PMC8326072 DOI: 10.25259/sni_353_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/09/2021] [Indexed: 11/04/2022] Open
Abstract
Background Glioblastoma (GBM) is the most common malignant brain tumor and carries a dismal prognosis. Attempts to develop biologically targeted therapies are challenging as the blood-brain barrier can limit drugs from reaching their target when administered through conventional (intravenous or oral) routes. Furthermore, systemic toxicity of drugs often limits their therapeutic potential. To circumvent these problems, convection-enhanced delivery (CED) provides direct, targeted, intralesional therapy with a secondary objective to alter the tumor microenvironment from an immunologically "cold" (nonresponsive) to an "inflamed" (immunoresponsive) tumor. Case Description We report a patient with right occipital recurrent GBM harboring poor prognostic genotypes who was treated with MRI-guided CED of a fusion protein MDNA55 (a targeted toxin directed toward the interleukin-4 receptor). The patient underwent serial anatomical, diffusion, and perfusion MRI scans before initiation of targeted therapy and at 1, 3-month posttherapy. Increased mean diffusivity along with decreased fractional anisotropy and maximum relative cerebral blood volume was noted at follow-up periods relative to baseline. Conclusion Our findings suggest that diffusion and perfusion MRI techniques may be useful in evaluating early response to CED of MDNA55 in recurrent GBM patients.
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Affiliation(s)
- Suyash Mohan
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Sumei Wang
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Sanjeev Chawla
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Kalil Abdullah
- Department of Neurosurgery, University of Texas-Southwestern Medical Center, Dallas, Texas, United States
| | - Arati Desai
- Department of Medicine Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Eileen Maloney
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Steven Brem
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Physiological Imaging Methods for Evaluating Response to Immunotherapies in Glioblastomas. Int J Mol Sci 2021; 22:ijms22083867. [PMID: 33918043 PMCID: PMC8069140 DOI: 10.3390/ijms22083867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 12/19/2022] Open
Abstract
Glioblastoma (GBM) is the most malignant brain tumor in adults, with a dismal prognosis despite aggressive multi-modal therapy. Immunotherapy is currently being evaluated as an alternate treatment modality for recurrent GBMs in clinical trials. These immunotherapeutic approaches harness the patient's immune response to fight and eliminate tumor cells. Standard MR imaging is not adequate for response assessment to immunotherapy in GBM patients even after using refined response assessment criteria secondary to amplified immune response. Thus, there is an urgent need for the development of effective and alternative neuroimaging techniques for accurate response assessment. To this end, some groups have reported the potential of diffusion and perfusion MR imaging and amino acid-based positron emission tomography techniques in evaluating treatment response to different immunotherapeutic regimens in GBMs. The main goal of these techniques is to provide definitive metrics of treatment response at earlier time points for making informed decisions on future therapeutic interventions. This review provides an overview of available immunotherapeutic approaches used to treat GBMs. It discusses the limitations of conventional imaging and potential utilities of physiologic imaging techniques in the response assessment to immunotherapies. It also describes challenges associated with these imaging methods and potential solutions to avoid them.
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Ma X, Huang X, Chen C, Ding Y. A Preliminary Report Requiring Continuation of Research to Confirm Fallopian Tube Adenocarcinoma: A Non-Experimental, Non-Randomized, Cross-Sectional Study. Med Sci Monit 2018; 24:5301-5308. [PMID: 30059956 PMCID: PMC6080584 DOI: 10.12659/msm.909661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Transvaginal ultrasound has fair characteristics, and pathology is an invasive technique for fallopian tube tumor diagnosis. Magnetic resonance images have better intra- and inter-observer reliabilities for detection of primary fallopian tube malignant tumor(s) than the other diagnostic modalities. The purpose of this study was to investigate parameters of different types of magnetic resonance images for women with fallopian tube adenocarcinoma and to compare these parameters with the FIGO grading system to improve the accuracy of diagnosis and prognosis. Material/Methods A total of 121 women who had clinically-proven fallopian tube adenocarcinoma were included in this cross-sectional study. A 3.0 T magnetic resonance images system was used for spin-lattice relaxation-weighted (T1WI), spin-spin relaxation-weighted (T2WI), diffusion-weighted, (DWI), and apparent diffusion coefficient (ADC) images. ANOVA following Tukey post hoc tests and Spearman rank correlation were performed at 99% confidence level. Results Axial T1WI, axial T2WI, and axial DWI, were provided low, intermediate, and high fluid signal intensity, respectively, for a tumor. Sagittal T1WI showed contrast uptake by the mass with necrosis. Sagittal T2WI showed a solid mass with well-defined walls. Sagittal DWI showed restriction to diffusion. ADC values were significantly higher for FIGO grade 1 women than for FIGO grade 3 women (p<0.0001, q=16.591). The Spearman correlation coefficient was 0.1012 between mean ADC and FIGO grading. Conclusions We recommend that magnetic resonance images be included in the FIGO guideline for grading of malignancies in the female genital tract.
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Affiliation(s)
- Xiaomin Ma
- Department of Radiology, Maternal and Child Health Care Hospital, Xiamen, Fujian, China (mainland)
| | - Xinfa Huang
- Department of Radiology, Maternal and Child Health Care Hospital, Xiamen, Fujian, China (mainland)
| | - Chunhua Chen
- Department of Radiotherapy, Maternal and Child Health Care Hospital, Xiamen, Fujian, China (mainland)
| | - Yaling Ding
- Department of Radiotherapy, Maternal and Child Health Care Hospital, Xiamen, Fujian, China (mainland)
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Xie Y, Huang H, Guo J, Zhou D. Relative cerebral blood volume is a potential biomarker in late delayed radiation-induced brain injury. J Magn Reson Imaging 2017; 47:1112-1118. [PMID: 28796443 DOI: 10.1002/jmri.25837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/25/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To assess whether relative cerebral blood volume (rCBV) can provide information to reliably evaluate the stages of late delayed radiation-induced brain injury. MATERIALS AND METHODS Forty patients diagnosed with late delayed radiation-induced brain injury were enrolled. The patients were examined using a 1.5T magnetic resonance imaging (MRI) system equipped with an 8-channel head coil. An echo planar imaging (EPI) sequence was used in perfusion-weighted imaging (PWI). The location of 1H-MR spectroscopy scanning was acquired by a point-resolved spectroscopy sequence. Lesions of the temporal lobe were divided into one of two groups according to rCBV value: rCBV<1 (low rCBV [group 1; n = 45]); and rCBV>1 (elevated rCBV [group 2; n = 14]). PWI and MRS parameters, as well as morphological lesion types, in these two groups were compared. Morphological severity was assessed independently and agreed on by two imaging specialists (J.L. and H.X.S., with 16 and 24 years' experience, respectively). If necessary, a third imaging professor (Z.M.H.) with 30 years' experience resolved disagreement(s). Standards for evaluating morphological lesion types were based on previously published criteria. After testing the skewness of data, the Mann-Whitney U-test or Student's t-test was used, as appropriate. RESULTS rCBV, relative cerebral blood flow (rCBF), and relative mean transit time (rMTT) in group 2 (n = 14) were significantly higher than in group 1 (n = 45) (rCBV: 1.21 ± 0.38 vs. 0.72 ± 0.32, respectively; P < 0.001; rCBF: 1.13 ± 0.02 vs. 0.74 ± 0.04, respectively; P < 0.001; rMTT: 1.10 ± 0.26 vs. 0.96 ± 0.20, P < 0.001). The levels of choline-containing compounds (CHO) / creatine (Cr) and CHO/N-acetylaspartate (NAA) in group 1 were significantly greater than in group 2 (CHO/Cr: 1.89 ± 1.83 vs. 1.22 ± 1.31, respectively; P = 0.016; CHO/NAA: 1.85 ± 3.50 vs. 1.17 ± 0.75, respectively; P = 0.022). More severe morphological lesions were present in lesions with low rCBV compared with elevated rCBV (overall severity: 7.00 ± 4.25 vs. 5.00 ± 5.13, respectively; P = 0.029). CONCLUSION Elevated rCBV accompanied by a more conservative metabolic pattern and milder lesion(s) may represent a less advanced stage in the development of late delayed radiation-induced brain injury. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1112-1118.
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Affiliation(s)
- Ying Xie
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Haiwei Huang
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Junjie Guo
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Dongxiao Zhou
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
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Mohan S, Chawla S, Wang S, Verma G, Skolnik A, Brem S, Peters KB, Poptani H. Assessment of early response to tumor-treating fields in newly diagnosed glioblastoma using physiologic and metabolic MRI: initial experience. CNS Oncol 2016; 5:137-44. [PMID: 27076281 DOI: 10.2217/cns-2016-0003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Tumor-treating fields (TTFields) is a novel antimitotic treatment modality for patients with glioblastoma. To assess response to TTFields, a newly diagnosed patient with glioblastoma underwent diffusion, perfusion and 3D echo-planar spectroscopic imaging prior to initiation of TTFields plus temozolamide (baseline) and at 1- and 2-month follow-up periods. Increased mean diffusivity along with decreased fractional anisotropy and maximum relative cerebral blood volume were noted at 2 months relative to baseline suggesting inhibition of tumor growth and angiogenesis. Additionally, a reduction in choline/creatine was also noted during this period. These preliminary data indicate the potential of physiologic and metabolic MRI in assessing early treatment response to TTFields in combination with temozolamide.
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Affiliation(s)
- Suyash Mohan
- Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sanjeev Chawla
- Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sumei Wang
- Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gaurav Verma
- Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Aaron Skolnik
- Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Brem
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine B Peters
- The Preston Robert Tisch Brain Tumor Center, Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Harish Poptani
- Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Cellular & Molecular Physiology, University of Liverpool, Liverpool, UK
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