Optimization of Brain Tumor MR Image Classification Accuracy Using Optimal Threshold, PCA and Training ANFIS with Different Repetitions

BACKGROUND

One of the leading causes of death is brain tumors. Accurate tumor classification leads to appropriate decision making and providing the most efficient treatment to the patients. This study aims to optimize brain tumor MR images classification accuracy using optimal threshold, PCA and training Adaptive Neuro Fuzzy Inference System (ANFIS) with different repetitions.

MATERIAL AND METHODS

The procedure used in this study consists of five steps: (1) T1, T2 weighted images collection, (2) tumor separation with different threshold levels, (3) feature extraction, (4) presence and absence of feature reduction applying principal component analysis (PCA) and (5) ANFIS classification with 0, 20 and 200 training repetitions.

RESULTS

ANFIS accuracy was 40%, 80% and 97% for all features and 97%, 98.5% and 100% for the 6 selected features by PCA in 0, 20 and 200 training repetitions, respectively.

CONCLUSION

The findings of the present study demonstrated that accuracy can be raised up to 100% by using an optimized threshold method, PCA and increasing training repetitions.

Introduction of a simple algorithm to create synthetic-Computed tomography of the head from magnetic resonance imaging

Background:

Recently, magnetic resonance imaging (MRI)-based radiotherapy has become a favorite science field for treatment planning purposes. In this study, a simple algorithm was introduced to create synthetic computed tomography (sCT) of the head from MRI.

Methods:

A simple atlas-based method was proposed to create sCT images based on the paired T1/T2-weighted MRI and bone/brain window CT. Dataset included 10 patients with glioblastoma multiforme and 10 patients with other brain tumors. To generate a sCT image, first each MR from dataset was registered to the target-MR, the resulting transformation was applied to the corresponding CT to create the set of deformed CTs. Then, deformed-CTs were fused to generate a single sCT image. The sCT images were compared with the real CT images using geometric measures (mean absolute error [MAE] and dice similarity coefficient of bone [DSC_bone]) and Hounsfield unit gamma-index (Г_HU) with criteria 100 HU/2 mm.

Results:

The evaluations carried out by MAE, DSC_bone, and Г_HU showed a good agreement between the synthetic and real CT images. The results represented the range of 78–93 HU and 0.80–0.89 for MAE and DSC_bone, respectively. The Г_HU also showed that approximately 91%–93% of pixels fulfilled the criteria 100 HU/2 mm for brain tumors.

Conclusion:

This method showed that MR sequence (T1w or T2w) should be selected depending on the type of tumor. In addition, the brain window synthetic CTs are in better agreement with real CT relative to bone window sCT images.

Role of CT scan in theranostic and management of traumatic spinal cord injury

Traumatic spinal cord injury (TSCI) is a condition with suffering of neural structures from acute trauma with short-term or permanent sensory and motor problems. This study was conducted with the aim of determining the prevalence of TSCI in Tehran with emphasis on demographic characteristics of patients and to evaluate the effect of computed tomography (CT) in determining fracture type and severity grade of injury among TSCI patients. In a cross-sectional study, all TSCI and spinal fracture patients (N = 520) who referred to the main trauma center in Tehran, Iran, in 2013 and 2014 were selected. Radiography and CT scan were prepared and reported blindedly by two radiologists. Majority of the patients was 21-30 years male, married and their most common occupation was car driver. A significant difference was observed between gender and etiology (P = 0.001). The main etiology was traffic accident followed by falling from height. While the most common location of injury for males was thoracic vertebrae followed by lumbar vertebrae; for females it was lumbar followed by thoracic. Majority of patients had ASIA (American Spinal Injury Association) impairment scale of E (normal), followed by B (sensory incomplete). Most of the cases were hospitalized less than one week. Age of the patient and duration of hospitalization had a significant association (P = 0.015). The results showed that in traumatic spinal cord events, traffic accident and falling from height are the main etiologies; hence, authorities in Iranian health system could consider preventive policies to decline the load and TSCI effects in hospitals and population.

SRT1720, a potential sensitizer for radiotherapy and cytotoxicity effects of NVB-BEZ235 in metastatic breast cancer cells

BACKGROUND

Chemo-radio therapy (CRT) resistance is a main barrier in treating the triple negative breast cancer (TNBC). The success of conventional treatment may be ameliorated by elevating the responsiveness of the cancer cells to CRT. NVP-BEZ235 as a PI3K/AKT/mTOR dual inhibitor has been shown promising results in treating breast cancer cells. However, potential radiation-sensitizing effect of NVP-BEZ235 in TNBC remained unclear. In addition, SIRT-1 activation state and environmental cytokine were identified as being responsible for cancer cells responses to CRT. Herein, we investigate the role of interleukin 6 (IL-6) as a tumor environmental cytokine and SIRT1 in the effectiveness of NVP-BEZ235 plus radiotherapy.

MATERIAL AND METHODS

TNBC cells were pre-treated with/without IL-6 and were exposed to single and combination of SRT1720 (SIRT1 activator)/EX-527 (SIRT1 inhibitor) and/or NVP-BEZ235 and/or gamma radiation. The effect of our treatments on cellular growth was determined by MTT and the cellular death and CSCs percentage were determined by Flow cytometry. Senescence detection kit was used to assay the effect of our treatments on cellular senescence induction.

RESULTS

Activation of SIRT1 via SRT1720 increased the efficacy of CRT in TNBC cells, especially when IL-6 exists in tumor microenvironment. Additionally, IL-6 pre-treatment followed by exposure to SRT1720 and NVP-BEZ235 significantly increased sensitivity of the cancer stem cells to radiation (p < 0.05).

CONCLUSION

Our result shows that combination of NVP-BEZ235 and SRT1720 may effectively improve late stage breast cancer cells therapeutics approach. Activation of SIRT1 and STAT3 in resistance breast cancer cells improves the in-vitro therapeutic efficacy of CRT.

Effects of gamma rays on rat testis tissue according to the morphological parameters and immunohistochemistry: radioprotective role of silymarin

OBJECTIVE

To determine the radioprotective effects of Silymarin in adult male Sprague-Dawley rats irradiated with γ-rays.

METHODS

The present experimental study was performed in Tehran University of Medical Sciences, Tehran, Iran from December 2009 to March 2010. The study was performed on 40 rats, which were randomly and equally divided into four groups: 1) control group: neither received Silymarin nor irradiated with γ-rays; 2) γ-irradiation group: testis region exposed to 2Gy of γ-rays; 3) Silymarin & γ-irradiation: rats received 100 mg/kg of Silymarin 24hrs before exposure to 2Gy of γ-rays; 4) Silymarin & γ-irradiation: rats received 200 mg/kg of Silymarin 24hrs before exposure to 2Gy of γ-rays. After animal experiments and preparing the tissue sections, different histological and histomorphological parameters of seminiferous tubules and the biological characteristics of Leydig cells were evaluated applying quantitative assessment, Johnson scoring, and Leydig cell apoptosis assay by TUNEL method. The data were analyzed applying ANOVA and Tukey's post hoc test, using SPSS software (V.19).

RESULTS

Irradiation of 2 Gy γ-rays to the testis of the rats significantly affected the frequency of spermatogonia, primary spermatocyte, round spermatid, spermatozoa, seminiferous tube and lumen diameters, thickness of the epithelium, Leydig cell nuclear diameter and volume, epithelium height, and apoptotic cells (p<0.05). However, administration of Silymarin improved the mentioned parameters specifically in 200 mg/kg of dosage.

CONCLUSION

Silymarin could act as a potent radioprotector and it can be used in modulation as well as improvement to radiation therapy to prevent male reproductive function, specifically seminiferous tubules in an animal model; however, its molecular mechanism is still not clear and needs more molecular researches.

Color doppler indices of proximal and distal parts of middle cerebral artery in fetuses with intrauterine growth restriction

INTRODUCTION

Intrauterine growth restriction (IUGR) is a major clinical issue for pregnant women. The purpose of this study was to evaluate color Doppler indices of the proximal and distal parts of the middle cerebral artery (MCA) of the fetus.

METHODS

In this cross-sectional study, 350 pregnant patients, with gestation age of 32-40 who were suspected to have intrauterine growth restriction, participated. The patients were referred for color Doppler sonography at the Imam Reza Hospital (Kermanshah, Iran) from May 2011 to September 2012. The following indices were measured for the proximal and distal part of the MCA: pulsatility index (PI), resistive index (RI), fetal heart rate (FHR), systolic to diastolic (S/D) ratio, and peak systolic velocity (PSV). The data were analyzed applying Tukey's-test, Paired-Samples t-test, and simple linear regression analysis using SPSS 19.

RESULTS

Average age of the mother, the frequency of pregnancy, and fetus gestational age were 27.79±0.17 years, 2.09±1.3, and 34.19±2.52 weeks, respectively. For gestation age of <36weeks, all Doppler indices of the distal part of the fetus MCA were significantly different from those of proximal part (p<0.05). Comparing indices of gestation age <36 weeks with those of >36 weeks, significant difference was found between the Doppler indices of the proximal parts as well as for the distal parts (p<0.05).

CONCLUSION

Measurement of fetus MCA indices may depend to the sampling location; however, this needs further investigation in order to find a clear probe location.

Efficacy of Multidetector-Row Computed Tomography as a Practical Tool in Comparison to Invasive Procedures for Visualization of the Biliary Obstruction

Introduction:

Recently, multidetector computed tomography (MDCT) has been introduced into clinical practice. MDCT has become the noninvasive diagnostic test of choice for detailed evaluation of biliary obstruction.

Aim:

the main objective of the present study was to evaluate the diagnostic value of MDCT compared to invasive procedures for detecting biliary obstruction causes.

Material and Methods:

Since February 2009 until May 2011 fifty biliary obstruction patients based on clinical, laboratory or ultrasonographic findings, were evaluated by Multidetector-row computed tomography. The causes of biliary obstruction, which was identified using. MDCT were classified into three categories: calculus, benign stricture, and malignancy. Final diagnosis was conducted based on percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography, biopsy, or surgery. The MDCT diagnosis and were compared with the final diagnosis.

Results:

A correct diagnosis of causes of biliaryobstruction was made on the basis of MDCT findings for 44 of the total 50 patients. Two patients with chronic pancreatitis were incorrectly diagnosed with a pancreatic head adenocarcinoma on the basis of MDCT findings. One patient with biliary stone was incorrectly diagnosed with a periampullary adenocarcinoma on the basis of MDCT findings. The Sensitivity, specificity and accuracy of MDCT in the diagnosis of causes of biliary obstruction were 94.12% and87.87% and94.6% respectively.

Conclusion:

Based on the findings of this study MDCT has an excellent image quality, providing valuable information about the biliary tree and other abdominal organs. The use of advanced image processing, including maximum intensity projection and multiplanar reconstruction (especially coronal or sagittal reformatted images), allows superior visualization of the biliary tree and vascular structures. Three-dimensional reconstruction images complement axial images by providing a more anatomically meaningful display of the lesion and its relationship to adjacent structures, and accurate determining the craniocaudal extent of the lesion. High accuracy, wide availability and ease of use, make the MDCT the imaging modality of choice for evaluation of biliary obstruction.

Efficient functionalization of gold nanoparticles using cysteine conjugated protoporphyrin IX for singlet oxygen production in vitro

Gold nanoparticles with suitable properties are supreme therapeutic agents and provide effective signal enhancement in photodynamic therapy (PDT).

In vivo imaging of brain cancer using epidermal growth factor single domain antibody bioconjugated to near-infrared quantum dots

Diagnosis of glioblastoma multiform (GBM) with MRI lacks molecular information and requires a biopsy for pathologic confirmation. The EGFRvIII, is a constitutively active mutant of the EGF receptor, identified in a high percentage of brain cancers and associated with increased invasiveness and resistance, making it a good target to improve imaging and diagnosis. The present study shows that conjugation of near-infrared quantum dot (Qd800) to an anti-EGFRvIII single domain antibody, made of the variable region with an extra cysteine for site-specific conjugation (EG2-Cys), increased its internalization in U87MG-EGFRvIII cells in vitro compared to Qd800 conjugated with the Fc region of the antibody (EG2-hFc) or unconjugated. EG2-Cys also improved the contrast in Near-Infrared Imaging of mice bearing orthotopic glioblastoma. The increased accumulation was confirmed by fluorescence microscopy of brain sections. The specificity of EG2-Cys in brain tumor expressing the EGFRvIII mutant receptor may provide an accurate less invasive diagnosis and determine the level of tumor aggressiveness and resistance.

Quality of Life in Cancer Patients undergoing Chemotherapy

OBJECTIVES

The objective of this study is to describe the quality of life (QoL) in cancer patients with solid tumors and at different chemotherapy (CT) cycles.

METHODS

A total of 200 cancer patients were included. With some modification, the European Organization for Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ-C30) was used to measure QoL in the student patients.

RESULTS

There was no correlation between the QoL and variables such as age, sex, marital status, duration of disease, economic conditions, and occupational function. Furthermore, no correlation was found between QoL and the patients' educational level (literate or illiterate). Nevertheless, a significant difference was found between the level of QoL in patients with ≤ 2 CT cycles and/or with 3-5 cycles (p< 0.001).

CONCLUSION

This study suggests that encouraging cancer patients to complete a CT course plays an important role in the treatment outcome and the QoL in cancer patients undergoing CT.

Influence of glioma tumour microenvironment on the transport of ANG1005 via low-density lipoprotein receptor-related protein 1

BACKGROUND

ANG1005 consists of three molecules of paclitaxel conjugated via ester bonds to the 19-amino-acid peptide Angiopep-2. The new chemical agent has been shown to cross the blood-brain barrier (BBB) by receptor-mediated transcytosis via low-density lipoprotein receptor-related protein 1 (LRP1). The experiments here examined the role of LRP1 in the subsequent endocytosis of drug into cancer cells.

METHODS

Localisation of ANG1005 and Angiopep-2 was examined by immunohistochemistry and in-vivo near-infrared fluorescence imaging in mice carrying orthotopic glioma tumours. Transport of ANG1005 and Angiopep-2 was examined in U87 glioblastoma cell lines.

RESULTS

Systemically administered ANG1005 and Cy5.5Angiopep-2 localised to orthotopic glioma tumours in mice. The glioma transplants correlated with high expression levels of LRP1. Decreasing LRP1 activity, by RNA silencing or LRP1 competitors, decreased uptake of ANG1005 and Angiopep-2 into U87 glioblastoma cells. Conversely, LRP1 expression and endocytosis rates for ANG1005 and Angiopep-2 increased in U87 cells under conditions that mimicked the microenvironment near aggressive tumours, that is, hypoxic and acidic conditions.

CONCLUSION

ANG1005 might be a particularly effective chemotherapeutic agent for the wide array of known LRP1-expressing brain and non-brain cancers, in particular those with an aggressive phenotype.

RHyThM, a tool for analysis of PDOS formatted hyperthermia treatment data generated by the BSD2000/3D system

One of the systems used by hyperthermia (HT) groups for heating tumours in the pelvic region is the BSD2000 system. Previous versions of the BSD2000 operate on a PDOS machine and the majority of the currently installed BSD2000/3D systems are still running under PDOS. Availability of the PDOS formatted treatment data provided by the BSD2000/3D has some difficulties. To facilitate analysis of the PDOS formatted treatment data generated by the BSD2000/3D a programme, called RHyThM (Rotterdam Hyperthermia Thermal Modulator) has been created. The purpose of RHyThM is first to read and check the integrity and validity of the treatment data for each measurement in time and space as provided by the BSD2000/3D and secondly to register a tissue type, based on computer tomography information, for each temperature probe position. Prior to any analyses, RHyThM shows the temperature profiles enabling the user to check on probe movement and to correct for unrealistically high temperature gradients in time and space. Subsequently, this approved data set is saved in a 'mother-file' for future on-demand thermal dose analyses. A unique feature of RHyThM is that it also shows all radiofrequency (RF) power signals for inspection. Finally, to make a quick assessment of the quality of the applied HT-treatment, RHyThM reports several temperature indices for bladder, vagina and rectum as well as RF-power related quantities. In summary, RHyThM is considered a valuable tool as it quickly provides a quality index per treatment, which serves as input for the preparation of the next treatment. Further, it makes verified and improved primary data sets accessible for further analysis with advanced statistical programmes.

Intra-luminal thermometry: Is tissue type assignment a necessity for thermal analysis?

INTRODUCTION

Tissue type assignment, i.e. differentiation tumour from normal tissue, is a normal procedure for interstitial thermometry. In our department, thermometry in patients with a tumour in the lower pelvis is usually restricted to the intra-luminal tracks. It is unknown whether discrimination between normal and tumour tissue is relevant for deep regional hyperthermia thermal dosimetry using only intra-luminal tumour contact and tumour adjacent thermometry. This study has analysed the acquired temperature data in order to answer this question.

PATIENTS AND METHODS

Seventy-five patients with locally advanced cervical carcinoma were selected randomly. Patients were treated with a two or three modality combination, i.e. radiotherapy +hyperthermia or radiotherapy + hyperthermia + chemotherapy from October 1997 to September 2003. The first 100 hyperthermia treatments fulfilling the only selection criterion: no displacement of the thermometry catheter along the insertion length during the treatment, were included in the study, resulting in 43 patients with one-to-five treatments/patient (median 2). Using RHyThM (Rotterdam Hyperthermia Thermal Modulator), for each single treatment tissue type, was defined on the basis of information given by a CT scan in radiotherapy position. A step change in the slope of the profile of the first temperature map was identified to verify the insertion length of the catheter.

RESULTS

The average T50 (median temperature) in bladder tumour indicative, vagina tumour contact and rectum tumour indicative was 40.9 +/- 0.9 degrees C, 39.7 +/- 0.9 degrees C and 40.6 +/- 0.8 degrees C, respectively. The average normal tissue T50 in bladder, vagina and rectum was 40.8 +/- 0.9 degrees C, 40.1 +/- 0.9 degrees C and 40.7 +/- 0.8 degrees C, respectively. The differences between bladder tumour indicative T50 and bladder normal tissue T50 and also between vagina tumour contact T50 and vagina normal tissue T50 were significant ( p = 0.0001). No statistical difference was found between rectum tumour indicative t50 and rectum normal tissue T50.

CONCLUSION

At present the cause of the temperature difference is not known. However, as the difference between tumour (indicative/contact) and normal tissue is very small and considering also the inaccuracy in the tissue type assignment it can be stated that this study does not provide sufficient evidence to conclude that the statistical difference has clinical relevance. Therefore, it was concluded that at this time there is no need to differentiate between normal and tumour tissue in intra-luminal thermometry.

Weekly systemic cisplatin plus locoregional hyperthermia: an effective treatment for patients with recurrent cervical carcinoma in a previously irradiated area

PURPOSE

Patients with recurrent cervical carcinoma within a previously irradiated area respond poorly to chemotherapy. We have treated these patients with simultaneous cisplatin and hyperthermia (CDDP + HT) and investigated response, toxicity, palliative effect and survival.

MATERIALS AND METHODS

Between 1992 and 2005 47 patients received CDDP + HT. Response was evaluated by gynaecologic examination and CT-scan. The Common Toxicity Criteria (CTC) were used for evaluation of toxicity and palliative effect. The Kaplan-Meier method was used to estimate survival, and Cox regression analysis to evaluate the influence of prognostic factors.

RESULTS

The objective response rate was 55%, palliation was achieved in 74% and operability in 19% of patients. Two patients are currently disease free at 9 years and 18 + months following treatment and 2 remained disease free until death by other causes. The median survival was 8 months and was influenced by duration of disease free interval and tumour diameter. Grade 3-4 haematological toxicity was observed in 36% of patients and renal toxicity was maximum grade 2.

CONCLUSION

CDDP + HT results in a high response rate and acceptable toxicity in patients with recurrent cervical cancer.

Comparison of Intratumor and Intraluminal Temperatures During Locoregional Deep Hyperthermia of Pelvic Tumors

PURPOSE

To investigate whether intraluminal thermometry provides sufficient information to apply high quality deep hyperthermia in pelvic tumors.

PATIENTS AND METHODS

The intratumor and intraluminal temperatures of 48 patients were analyzed per cancer type: rectum (21 male, 14 female), cervix (n=8), and bladder (n=5). Temperature-dose parameters were calculated, temperature curves within each treatment session were compared, and correlation between intratumor and intraluminal temperatures was analyzed.

RESULTS

Intratumor and intraluminal temperatures at the same time points during individual treatments were highly correlated (mean correlation coefficient: 0.93). However, the quantitative level differed from 0.1 to 1.1 degrees C and the differences of the time-temperature graphs varied per tumor group. Average intratumor and intraluminal temperatures were not different in the four groups. Intratumor thermometry was found not superior over intraluminal thermometry to improve tumor temperature level and homogeneity by SAR steering.

CONCLUSION

Intraluminal thermometry provides sufficient information to apply deep hyperthermia to individual patients with centrally located rectum, cervix or bladder cancer.

Temperature data analysis for 22 patients with advanced cervical carcinoma treated in Rotterdam using radiotherapy, hyperthermia and chemotherapy: a reference point is needed

INTRODUCTION

The growing interest and participation in multi-institutional trials involving deep hyperthermia treatment is an important step towards the further consolidation of hyperthermia as an oncological treatment modality. However, the differences in the clinical procedures of hyperthermia application also raises questions as how to compare the reported temperatures data obtained by the different institutes. In this study our recent developed approach, RHyThM (Rotterdam Hyperthermia Thermal Modulator), has been used for thermal data analysis to investigate the temperature dynamics behaviour of a series of deep hyperthermia treatments.

PATIENTS AND METHODS

All 22 patients (104 hyperthermia treatments) with locally advanced cervical carcinoma who participated in a feasibility study for treatment with a three-modality therapy were selected. The patients received mega-voltage external beam radiotherapy to the pelvis in daily fractions of 2 Gy five times a week to a total dose of 46 Gy and additional brachytherapy, at least four courses of weekly cisplatin (40 mg m-2) and five sessions of weekly loco regional deep hyperthermia treatments with the BSD2000-3D with the Sigma 60 or the Sigma-eye applicators at frequencies 70-120 MHz. Using RHyThM tissue type was defined along the insertion length, based on the CT scan information in radiotherapy position, for each single treatment. A step change in the slope of the profile of the first temperature map was identified to verify the insertion length of the thermometry catheter and precise location of the transition between in- and outside the body. Data analysis was performed based on the temperature readout provided by RHyThM.

RESULTS

The temperature and RF-power data of 97 treatments could be analysed. The intra-vaginal temperature indices were slightly lower than those for bladder and rectum. The average T50 (median temperature) in all lumens, i.e. bladder, vagina and rectum, was 40.4 +/- 0.6 degrees Celsius. The average vagina all lumen T50 was 40.0 +/- 0.8 degrees Celsius. The average bladder and rectum all lumen T50 was 40.6 +/- 0.7 degrees Celsius and 40.5 +/- 0.6, respectively. When the analysis was restricted to the deepest 5 cm of the vagina lumen, the average T50 was 39.8 +/- 0.9 degrees Celsius. Good correlation exists between the various temperature indices like T20, T50 and T90, for all lumen measurements in bladder, vagina and rectum. No correlation was found between temperature indices and treatment number. For the complete patient population, no relationship was found between T50 and net integrated RF-power applied. In an explorative analysis on individual patients a positive correlation coefficient or trend was found in 14 patients between normalized net integrated RF-power and vagina T50.

CONCLUSION

Average all lumen T50 for bladder, vagina and rectum differ less than 1 degrees Celsius, indicating that a large volume was heated relatively homogeneously. The vagina T50 value depends on how many measurement points are included for the analysis. In this group of patients the vagina T50 of the first treatment is not a good measure to discriminate between patients with 'heatable' and 'non-heatable' tumours. In order to compare temperature data reported by different institutes dealing with the same group of patients, one needs a strict and clear agreement on which temperature measurements or reference point(s) that should be included in the analysis.