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Ristow I, Well L, Wiese NJ, Warncke M, Tintelnot J, Karimzadeh A, Koehler D, Adam G, Bannas P, Sauer M. Tumor Response Evaluation Using iRECIST: Feasibility and Reliability of Manual Versus Software-Assisted Assessments. Cancers (Basel) 2024; 16:993. [PMID: 38473353 DOI: 10.3390/cancers16050993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES To compare the feasibility and reliability of manual versus software-assisted assessments of computed tomography scans according to iRECIST in patients undergoing immune-based cancer treatment. METHODS Computed tomography scans of 30 tumor patients undergoing cancer treatment were evaluated by four independent radiologists at baseline (BL) and two follow-ups (FU), resulting in a total of 360 tumor assessments (120 each at BL/FU1/FU2). After image interpretation, tumor burden and response status were either calculated manually or semi-automatically as defined by software, respectively. The reading time, calculated sum of longest diameter (SLD), and tumor response (e.g., "iStable Disease") were determined for each assessment. After complete data collection, a consensus reading among the four readers was performed to establish a reference standard for the correct response assignments. The reading times, error rates, and inter-reader agreement on SLDs were statistically compared between the manual versus software-assisted approaches. RESULTS The reading time was significantly longer for the manual versus software-assisted assessments at both follow-ups (median [interquartile range] FU1: 4.00 min [2.17 min] vs. 2.50 min [1.00 min]; FU2: 3.75 min [1.88 min] vs. 2.00 min [1.50 min]; both p < 0.001). Regarding reliability, 2.5% of all the response assessments were incorrect at FU1 (3.3% manual; 0% software-assisted), which increased to 5.8% at FU2 (10% manual; 1.7% software-assisted), demonstrating higher error rates for manual readings. Quantitative SLD inter-reader agreement was inferior for the manual compared to the software-assisted assessments at both FUs (FU1: ICC = 0.91 vs. 0.93; FU2: ICC = 0.75 vs. 0.86). CONCLUSIONS Software-assisted assessments may facilitate the iRECIST response evaluation of cancer patients in clinical routine by decreasing the reading time and reducing response misclassifications.
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Affiliation(s)
- Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Nis Jesper Wiese
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Malte Warncke
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Joseph Tintelnot
- Department of Oncology and Hematology, Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Amir Karimzadeh
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Daniel Koehler
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Markus Sauer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Ristow I, Hancken-Pauschinger CV, Zhang S, Stark M, Kaul MG, Rickers C, Herrmann J, Adam G, Bannas P, Well L, Weinrich JM. Non-contrast free-breathing 2D CINE compressed SENSE T1-TFE cardiovascular MRI at 3T in sedated young children for assessment of congenital heart disease. PLoS One 2024; 19:e0297314. [PMID: 38330070 PMCID: PMC10852305 DOI: 10.1371/journal.pone.0297314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/03/2024] [Indexed: 02/10/2024] Open
Abstract
Cardiac MRI is a crucial tool for assessing congenital heart disease (CHD). However, its application remains challenging in young children when performed at 3T. The aim of this retrospective single center study was to compare a non-contrast free-breathing 2D CINE T1-weighted TFE-sequence with compressed sensing (FB 2D CINE CS T1-TFE) with 3D imaging for diagnostic accuracy of CHD, image quality, and vessel diameter measurements in sedated young children. FB 2D CINE CS T1-TFE was compared with a 3D non-contrast whole-heart sequence (3D WH) and 3D contrast-enhanced MR angiography (3D CE-MRA) at 3T in 37 CHD patients (20♂, 1.5±1.4 years). Two radiologists independently assessed image quality, type of CHD, and diagnostic confidence. Diameters and measures of contrast and sharpness of the aorta and pulmonary vessels were determined. A non-parametric multi-factorial approach was used to estimate diagnostic accuracy for the diagnosis of CHD. Linear mixed models were calculated to compare contrast and vessel sharpness. Krippendorff's alpha was determined to quantify vessel diameter agreement. FB 2D CINE CS T1-TFE was rated superior regarding image quality, diagnostic confidence, and diagnostic sensitivity for both intra- and extracardiac pathologies compared to 3D WH and 3D CE-MRA (all p<0.05). FB 2D CINE CS T1-TFE showed superior contrast and vessel sharpness (p<0.001) resulting in the highest proportion of measurable vessels (740/740; 100%), compared to 3D WH (530/620; 85.5%) and 3D CE-MRA (540/560; 96.4%). Regarding vessel diameter measurements, FB 2D CINE CS T1-TFE revealed the closest inter-reader agreement (Krippendorff's alpha: 0.94-0.96; 3D WH: 0.78-0.94; 3D CE-MRA: 0.76-0.93). FB 2D CINE CS T1-TFE demonstrates robustness at 3T and delivers high-quality diagnostic results to assess CHD in sedated young children. Its ability to function without contrast injection and respiratory compensation enhances ease of use and could encourage widespread adoption in clinical practice.
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Affiliation(s)
- Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caroline-Viktoria Hancken-Pauschinger
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shuo Zhang
- Philips GmbH Market DACH, Hamburg, Germany
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael G. Kaul
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Rickers
- University Heart Center, Adult Congenital Heart Disease Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Özden C, Mautner VF, Farschtschi S, Molwitz I, Ristow I, Bannas P, Well L, Klutmann S, Adam G, Apostolova I, Buchert R. Asymmetry of thalamic hypometabolism on FDG-PET/CT in neurofibromatosis type 1: Association with peripheral tumor burden. J Neuroimaging 2024; 34:138-144. [PMID: 37942683 DOI: 10.1111/jon.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/15/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Thalamic hypometabolism is a consistent finding in brain PET with F-18 fluorodeoxyglucose (FDG) in patients with neurofibromatosis type 1 (NF1). However, the pathophysiology of this metabolic alteration is unknown. We hypothesized that it might be secondary to disturbance of peripheral input to the thalamus by NF1-characteristic peripheral nerve sheath tumors (PNSTs). To test this hypothesis, we investigated the relationship between thalamic FDG uptake and the number, volume, and localization of PNSTs. METHODS This retrospective study included 22 adult NF1 patients (41% women, 36.2 ± 13.0 years) referred to whole-body FDG-PET/contrast-enhanced CT for suspected malignant transformation of PNSTs and 22 sex- and age-matched controls. Brain FDG uptake was scaled voxelwise to the individual median uptake in cerebellar gray matter. Bilateral mean and left-right asymmetry of thalamic FDG uptake were determined using a left-right symmetric anatomical thalamus mask. PNSTs were manually segmented in contrast-enhanced CT. RESULTS Thalamic FDG uptake was reduced in NF1 patients by 2.0 standard deviations (p < .0005) compared to controls. Left-right asymmetry was increased by 1.3 standard deviations (p = .013). Thalamic hypometabolism was higher in NF1 patients with ≥3 PNSTs than in patients with ≤2 PNSTs (2.6 vs. 1.6 standard deviations, p = .032). The impact of the occurrence of paraspinal/paravertebral PNSTs and of the mean PNST volume on thalamic FDG uptake did not reach statistical significance (p = .098 and p = .189). Left-right asymmetry of thalamic FDG uptake was not associated with left-right asymmetry of PNST burden (p = .658). CONCLUSIONS This study provides first evidence of left-right asymmetry of thalamic hypometabolism in NF1 and that it might be mediated by NF1-associated peripheral tumors.
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Affiliation(s)
- Cansu Özden
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Klutmann
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivayla Apostolova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Buchert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ristow I, Riedel C, Lenz A, Well L, Adam G, Panuccio G, Kölbel T, Bannas P. Current Imaging Strategies in Patients with Abdominal Aortic Aneurysms. ROFO-FORTSCHR RONTG 2024; 196:52-61. [PMID: 37699431 DOI: 10.1055/a-2119-6448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND An abdominal aortic aneurysm (AAA) is defined as a localized dilatation of the abdominal aorta of ≥ 3 cm. With a prevalence of 4-8 %, AAA is one of the most common vascular diseases in Western society. Radiological imaging is an elementary component in the diagnosis, monitoring, and treatment planning of AAA patients. METHOD This is a narrative review article on preoperative imaging strategies of AAA, incorporating expert opinions based on the current literature and standard-of-care practices from our own center. Examples are provided to illustrate clinical cases from our institution. RESULTS AND CONCLUSION Radiological imaging plays a pivotal role in the initial diagnosis and monitoring of patients with AAA. Ultrasound is the mainstay imaging modality for AAA screening and surveillance. Contrast-enhanced CT angiography is currently considered the gold standard for preoperative imaging and image-based treatment planning in AAA repair. New non-contrast MR angiography techniques are robustly applicable and allow precise determination of aortic diameters, which is of critical importance, particularly with regard to current diameter-based surgical treatment guidelines. 3D imaging with multiplanar reformation and automatic centerline positioning enables more accurate assessment of the maximum aortic diameter. Modern imaging techniques such as 4D flow MRI have the potential to further improve individualized risk stratification in patients with AAA. KEY POINTS · Ultrasound is the mainstay imaging modality for AAA screening and monitoring. · Contrast-enhanced CT angiography is the gold standard for preoperative imaging in AAA repair. · Non-contrast MR angiography allows for accurate monitoring of aortic diameters in AAA patients. · Measurement of aortic diameters is more accurate with 3D-CT/MRI compared to ultrasound. · Research seeks new quantitative imaging biomarkers for AAA risk stratification, e. g., using 4D flow MRI.
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Affiliation(s)
- Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Riedel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ristow I, Kaul MG, Stark M, Zapf A, Riedel C, Lenz A, Mautner VF, Farschtschi S, Apostolova I, Adam G, Bannas P, Salamon J, Well L. Discrimination of benign, atypical, and malignant peripheral nerve sheath tumors in neurofibromatosis type 1 using diffusion-weighted MRI. Neurooncol Adv 2024; 6:vdae021. [PMID: 38468867 PMCID: PMC10926940 DOI: 10.1093/noajnl/vdae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Background Neurofibromatosis type 1 (NF1) is associated with the development of benign (BPNST) and malignant (MPNST) peripheral nerve sheath tumors. Recently described atypical neurofibromas (ANF) are considered pre-malignant precursor lesions to MPNSTs. Previous studies indicate that diffusion-weighted magnetic resonance imaging (DW-MRI) can reliably discriminate MPNSTs from BPNSTs. We therefore investigated the diagnostic accuracy of DW-MRI for the discrimination of benign, atypical, and malignant peripheral nerve sheath tumors. Methods In this prospective explorative single-center phase II diagnostic study, 44 NF1 patients (23 male; 30.1 ± 11.8 years) underwent DW-MRI (b-values 0-800 s/mm²) at 3T. Two radiologists independently assessed mean and minimum apparent diffusion coefficients (ADCmean/min) in areas of largest tumor diameters and ADCdark in areas of lowest signal intensity by manual contouring of the tumor margins of 60 BPNSTs, 13 ANFs, and 21 MPNSTs. Follow-up of ≥ 24 months (BPNSTs) or histopathological evaluation (ANFs + MPNSTs) served as diagnostic reference standard. Diagnostic ADC-based cut-off values for discrimination of the three tumor groups were chosen to yield the highest possible specificity while maintaining a clinically acceptable sensitivity. Results ADC values of pre-malignant ANFs clustered between BPNSTs and MPNSTs. Best BPNST vs. ANF + MPNST discrimination was obtained using ADCdark at a cut-off value of 1.6 × 10-3 mm2/s (85.3% sensitivity, 93.3% specificity), corresponding to an AUC of 94.3% (95% confidence interval: 85.2-98.0). Regarding BPNST + ANF vs. MPNST, best discrimination was obtained using an ADCdark cut-off value of 1.4 × 10-3 mm2/s (83.3% sensitivity, 94.5% specificity). Conclusions DW-MRI using ADCdark allows specific and noninvasive discrimination of benign, atypical, and malignant nerve sheath tumors in NF1.
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Affiliation(s)
- Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael G Kaul
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Riedel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivayla Apostolova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Care Center Beste Trave, Bad Oldesloe, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kresbach C, Dottermusch M, Eckhardt A, Ristow I, Paplomatas P, Altendorf L, Wefers AK, Bockmayr M, Belakhoua S, Tran I, Pohl L, Neyazi S, Bode H, Farschtschi S, Well L, Friedrich RE, Reuss D, Snuderl M, Hagel C, Mautner VF, Schüller U. Atypical neurofibromas reveal distinct epigenetic features with proximity to benign peripheral nerve sheath tumor entities. Neuro Oncol 2023; 25:1644-1655. [PMID: 36866403 PMCID: PMC10479771 DOI: 10.1093/neuonc/noad053] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Plexiform neurofibromas can transform into atypical neurofibromas (ANF) and then further progress to aggressive malignant peripheral nerve sheath tumors (MPNST). ANF have been described to harbor distinct histological features and frequent loss of CDKN2A/B. However, histological evaluation may be rater-dependent, and detailed knowledge about the molecular mechanisms of malignant transformation is scarce. In general, malignant transformation can be accompanied by significant epigenetic changes, and global DNA methylation profiling is able to differentiate relevant tumor subgroups. Therefore, epigenetic profiling might provide a valuable tool to distinguish and characterize ANF with differing extent of histopathological atypia from neurofibromas and MPNST. METHODS We investigated 40 tumors histologically diagnosed as ANF and compared their global methylation profile to other peripheral nerve sheath tumors. RESULTS Unsupervised class discovery and t-SNE analysis indicated that 36/40 ANF cluster with benign peripheral nerve sheath tumors with clear separation from MPNST. 21 ANF formed a molecularly distinct cluster in proximity to schwannomas. Tumors in this cluster had a frequent heterozygous or homozygous loss of CDKN2A/B and significantly more lymphocyte infiltration than MPNST, schwannomas, and NF. Few ANF clustered closely with neurofibromas, schwannomas, or MPNST, raising the question, whether diagnosis based on histological features alone might pose a risk to both over- and underestimate the aggressiveness of these lesions. CONCLUSIONS Our data suggest that ANF with varying histological morphology show distinct epigenetic similarities and cluster in proximity to benign peripheral nerve sheath tumor entities. Future investigations should pay special respect to correlating this methylation pattern to clinical outcomes.
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Affiliation(s)
- Catena Kresbach
- Department of Diagnostics, Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Matthias Dottermusch
- Department of Diagnostics, Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
| | - Alicia Eckhardt
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
- Lab of Radiobiology & Experimental Radiation Oncology, Hubertus Wald Tumorzentrum, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petros Paplomatas
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
| | - Lea Altendorf
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
| | - Annika K Wefers
- Department of Diagnostics, Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Michael Bockmayr
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - Sarra Belakhoua
- Department of Pathology, NYU Langone Health and School of Medicine, New York, New York, USA
| | - Ivy Tran
- Department of Pathology, NYU Langone Health and School of Medicine, New York, New York, USA
| | - Lara Pohl
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
| | - Sina Neyazi
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
| | - Helena Bode
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhard E Friedrich
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David Reuss
- Department of Neuropathology, University of Heidelberg, Heidelberg, Germany
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health and School of Medicine, New York, New York, USA
| | - Christian Hagel
- Department of Diagnostics, Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Schüller
- Department of Diagnostics, Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center, Hamburg, Germany
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Riedel C, Ristow I, Lenz A, Schoennagel BP, Hoffmann M, Piecha F, Adam G, Reeder SB, Bannas P. Validation of 4D flow cardiovascular magnetic resonance in TIPS stent grafts using a 3D-printed flow phantom. J Cardiovasc Magn Reson 2023; 25:9. [PMID: 36775827 PMCID: PMC9923912 DOI: 10.1186/s12968-023-00920-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/16/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) is feasible for portal blood flow evaluation after placement of transjugular intrahepatic portosystemic shunts (TIPS) in patients with liver cirrhosis. However, clinical acceptance of 4D flow CMR in TIPS patients is limited due to the lack of validation studies. The purpose of this study was to validate 4D flow CMR-derived measurements in TIPS stent grafts using a three-dimensional (3D)-printed flow phantom. METHODS A translucent flow phantom of the portal vasculature was 3D-printed. The phantom consisted of the superior mesenteric vein and the splenic vein draining into the portal vein, the TIPS-tract, and the hepatic vein. A TIPS stent graft (Gore® Viatorr®) was positioned within the TIPS-tract. Superior mesenteric vein and splenic vein served as inlets for blood-mimicking fluid. 4D flow CMR acquisitions were performed at 3T at preset flow rates of 0.8 to 2.8 l/min using velocity encoding of both 1.0 and 2.0 m/s. Flow rates and velocities were measured at predefined levels in the portal vasculature and within the stent graft. Accuracy of 4D flow CMR was assessed through linear regression with reference measurements obtained by flow sensors and two-dimensional (2D) phase contrast (PC) CMR. Intra- and interobserver agreement were assessed through Bland-Altman analyses. RESULTS At a velocity encoding of 2.0 m/s, 4D flow CMR-derived flow rates and velocities showed an excellent correlation with preset flow rates and 2D PC CMR-derived flow velocities at all vascular levels and within the stent graft (all r ≥ 0.958, p ≤ 0.003). At a velocity encoding of 1.0 m/s, aliasing artifacts were present within the stent graft at flow rates ≥ 2.0 l/min. 4D flow CMR-derived measurements revealed high intra- and interobserver agreement. CONCLUSIONS The in vitro accuracy and precision of 4D flow CMR is unaffected by the presence of TIPS stent grafts, suggesting that 4D flow CMR may be used to monitor TIPS patency in patients with liver cirrhosis.
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Affiliation(s)
- Christoph Riedel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Marko Hoffmann
- Institute of Multiphase Flows, Hamburg University of Technology, Hamburg, Germany
| | - Felix Piecha
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Ristow I, Kärgel C. The Role of Atypical Sexual Preference and Behavior in Neuroelectrophysiological Research of Human Sexual Behavior. Arch Sex Behav 2023; 52:607-610. [PMID: 33575945 PMCID: PMC9886628 DOI: 10.1007/s10508-021-01927-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Inka Ristow
- Clinical Affective Neuroimaging Laboratory, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Christian Kärgel
- Division of Forensic Psychiatry, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
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Wright F, Warncke M, Sinn M, Ristow I, Lenz A, Riedel C, Schoennagel BP, Zhang S, Kaul MG, Adam G, von Kodolitsch Y, Sehner S, Bannas P. Assessment of aortic diameter in Marfan patients: intraindividual comparison of 3D-Dixon and 2D-SSFP magnetic resonance imaging. Eur Radiol 2023; 33:1687-1697. [PMID: 36269370 PMCID: PMC9935710 DOI: 10.1007/s00330-022-09162-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare the accuracy and precision of 3D-Dixon and 2D-SSFP MR-imaging for assessment of aortic diameter in Marfan patients. METHODS This prospective single-center study investigated respiratory-gated 3D-Dixon and breath-hold 2D-SSFP non-contrast MR-imaging at 3 T in 47 Marfan patients (36.0 ± 13.2 years, 28♀,19♂). Two radiologists performed individual diameter measurements at five levels of the thoracic aorta and evaluated image quality on a four-grade scale (1 = poor, 4 = excellent) and artifacts (1 = severe, 4 = none). Aortic root diameters acquired by echocardiography served as a reference standard. Intraclass correlation coefficient, Bland-Altman analyses, F-test, t-test, and regression analyses were used to assess agreement between observers and methods. RESULTS Greatest aortic diameters were observed at the level of the sinuses of Valsalva (SOV) for 3D-Dixon (38.2 ± 6.8 mm) and 2D-SSFP (38.3 ± 7.1 mm) (p = 0.53). Intra- and interobserver correlation of diameter measurements was excellent at all aortic levels for both 3D-Dixon (r = 0.94-0.99 and r = 0.94-0.98) and 2D-SSFP (r = 0.96-1.00 and r = 0.95-0.99). 3D-Dixon-derived and 2D-SSFP-derived diameter measurements at the level of the SOV revealed a strong correlation with echocardiographic measurements (r = 0.92, p < 0.001 and r = 0.93, p < 0.001, respectively). The estimated mean image quality at the level of SOV was higher for 2D-SSFP compared to that for 3D-Dixon (3.3 (95%-CI: 3.1-3.5) vs. 2.9 (95%-CI: 2.7-3.1)) (p < 0.001). Imaging artifacts were less at all aortic levels for 3D-Dixon compared to 2D-SSFP (3.4-3.8 vs. 2.8-3.1) (all p < 0.002). CONCLUSION Respiratory-gated 3D-Dixon and breath-hold 2D-SSFP MR-imaging provide accurate and precise aortic diameter measurements. We recommend 3D-Dixon imaging for monitoring of aortic diameter in Marfan patients due to fewer imaging artifacts and the possibility of orthogonal multiplanar reformations of the aortic root. KEY POINTS • Respiratory-gated 3D-Dixon and breath-hold 2D-SSFP imaging provide accurate and precise aortic diameter measurements in patients suffering from Marfan syndrome. • Imaging artifacts are stronger in 2D-SFFP imaging than in 3D-Dixon imaging. • We recommend 3D-Dixon imaging for monitoring of aortic diameter in Marfan patients due to fewer imaging artifacts and the possibility of orthogonal multiplanar reformations.
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Affiliation(s)
- Felicia Wright
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Malte Warncke
- grid.13648.380000 0001 2180 3484Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Martin Sinn
- grid.13648.380000 0001 2180 3484Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Inka Ristow
- grid.13648.380000 0001 2180 3484Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Alexander Lenz
- grid.13648.380000 0001 2180 3484Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Christoph Riedel
- grid.13648.380000 0001 2180 3484Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Bjoern P. Schoennagel
- grid.13648.380000 0001 2180 3484Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Shuo Zhang
- grid.418621.80000 0004 0373 4886Philips GmbH Market DACH, Hamburg, Germany
| | - Michael G. Kaul
- grid.13648.380000 0001 2180 3484Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Gerhard Adam
- grid.13648.380000 0001 2180 3484Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Yskert von Kodolitsch
- grid.13648.380000 0001 2180 3484Department of Vascular Medicine, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Susanne Sehner
- grid.13648.380000 0001 2180 3484Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- grid.13648.380000 0001 2180 3484Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Tintelnot J, Ristow I, Sauer M, Simnica D, Schultheiß C, Scholz R, Goekkurt E, von Wenserski L, Willscher E, Paschold L, Lorenzen S, Riera-Knorrenschild J, Depenbusch R, Ettrich TJ, Dörfel S, Al-Batran SE, Karthaus M, Pelzer U, Hinke A, Bauer M, Massa C, Seliger B, Wickenhauser C, Bokemeyer C, Hegewisch-Becker S, Binder M, Stein A. Translational analysis and final efficacy of the AVETUX trial - Avelumab, cetuximab and FOLFOX in metastatic colorectal cancer. Front Oncol 2022; 12:993611. [PMID: 36605436 PMCID: PMC9808039 DOI: 10.3389/fonc.2022.993611] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction In metastatic colorectal cancer (mCRC), the efficacy of immune checkpoint blockade (ICB) has so far been limited to patients with microsatellite instability high tumors (MSI-H). Unfortunately, most mCRC patients suffer from non-immunogenic microsatellite stable (MSS) tumors. Therefore, new combinatorial strategies are urgently needed to enhance the immunogenicity of MSS tumors to finally increase the number of patients benefiting from ICB. Methods The AVETUX trial aimed to combine the PD-L1 antibody avelumab with the standard of care chemotherapy combination FOLFOX and the anti-EGFR antibody cetuximab. Furthermore, we performed a central radiological review of the pre- and on-treatment computed tomography scans to better define the individual response to treatment. Results and Discussion In total, 43 patients were treated of which 39 patients were confirmed as RAS/BRAF wildtype in central tissue review and finally response evaluated. A final progression-free survival (PFS) of 11.1 (range: 0.8 to 22.3 months) and a herein updated final overall survival (OS) of 32.9 months (range: 0.8 to 47.1 months) was reached. We observed a strong median depth of response of 67.5% tumor shrinkage and deepness of response correlated significantly with survival. On the other hand, early tumor shrinkage was not an indicator of better outcome at a cut-off of 20% (median values). In a next step, we correlated the individual best radiological response with potential ICB response biomarkers and found that the clonality and diversity, but not frequency of tumor infiltrating lymphocytes (TiLs) and peripheral blood mononuclear cells (PBMCs), strongly correlated with response. In summary, we report the final overall survival of the AVETUX trial and propose T cell clonality and diversity as a potential marker to predict response to chemo-immunotherapy combinations in MSS mCRC by performing a central radiological review. Clinical Trial Registration ClinicalTrials.gov, identifier (NCT03174405).
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Affiliation(s)
- Joseph Tintelnot
- Department of Oncology and Hematology, Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,*Correspondence: Joseph Tintelnot, ; Alexander Stein,
| | - Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Sauer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Donjete Simnica
- Department of Internal Medicine IV – Oncology/Hematology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Christoph Schultheiß
- Department of Internal Medicine IV – Oncology/Hematology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Rebekka Scholz
- Department of Internal Medicine IV – Oncology/Hematology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Eray Goekkurt
- Department of Oncology and Hematology, Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Hämatologisch-Onkologische Praxis Eppendorf, Hamburg, Germany
| | - Lisa von Wenserski
- Department of Internal Medicine IV – Oncology/Hematology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Edith Willscher
- Department of Internal Medicine IV – Oncology/Hematology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Lisa Paschold
- Department of Internal Medicine IV – Oncology/Hematology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Sylvie Lorenzen
- Department of Internal Medicine III (Haematology/Medical Oncology), Technical University of Munich Hospital Rechts der Isar, Munchen, Bayern, Germany
| | | | - Reinhard Depenbusch
- Private Practice Onkodoc GmbH Götersloh, Götersloh, Nordrhein-Westfalen, Germany
| | - Thomas J. Ettrich
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Baden-Wörttemberg, Germany
| | - Steffen Dörfel
- Private Practice Onkozentrum Dresden, Dresden, Sachsen, Germany
| | - Salah-Eddin Al-Batran
- Institute of Clinical Cancer Research Institut für Klinisch-Onkologische Forschung (IKF) at Northwest Hospital, Frankfurt, Hessen, Germany
| | - Meinolf Karthaus
- Department of Hematology and Oncology, Munich Hospital Neuperlach, Munchen, Bayern, Germany
| | - Uwe Pelzer
- Department of Hematology, Oncology and Tumorimmunology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Axel Hinke
- Clinical Cancer Research Consulting (CCRC), Dösseldorf, Germany
| | - Marcus Bauer
- Institute of Pathology, Martin Luther University Halle Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Chiara Massa
- Institute of Medical Immunology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Barbara Seliger
- Institute of Medical Immunology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | | | - Carsten Bokemeyer
- Department of Oncology and Hematology, Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Mascha Binder
- Department of Internal Medicine IV – Oncology/Hematology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Alexander Stein
- Department of Oncology and Hematology, Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Hämatologisch-Onkologische Praxis Eppendorf, Hamburg, Germany,*Correspondence: Joseph Tintelnot, ; Alexander Stein,
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11
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Piffko A, Asey B, Dührsen L, Ristow I, Salamon J, Wikman H, Maire C, Lamszus K, Westphal M, Sauvigny T, Mohme M. NCOG-01. CLINICAL DETERMINANTS IMPACTING OVERALL SURVIVAL OF PATIENTS WITH OPERABLE BRAIN METASTASES FROM NON-SMALL CELL LUNG CANCER. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
The incidence of brain metastases (BM) in non-small cell lung cancer (NSCLC) patients is continuously increasing. The recent improvements of systemic treatment in NSCLC necessitate continuous updates on prognostic subgroups and factors determining overall survival. In order to improve clinical decision-making, we investigated the clinical determinants affecting survival in patients with resectable NSCLC BM. A retrospective analysis was conducted of NSCLC patients with surgically resectable BM treated in our institution between 01/2015 and 12/2020. Relevant clinical factors affecting survival identified by univariate analysis where included in a multivariate logistic regression model. Overall, 264 patients were identified, with a mean age of 62.39 ± 9.98 years at initial diagnosis of NSCLC BM and overall survival (OS) of 23.22 ± 1.71 months. Factors that significantly affected overall survival from time of primary tumor diagnosis included the systemic metastatic load (mean: 45.9 ± 9.7 vs. 58.9 ± 9.4 months, p = 0.021) as well as a number of BM < 2 (mean: 25.5 ± 4.4 vs. 57.4 ± 7.8 months, p = 0.014). When adjusted for survival time after neurosurgical intervention, a significant survival benefit was found in patients < 60 years (32.5 ± 4.3 vs. 28.5 ± 5.2 months, p = 0.036) and patients without any concurrent systemic metastases at time of NSCLC BM diagnosis (mean 32.4 vs. 34.1, p = 0.032). Our data shows that the number of BM (singular/solitary), gender and age, but not localization (infra-/supratentorial), mass-edema index or time to BM occurrence impact overall survival in NSCLC BM patients.Additionally, our study shows that patients in prognostically favorable clinical subgroups have an overall survival, which differs significantly from current statements in literature. The described clinically relevant factors may improve the understanding of the risks and the course of this disease and aid future clinical decision making in tumor boards.
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Affiliation(s)
- Andras Piffko
- University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Benedikt Asey
- University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Lasse Dührsen
- University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Inka Ristow
- University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | | | - Harriet Wikman
- University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Cecile Maire
- University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Katrin Lamszus
- University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | | | - Thomas Sauvigny
- University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Malte Mohme
- University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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12
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Piffko A, Asey B, Dührsen L, Ristow I, Salamon J, Wikman H, Maire CL, Lamszus K, Westphal M, Sauvigny T, Mohme M. Clinical determinants impacting overall survival of patients with operable brain metastases from non-small cell lung cancer. Front Oncol 2022; 12:951805. [DOI: 10.3389/fonc.2022.951805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is currently the leading cause of cancer-related death worldwide, and the incidence of brain metastases (BM) in NSCLC patients is continuously increasing. The recent improvements of systemic treatment in NSCLC necessitate continuous updates on prognostic subgroups and factors determining overall survival (OS). In order to improve clinical decision-making in tumor boards, we investigated the clinical determinants affecting survival in patients with resectable NSCLC BM. A retrospective analysis was conducted of NSCLC patients with surgically resectable BM treated in our institution between 01/2015 and 12/2020. The relevant clinical factors affecting survival identified by univariate analysis were included in a multivariate logistic regression model. Overall, 264 patients were identified, with a mean age of 62.39 ± 9.98 years at the initial diagnosis of NSCLC BM and OS of 23.22 ± 1.71 months. The factors that significantly affected OS from the time of primary tumor diagnosis included the systemic metastatic load (median: 28.40 ± 4.82 vs. 40.93 ± 11.18 months, p = 0.021) as well as a number of BM <2 (median: 17.20 ± 2.52 vs. 32.53 ± 3.35 months, p = 0.014). When adjusted for survival time after neurosurgical intervention, a significant survival benefit was found in patients <60 years (median 16.13 ± 3.85 vs. 9.20 ± 1.39 months, p = 0.011) and, among others, patients without any concurrent systemic metastases at time of NSCLC BM diagnosis. Our data shows that the number of BM (singular/solitary), the Karnofsky Performance Status, gender, and age but not localization (infra-/supratentorial), mass-edema index or time to BM occurrence impact OS, and postsurgical survival in NSCLC BM patients. Additionally, our study shows that patients in prognostically favorable clinical subgroups an OS, which differs significantly from current statements in literature. The described clinically relevant factors may improve the understanding of the risks and the course of this disease and Faid future clinical decision making in tumor boards.
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13
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Riedel C, Lenz A, Ristow I, Wright F, Adam G, Schönnagel B, Bannas P. Quantitative 4D Fluss MRT in TIPS Stents: Validierung mittels 3D-gedrucktem Flussphantom. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- C Riedel
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Diagn. und Interv. Radiologie, Hamburg
| | - A Lenz
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - I Ristow
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - F Wright
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - G Adam
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - B Schönnagel
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - P Bannas
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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14
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Ristow I, Madesta F, Well L, Shenas F, Wright F, Molwitz I, Farschtschi S, Bannas P, Adam G, Mautner VF, Werner R, Salamon J. Evaluation of magnetic resonance imaging-based radiomics characteristics for differentiation of benign and malignant peripheral nerve sheath tumors in neurofibromatosis type 1. Neuro Oncol 2022; 24:1790-1798. [PMID: 35426432 PMCID: PMC9527508 DOI: 10.1093/neuonc/noac100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients with neurofibromatosis type 1 (NF1) develop benign (BPNST), premalignant atypical (ANF), and malignant (MPNST) peripheral nerve sheath tumors. Radiological differentiation of these entities is challenging. Therefore, we aimed to evaluate the value of a magnetic resonance imaging (MRI)-based radiomics machine-learning (ML) classifier for differentiation of these three entities of internal peripheral nerve sheath tumors in NF1 patients. METHODS MRI was performed at 3T in 36 NF1 patients (20 male; age: 31 ± 11 years). Segmentation of 117 BPNSTs, 17 MPNSTs, and 8 ANFs was manually performed using T2w spectral attenuated inversion recovery sequences. One hundred seven features per lesion were extracted using PyRadiomics and applied for BPNST versus MPNST differentiation. A 5-feature radiomics signature was defined based on the most important features and tested for signature-based BPNST versus MPNST classification (random forest [RF] classification, leave-one-patient-out evaluation). In a second step, signature feature expressions for BPNSTs, ANFs, and MPNSTs were evaluated for radiomics-based classification for these three entities. RESULTS The mean area under the receiver operator characteristic curve (AUC) for the radiomics-based BPNST versus MPNST differentiation was 0.94, corresponding to correct classification of on average 16/17 MPNSTs and 114/117 BPNSTs (sensitivity: 94%, specificity: 97%). Exploratory analysis with the eight ANFs revealed intermediate radiomic feature characteristics in-between BPNST and MPNST tumor feature expression. CONCLUSION In this proof-of-principle study, ML using MRI-based radiomics characteristics allows sensitive and specific differentiation of BPNSTs and MPNSTs in NF1 patients. Feature expression of premalignant atypical tumors was distributed in-between benign and malignant tumor feature expressions, which illustrates biological plausibility of the considered radiomics characteristics.
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Affiliation(s)
- Inka Ristow
- Corresponding Author: Inka Ristow, MD, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany ()
| | - Frederic Madesta
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Farzad Shenas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felicia Wright
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf
, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf
, Hamburg, Germany
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15
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Krylova M, Ristow I, Marr V, Borchardt V, Li M, Witzel J, Drumkova K, Harris JA, Zacharias N, Schiltz K, Amelung T, Beier KM, Kruger THC, Ponseti J, Schiffer B, Walter H, Kärgel C, Walter M. MEG reveals preference specific increases of sexual-image-evoked responses in paedophilic sexual offenders and healthy controls. World J Biol Psychiatry 2021; 22:257-270. [PMID: 32623929 DOI: 10.1080/15622975.2020.1789216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Paedophilic disorder is characterised by sexual attraction towards children. Classification of a counterpart as sexually attractive likely occurs rapidly, and involves both conscious and unconscious attentional and cognitive processes. Magnetoencephalography (MEG) is an imaging method especially well-suited to examine visual and attentional processes triggered by sexual images within the range of milliseconds. METHODS We investigated brain responses to sexual images depicting adults (frequent) and children (infrequent stimulus) in seventeen paedophilic patients with a history of child sexual offending (P + CSO) and twenty healthy controls (HC) during a passive visual oddball paradigm. Event-related fields (ERF) were measured to extract the magnetic visual mismatch negativity (vMMNm), and how it relates to the processing of different classes of sexual stimuli. RESULTS P + CSO exhibited significantly longer vMMNm latencies (100-180 ms post-stimulus) than HC. Moreover, P + CSO showed widespread increased amplitudes in response to child images starting from P3a and P3b components and lasting up to 400 ms post-stimulus presentation localised in frontal and temporal brain regions. CONCLUSIONS This study uncovers the first MEG differences in automatic change detection between P + CSO and HC during the presentation of subliminal sexual images of adults and children, contributing towards a better understanding of the neurobiological processes of P + CSO.
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Affiliation(s)
- Marina Krylova
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany.,Department of Psychiatry, Eberhard Karls University, Tübingen, Germany
| | - Inka Ristow
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany.,Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany.,Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vanessa Marr
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany.,Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Viola Borchardt
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany.,Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Meng Li
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Joachim Witzel
- Forensic Psychiatric State Hospital of Saxony-Anhalt, Stendal-Uchtspringe, Germany
| | - Krasimira Drumkova
- Forensic Psychiatric State Hospital of Saxony-Anhalt, Stendal-Uchtspringe, Germany
| | - Joseph A Harris
- Department of Psychology, Bradley University, Peoria, IL, USA
| | - Norman Zacharias
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kolja Schiltz
- Section of Forensic Psychiatry, Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany.,Department of Psychiatry and Psychotherapy, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - Till Amelung
- Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klaus M Beier
- Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tillmann H C Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Section of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hannover, Germany
| | - Jorge Ponseti
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Medical School, Kiel, Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Christian Kärgel
- Division of Forensic Psychiatry, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany.,Department of Psychiatry, Eberhard Karls University, Tübingen, Germany.,Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany.,Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany.,Department of Psychiatry and Psychotherapy, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany.,Max Planck Institute for Biological Cybernetics, Tübingen, Germany
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16
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Denzel D, Colic L, Demenescu LR, von Düring F, Ristow I, Nießen H, Hermann L, Kaufmann J, Dannlowski U, Frommer J, Vogel M, Li M, Lord A, Walter M. Local glutamate in cingulate cortex subregions differentially correlates with affective network activations during face perception. Eur J Neurosci 2020; 52:3047-3060. [PMID: 32239708 DOI: 10.1111/ejn.14733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/03/2020] [Accepted: 03/27/2020] [Indexed: 12/01/2022]
Abstract
The cingulate cortex is involved in emotion recognition/perception and regulation. Rostral and caudal subregions belong to different brain networks with distinct roles in affective perception. Despite recent accounts of the relevance of cingulate cortex glutamate (Glu) on blood-oxygen-level-dependent (BOLD) responses, the specificity of the subregional Glu levels during emotional tasks remains unclear. Seventy-two healthy participants (age = 27.33 ± 6.67, 32 women) performed an affective face-matching task and underwent magnetic resonance spectroscopy (MRS) at 7 Tesla. Correlations between the BOLD response during emotion perception and Glu concentration in the pregenual anterior cingulate cortex (pgACC) and anterior midcingulate cortex (aMCC) were compared on a whole-brain level. Post hoc specificity of the association with an affect was assessed. Lower Glu in the pgACC correlated with stronger activation differences between negative and positive faces in the left inferior and superior frontal gyrus (L IFG and L SFG). In contrast, lower Glu in the aMCC correlated with BOLD contrasts in the posterior cingulate cortex (PCC). Furthermore, negative face detection was associated with prolonged response time (RT). Our results demonstrate a subregion-specific involvement of cingulate cortex Glu in interindividual differences during viewing of affective facial expressions. Glu levels in the pgACC were correlated with frontal area brain activations, whereas Glu in the salience network component aMCC modulated responses in the PCC-precuneus. We show that region-specific metabolite mapping enables specific activation of different BOLD signals in the brain underlying emotional perception.
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Affiliation(s)
- Dominik Denzel
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University, Magdeburg, Germany
| | - Lejla Colic
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University, Magdeburg, Germany.,Department Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | | | - Felicia von Düring
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University, Magdeburg, Germany.,Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inka Ristow
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University, Magdeburg, Germany.,Department for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Nießen
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University, Magdeburg, Germany
| | - Luisa Hermann
- Department of Psychiatry and Psychotherapy, Eberhard-Karls-University, Tübingen, Germany
| | - Jörn Kaufmann
- Department of Neurology, Otto von Guericke University, Magdeburg, Germany
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Jörg Frommer
- Department of Psychosomatic Medicine and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Matthias Vogel
- Department of Psychosomatic Medicine and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Meng Li
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University, Magdeburg, Germany.,Max Planck Institute for Biological Cybernetics Tübingen, Tübingen, Germany
| | - Anton Lord
- Immunology Department, QIMR Berghofer Medical Research Institute, Herston, Qld, Australia.,School of Public Health, The University of Queensland, Herston, Qld, Australia
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University, Magdeburg, Germany.,Department Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.,Department of Psychiatry and Psychotherapy, Eberhard-Karls-University, Tübingen, Germany.,Max Planck Institute for Biological Cybernetics Tübingen, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany.,Department of Psychiatry and Psychotherapy, Friedrich-Schiller-University, Jena, Germany
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17
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Unterhorst K, Gerwinn H, Pohl A, Kärgel C, Massau C, Ristow I, Kneer J, Amelung T, Walter H, Beier K, Walter M, Schiffer B, Kruger THC, Stirn A, Ponseti J. An Exploratory Study on the Central Nervous Correlates of Sexual Excitation and Sexual Inhibition. J Sex Res 2020; 57:397-408. [PMID: 30489159 DOI: 10.1080/00224499.2018.1539462] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Sexual Inhibition/Sexual Excitation Scales (SIS/SES) measure sexual excitation and sexual inhibition proneness. We used SIS and SES scores of 62 heterosexual teleiophilic men (Mage 34.3, SD = 9.9) to predict brain activation levels during the presentation of male and female visual sexual stimuli in a magnetic resonance imaging (MRI) scanner. Statistical analyses revealed significant correlations. SES and SIS1 scores were positively associated with brain activation in various brain regions during the presentation of both male and female stimuli. SIS2 turned out to be a weaker predictor of brain activation, still revealing one significant correlation in the right lateral orbitofrontal cortex. Significant regions for SES and SIS1 were, among others, primary and supplementary motor areas, the caudate nucleus, the dorsal anterior cingulate cortex, anterior insula, and prefrontal areas. Our study can be seen as an exploratory investigation of SIS and SES with means of functional brain imaging. The results provide a promising contribution to the assertion of neurophysiological systems of sexual inhibition and excitation proneness.
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Affiliation(s)
- K Unterhorst
- Institute for Sexual Medicine and Forensic Psychiatry and Psychotherapy, Center for Integrative Psychiatry
| | - H Gerwinn
- Institute for Sexual Medicine and Forensic Psychiatry and Psychotherapy, Center for Integrative Psychiatry
| | - A Pohl
- Institute for Sexual Medicine and Forensic Psychiatry and Psychotherapy, Center for Integrative Psychiatry
| | - C Kärgel
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy, and Preventive Medicine, LWL-University Hospital Bochum
- Institute of Forensic Psychiatry, University of Duisburg-Essen
| | - C Massau
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy, and Preventive Medicine, LWL-University Hospital Bochum
- Institute of Forensic Psychiatry, University of Duisburg-Essen
| | - I Ristow
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University Magdeburg
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology
| | - J Kneer
- Division of Clinical Psychology and Sexual Medicine, Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School
| | - T Amelung
- Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin
| | - H Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin
| | - K Beier
- Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin
| | - M Walter
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University Magdeburg
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology
- Department of Psychiatry, Eberhard Karls University of Tübingen
| | - B Schiffer
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy, and Preventive Medicine, LWL-University Hospital Bochum
- Institute of Forensic Psychiatry, University of Duisburg-Essen
| | - T H C Kruger
- Division of Clinical Psychology and Sexual Medicine, Department of Clinical Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School
| | - A Stirn
- Institute for Sexual Medicine and Forensic Psychiatry and Psychotherapy, Center for Integrative Psychiatry
| | - J Ponseti
- Institute for Sexual Medicine and Forensic Psychiatry and Psychotherapy, Center for Integrative Psychiatry
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18
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von Düring F, Ristow I, Li M, Denzel D, Colic L, Demenescu LR, Li S, Borchardt V, Liebe T, Vogel M, Walter M. Glutamate in Salience Network Predicts BOLD Response in Default Mode Network During Salience Processing. Front Behav Neurosci 2019; 13:232. [PMID: 31632250 PMCID: PMC6783560 DOI: 10.3389/fnbeh.2019.00232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/17/2019] [Indexed: 01/09/2023] Open
Abstract
Background Brain investigations identified salience network (SN) comprising the dorsal Anterior Cingulate Cortex (dACC) and the Anterior Insula (AI). Magnetic resonance spectroscopy (MRS) studies revealed the link between the glutamate concentration in the ACC and alterations in attentional scope. Hence, we investigated whether glutamate concentration in the dACC modulates brain response during salience processing. Methods Twenty-seven healthy subjects (12♀, 15♁) provided both STEAM MRS at 7T measuring glutamate concentrations in the dACC as well as a functional magnetic resonance imaging (fMRI) task to study the influence on content-related salience processing and expectedness. Salience was modulated for both sexual and non-sexual emotional photos in either expected or unexpected situations. Correlation between MRS and task fMRI was investigated by performing regression analyses controlling for age, gender, and gray matter partial volume. Results/Conclusion During picture processing, the extent of deactivation in the Posterior Cingulate Cortex (PCC) was attenuated by two different salience attributions: sexual content and unexpectedness of emotional content. Our results indicate that stimulus inherent salience induces an attenuation of the deactivation in PCC, which is in turn balanced by higher level of glutamate in the dACC.
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Affiliation(s)
- Felicia von Düring
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Inka Ristow
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Meng Li
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University Magdeburg, Magdeburg, Germany.,Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Dominik Denzel
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Lejla Colic
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University Magdeburg, Magdeburg, Germany.,Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Liliana Ramona Demenescu
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Shijia Li
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University Magdeburg, Magdeburg, Germany.,School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Viola Borchardt
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University Magdeburg, Magdeburg, Germany.,Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Thomas Liebe
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Matthias Vogel
- Department of Psychosomatic Medicine and Psychotherapy, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory, Otto von Guericke University Magdeburg, Magdeburg, Germany.,Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.,Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany.,Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, University of Jena, Jena, Germany
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19
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Gibbels C, Sinke C, Kneer J, Amelung T, Mohnke S, Beier KM, Walter H, Schiltz K, Gerwinn H, Pohl A, Ponseti J, Foedisch C, Ristow I, Walter M, Kaergel C, Massau C, Schiffer B, Kruger THC. Two Sides of One Coin: A Comparison of Clinical and Neurobiological Characteristics of Convicted and Non-Convicted Pedophilic Child Sexual Offenders. J Clin Med 2019; 8:E947. [PMID: 31261903 PMCID: PMC6678781 DOI: 10.3390/jcm8070947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 01/19/2023] Open
Abstract
High prevalence of child sexual offending stand in contradiction to low conviction rates (one-tenth at most) of child sexual offenders (CSOs). Little is known about possible differences between convicted and non-convicted pedophilic CSOs and why only some become known to the judicial system. This investigation takes a closer look at the two sides of "child sexual offending" by focusing on clinical and neurobiological characteristics of convicted and non-convicted pedophilic CSOs as presented in the Neural Mechanisms Underlying Pedophilia and sexual offending against children (NeMUP)*-study. Seventy-nine male pedophilic CSOs were examined, 48 of them convicted. All participants received a thorough clinical examination including the structured clinical interview (SCID), intelligence, empathy, impulsivity, and criminal history. Sixty-one participants (38 convicted) underwent an inhibition performance task (Go/No-go paradigm) combined with functional magnetic resonance imaging (fMRI). Convicted and non-convicted pedophilic CSOs revealed similar clinical characteristics, inhibition performances, and neuronal activation. However, convicted subjects' age preference was lower (i.e., higher interest in prepubescent children) and they had committed a significantly higher number of sexual offenses against children compared to non-convicted subjects. In conclusion, sexual age preference may represent one of the major driving forces for elevated rates of sexual offenses against children in this sample, and careful clinical assessment thereof should be incorporated in every preventive approach.
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Affiliation(s)
- Charlotte Gibbels
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hanover, Germany
| | - Christopher Sinke
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hanover, Germany
| | - Jonas Kneer
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hanover, Germany
| | - Till Amelung
- Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Sebastian Mohnke
- Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Klaus Michael Beier
- Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Kolja Schiltz
- Department of Forensic Psychiatry, Ludwig Maximilians University Munich, 80336 Munich, Germany
| | - Hannah Gerwinn
- Kiel University, Medical School, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, 24105 Kiel, Germany
| | - Alexander Pohl
- Kiel University, Medical School, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, 24105 Kiel, Germany
| | - Jorge Ponseti
- Kiel University, Medical School, Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, 24105 Kiel, Germany
| | - Carina Foedisch
- Department of Psychiatry, Otto-von Guericke-University Magdeburg, 39106 Magdeburg, Germany
| | - Inka Ristow
- Department of Psychiatry, Otto-von Guericke-University Magdeburg, 39106 Magdeburg, Germany
| | - Martin Walter
- Department of Psychiatry, Otto-von Guericke-University Magdeburg, 39106 Magdeburg, Germany
- Department of Psychiatry, University of Tübingen, 72076 Tübingen, Germany
| | - Christian Kaergel
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, 44791 Bochum, Germany
| | - Claudia Massau
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, 44791 Bochum, Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, 44791 Bochum, Germany
| | - Tillmann H C Kruger
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hanover, Germany.
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20
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Ristow I, Foell J, Kärgel C, Borchardt V, Li S, Denzel D, Witzel J, Drumkova K, Beier K, Kruger THC, Ponseti J, Schiffer B, Schiltz K, Walter H, Walter M. Expectation of sexual images of adults and children elicits differential dorsal anterior cingulate cortex activation in pedophilic sexual offenders and healthy controls. Neuroimage Clin 2019; 23:101863. [PMID: 31158692 PMCID: PMC6545409 DOI: 10.1016/j.nicl.2019.101863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 05/02/2019] [Accepted: 05/19/2019] [Indexed: 01/08/2023]
Abstract
Background Pedophilic disorder is characterized by increased sexual interest towards children, with comparatively lesser interest towards adults. In real life, the behavior of subjects with pedophilic disorder is shaped by evaluative processes in response to sexually relevant cues. Therefore, brain activation during anticipation of sexually relevant cues is of potential interest. Whereas previous research demonstrated reduced activation when viewing adult (non-preferred) sexual stimuli in pedophilic sex offenders (PSOs), it is not known if anticipation of preferred versus unpreferred stimuli will elicit differential brain activation. Methods Two fMRI studies (1.5 and 7 Tesla) were conducted in separate samples, each with 26 subjects (13/13 PSOs/controls) to assess brain activity during expectancy of subsequent adult (non-preferred) sexual stimuli. In the second study (7 Tesla) additionally child (preferred) cues were presented. Results As predicted, expectancy of adult sexual stimuli generated smaller dorsal anterior cingulate cortex (dACC) activation in PSOs in both studies, driven by stronger activation during expectancy of adult erotic stimuli in non-pedophilic controls (HCs). In the second study, PSOs showed significantly increased activations in dACC during expectancy of child stimuli compared with expectancy of adult stimuli. This difference was significantly greater compared to the same contrast in HCs, thus demonstrating preference specificity of dACC activation. Conclusion Our findings support the notion of decreased brain activation to adult cues in PSOs and preference specificity in neural response during expectancy of erotic stimuli. The localization of these cue reactivity differences in the salience network supports the interpretation that PSOs show abnormally increased preparatory activation even before relevant sexual stimuli are actually presented. We studied expectancy-related brain activity in pedophilic offenders and controls. Activation during anticipation elicits reactivity differences in salience network. Brain activation during expectancy was stronger compared to picture perception. Effects in dACC of patients and controls were found in 2 fMRI studies (1.5 and 7 T). DACC activation during expectancy revealed preference specificity in both groups.
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Affiliation(s)
- Inka Ristow
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Jens Foell
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Christian Kärgel
- Division of Forensic Psychiatry, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Viola Borchardt
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Shijia Li
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China; Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Dominik Denzel
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Joachim Witzel
- Forensic Psychiatric State Hospital of Saxony-Anhalt, Stendal-Uchtspringe, Germany
| | - Krasimira Drumkova
- Forensic Psychiatric State Hospital of Saxony-Anhalt, Stendal-Uchtspringe, Germany
| | - Klaus Beier
- Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Tillmann H C Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Section of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hannover, Germany
| | - Jorge Ponseti
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Boris Schiffer
- Division of Forensic Psychiatry, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Kolja Schiltz
- Section of Forensic Psychiatry, Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany; Department of Psychiatry and Psychotherapy, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Univesität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Institute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany; Department of Psychiatry and Psychotherapy, Otto von Guericke University of Magdeburg, Magdeburg, Germany; Department of Psychiatry, Eberhard Karls University, Tübingen, Germany; Max Planck Institute for Biological Cybernetics Tübingen, Germany.
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21
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Ristow I, Li M, Colic L, Marr V, Födisch C, von Düring F, Schiltz K, Drumkova K, Witzel J, Walter H, Beier K, Kruger THC, Ponseti J, Schiffer B, Walter M. Pedophilic sex offenders are characterised by reduced GABA concentration in dorsal anterior cingulate cortex. Neuroimage Clin 2018; 18:335-341. [PMID: 29876253 PMCID: PMC5987735 DOI: 10.1016/j.nicl.2018.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/14/2017] [Accepted: 01/15/2018] [Indexed: 12/14/2022]
Abstract
A pedophilic disorder is characterised by abnormal sexual urges towards prepubescent children. Child abusive behavior is frequently a result of lack of behavioral inhibition and current treatment options entail, next to suppressing unchangeable sexual orientation, measures to increase cognitive and attentional control. We tested, if in brain regions subserving attentional control of behavior and perception of salient stimuli, such inhibition deficit can be observed also on the level of inhibitory neurotransmitters. We measured GABA concentration in the dorsal anterior cingulate cortex (dACC) and in a control region, the pregenual anterior cingulate cortex (pgACC) in pedophilic sex offenders (N = 13) and matched controls (N = 13) using a 7 Tesla STEAM magnetic resonance spectroscopy (MRS). In dACC but not in the control region pedophilic sex offenders showed reduced GABA/Cr concentrations compared to healthy controls. The reduction was robust after controlling for potential influence of age and gray matter proportion within the MRS voxel (p < 0.04). Importantly, reduced GABA/Cr in patients was correlated with lower self-control measured with the Barratt Impulsiveness Scale (p = 0.028, r = -0.689). In a region related to cognitive control and salience mapping, pedophilic sex offenders showed reduction of the inhibitory neurotransmitter GABA which may be seen as a neuronal correlate of inhibition and behavioral control.
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Affiliation(s)
- Inka Ristow
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Insitute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Meng Li
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Department of Neurology, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Lejla Colic
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Insitute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Vanessa Marr
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Insitute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Carina Födisch
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Insitute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Felicia von Düring
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Insitute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany
| | - Kolja Schiltz
- Section of Forensic Psychiatry, Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany; Department of Psychiatry and Psychotherapy, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Krasimira Drumkova
- Forensic Psychiatric State Hospital of Saxony-Anhalt, Stendal-Uchtspringe, Germany
| | - Joachim Witzel
- Forensic Psychiatric State Hospital of Saxony-Anhalt, Stendal-Uchtspringe, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Klaus Beier
- Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Tillmann H C Kruger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Jorge Ponseti
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Boris Schiffer
- University of Duisburg-Essen, Institute of Forensic Psychiatry, Essen, Germany; LWL-University Hospital, Division of Forensic Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, Bochum, Germany
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory (CANLAB), Magdeburg, Germany; Leibniz Insitute for Neurobiology, Department for Behavioral Neurology, Magdeburg, Germany; Department of Neurology, Otto von Guericke University of Magdeburg, Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany; Department of Psychiatry and Psychotherapy, Otto von Guericke University of Magdeburg, Magdeburg, Germany; Department of Psychiatry, Eberhard Karls University, Tübingen, Germany; Max Planck Institute for Biological Cybernetics Tübingen, Germany.
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Ristow I, Li S, Demenescu R, Colic L, Li M, Walter H, Beier K, Krüger T, Schiffer B, Ponseti J, Walter M. EP 80. Sexual processing of pedophilic patients and healthy controls and the role of its metabolic markers – A fMRI and MRS study. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ristow I, Li S, Demenescu L, Walter H, Beier K, Kruger T, Schiffer B, Ponseti J, Walter M. Abnormal amygdala functional connectivity during an fMRI expectancy task in pedophilia. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
IntroductionPedophilia is a disorder where sexual preferences of adults are directed towards children. This disorder impacts society with 1–2 out of every 10 children being sexually approached by an adult, often resulting in prolonged negative psychological effects. Prior research reported structural and functional amygdala alterations in pedophilia. As the neurophenomenological model of sexual arousal suggests the importance of the amygdala in the emotional component, we focused on amygdala functional connectivity in pedophilia.AimsTo investigate amygdala functional connectivity (FC) modulated by expectancy and salient stimuli in pedophilic patients.MethodsThirteen pedophilic patients and 13 matched healthy controls underwent a salience expectancy task in a 7T ultra high fMRI study. Subjects perceived pictures of naked adults and children. Half of the pictures were preceded by an expectancy cue. Participants were instructed to actively expect the picture depending on the cue. We conducted psychophysiological analysis (PPI) to examine amygdala FC changes in two amygdala sub-regions for child/adult stimuli during the expectancy period and the visual stimuli consummation period using as seed regions the basolateral (BLA) and central nucleus of the amygdala (CeA).ResultsHealthy controls, relative to patients showed significant stronger left CeA to right post-central gyrus FC during expectancy of adult > child picture. For picture condition (adult > child picture) we found significant stronger left CeA to left dorsolateral prefrontal cortex FC in patients compared to healthy controls.ConclusionThese findings add to the recent literature by indicating that amygdala dysfunctional connectivity is involved in development of deviant sexual behavior.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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