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Barajas RF, Schwartz D, McConnell HL, Kersch CN, Li X, Hamilton BE, Starkey J, Pettersson DR, Nickerson JP, Pollock JM, Fu RF, Horvath A, Szidonya L, Varallyay CG, Jaboin JJ, Raslan AM, Dogan A, Cetas JS, Ciporen J, Han SJ, Ambady P, Muldoon LL, Woltjer R, Rooney WD, Neuwelt EA. Distinguishing Extravascular from Intravascular Ferumoxytol Pools within the Brain: Proof of Concept in Patients with Treated Glioblastoma. AJNR Am J Neuroradiol 2020; 41:1193-1200. [PMID: 32527840 DOI: 10.3174/ajnr.a6600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 04/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Glioblastoma-associated macrophages are a major constituent of the immune response to therapy and are known to engulf the iron-based MR imaging contrast agent, ferumoxytol. Current ferumoxytol MR imaging techniques for localizing macrophages are confounded by contaminating intravascular signal. The aim of this study was to assess the utility of a newly developed MR imaging technique, segregation and extravascular localization of ferumoxytol imaging, for differentiating extravascular-from-intravascular ferumoxytol contrast signal at a delayed 24-hour imaging time point. MATERIALS AND METHODS Twenty-three patients with suspected post-chemoradiotherapy glioblastoma progression underwent ferumoxytol-enhanced SWI. Segregation and extravascular localization of ferumoxytol imaging maps were generated as the voxelwise difference of the delayed (24 hours) from the early (immediately after administration) time point SWI maps. Continuous segregation and extravascular localization of ferumoxytol imaging map values were separated into positive and negative components. Image-guided biologic correlation was performed. RESULTS Negative segregation and extravascular localization of ferumoxytol imaging values correlated with early and delayed time point SWI values, demonstrating that intravascular signal detected in the early time point persists into the delayed time point. Positive segregation and extravascular localization of ferumoxytol imaging values correlated only with delayed time point SWI values, suggesting successful detection of the newly developed extravascular signal. CONCLUSIONS Segregation and extravascular localization of ferumoxytol MR imaging improves on current techniques by eliminating intrinsic tissue and intravascular ferumoxytol signal and may inform glioblastoma outcomes by serving as a more specific metric of macrophage content compared with uncorrected T1 and SWI techniques.
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Affiliation(s)
- R F Barajas
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
- Knight Cancer Institute Translational Oncology Research Program (R.F.B. Jr)
| | - D Schwartz
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
| | - H L McConnell
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | - C N Kersch
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | - X Li
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
| | - B E Hamilton
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - J Starkey
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - D R Pettersson
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - J P Nickerson
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - J M Pollock
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - R F Fu
- Medical Informatics and Clinical Epidemiology (R.F.F.)
| | - A Horvath
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
| | - L Szidonya
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
- Department of Diagnostic Radiology (L.S.), Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - C G Varallyay
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | | | - A M Raslan
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - A Dogan
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - J S Cetas
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - J Ciporen
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - S J Han
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - P Ambady
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | - L L Muldoon
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | | | - W D Rooney
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
| | - E A Neuwelt
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
- Portland Veterans Affairs Medical Center (E.A.N.), Portland, Oregon
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Li N, Wingfield MA, Nickerson JP, Pettersson DR, Pollock JM. Anoxic Brain Injury Detection with the Normalized Diffusion to ASL Perfusion Ratio: Implications for Blood-Brain Barrier Injury and Permeability. AJNR Am J Neuroradiol 2020; 41:598-606. [PMID: 32165356 DOI: 10.3174/ajnr.a6461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/28/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Anoxic brain injury is a result of prolonged hypoxia. We sought to describe the nonquantitative arterial spin-labeling perfusion imaging patterns of anoxic brain injury, characterize the relationship of arterial spin-labeling and DWI, and evaluate the normalized diffusion-to-perfusion ratio to differentiate patients with anoxic brain injury from healthy controls. MATERIALS AND METHODS We identified all patients diagnosed with anoxic brain injuries from 2002 to 2019. Twelve ROIs were drawn on arterial spin-labeling with coordinate-matched ROIs identified on DWI. Linear regression analysis was performed to examine the relationship between arterial spin-labeling perfusion and diffusion signal. Normalized diffusion-to-perfusion maps were generated using a custom-built algorithm. RESULTS Thirty-five patients with anoxic brain injuries and 34 healthy controls were identified. Linear regression analysis demonstrated a significant positive correlation between arterial spin-labeling and DWI signal. By means of a combinatory cutoff of slope of >0 and R2 of > 0.78, linear regression using arterial spin-labeling and DWI showed a sensitivity of 0.86 (95% CI, 0.71-0.94) and specificity of 0.82 (95% CI, 0.66-0.92) for anoxic brain injuries. A normalized diffusion-to-perfusion color map demonstrated heterogeneous ratios throughout the brain in healthy controls and homogeneous ratios in patients with anoxic brain injuries. CONCLUSIONS In anoxic brain injuries, a homogeneously positive correlation between qualitative perfusion and DWI signal was identified so that areas of increased diffusion signal showed increased ASL signal. By exploiting this relationship, the normalized diffusion-to-perfusion ratio color map may be a valuable imaging biomarker for diagnosing anoxic brain injury and potentially assessing BBB integrity.
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Affiliation(s)
- N Li
- From the Department of Radiology (N.L., M.A.W., J.P.N., D.R.P., and J.M.P.), Oregon Health & Science University, Portland, Oregon
| | - M A Wingfield
- From the Department of Radiology (N.L., M.A.W., J.P.N., D.R.P., and J.M.P.), Oregon Health & Science University, Portland, Oregon
| | - J P Nickerson
- From the Department of Radiology (N.L., M.A.W., J.P.N., D.R.P., and J.M.P.), Oregon Health & Science University, Portland, Oregon
| | - D R Pettersson
- From the Department of Radiology (N.L., M.A.W., J.P.N., D.R.P., and J.M.P.), Oregon Health & Science University, Portland, Oregon
| | - J M Pollock
- From the Department of Radiology (N.L., M.A.W., J.P.N., D.R.P., and J.M.P.), Oregon Health & Science University, Portland, Oregon
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