Heterogeneity of ASL perfusion MRI in low-grade paediatric glioma as imaging biomarker to assess treatment effect
Lejla AlićSanneke WillekensHenk J. M. M. MutsaertsJan PetrNetteke Schouten-van MeeterenMaarten H. LequinEvita Wiegers
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Abstract:
ASL-MRI is reported as an option to assess potentially heterogeneous physiological processes important for tumour treatment. Therefore, we explored the heterogeneity in normalised CBF as an imaging biomarker for assessment of treatment effect in pLGG. There is a noticeable effect of chemotherapy observed as a change in texture of healthy appearing brain tissue. A high difference in texture between treated and non-treated patients for non-enhancing tumour part is observed, suggesting that texture, based on co-occurrence matrices, is suitable as an imaging biomarker for assessment of treatment effect in pLGG.Keywords:
Imaging biomarker
Objective To observe the value of CT perfusion imaging(CTPI) in evaluating the therapeutic efficacy of anti-angiogenic therapy and chemotherapy for osteosarcoma.Methods Twenty-five patients with primary osteosarcoma were randomly divided into 2 groups: Chemotherapy plus anti-angiogenic combination therapy group(n=14) and chemotherapy group(n=11).All patients were examined with 64-slice spiral CT before and after treatment.The tumor size and perfusion parameters were measured and compared.Meanwhile,correlative analysis between perfusion parameters and microvessel density(MVD) was done.Results In chemotherapy plus anti-angiogenic combination therapy group,blood flow(BF),blood volume(BV),Patlak blood volume(PBV) and time to start(TTS) decreased significantly after treatment(P0.05),while time to peak(TTP) and permeability surface(PS) didn't change significantly(P0.05).The perfusion parameters didn't change significantly after treatment in chemotherapy group(P0.05).There was no statistically significant change of tumor volume after treatment in all two groups(P0.05).BF,BV,PS and PBV had significant positive correlation with MVD(P0.05),while TTP,TTS had no significant correlation with MVD(P0.05).The survival rate in chemotherapy plus anti-angiogenic combination therapy group and chemotherapy group was 84.71% and 55.25%,respectively(P0.05).Conclusion CTPI is more sensitive than morphologic imaging,therefore can provide quantitative parameters to evaluate changes after treatment and prognosis.
Therapeutic effect
Microvessel
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Objective To obtain relative cerebral blood volume(rCBV) value by using multi-slice helical CT perfusion imaging,to evaluate the correlation between rCBV value and vascular endothelial growth factor(VEGF) expression in human gliomas.Methods Multi-slice helical CT perfusion imaging was performed after routine scanning in 24 patients with brain glioma,including 8 cases of low-grade glioma,10 cases of anaplastic astrocytoma and 6 cases of glioblastoma.The rCBV values were calculated and the VEGF expressions in tumors were determined by immunohistochemistry.The correlation of CT perfusion imaging with the pathologic grade and VEGF expression was analyzed.Results The rCBV value in low-grade glioma,anaplastic astrocytoma and glioblastoma were 3.435±0.4628,6.672±0.8462,9.849±1.2636,respectively;and the ALD values of VEGF expression in different grade glioma groups were 0.3177±0.0768,0.4693±0.0956,0.6368±0.1072 respectively.Statistically significant difference in rCBV existed between different groups.The rCBV value was closely correlated with VEGF expression in glioma.Conclusion The VEGF expression of glioma has a positive correlation with rCBV value in CT perfusion imaging.CT perfusion imaging can indirectly reflect the angiogenesis activity of brain glioma.
Cerebral blood volume
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Objective: To investigate the value of CT perfusion imaging in the diagnosis of glioma and its relationship with microvessel density.Methods: A total of 70 glioma patients underwent brain CT perfusion scan were selected.ROIs cerebral blood flow,relative cerebral blood flow,cerebral blood volume and relative cerebral blood volume values were measured.Microvessel density and vascular endothelial growth factor expression in tumor tissue was detected.Results: CBF,rCBF,CBV and rCBV of high-grade gliomas was significantly higher than that of low-grade gliomas,and the differences were statistically significant(P0.01).VEGF positive ratio of high-grade gliomas was 90.00%(36/40),significantly higher than the low-grade gliomas,average MVD was(69.76 ± 7.82)/HP,significantly more than the low-grade gliomas(P0.01).rCBV values of glioma CT perfusion had significant positive correlation with MVD and VEGF expression(r=0.571,P0.05;r=0.621,P0.05).Conclusions: There are significant differences in gliomas CT perfusion imaging parameters between high-grade gliomas and low-grade,and there are significant positive correlation between rCBV and MVDVEGF.
Cerebral blood volume
Grading (engineering)
Microvessel
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Objective: To investigate the value of CT perfusion imaging in the diagnosis of glioma.Method: Selected 50 cases of glioma patients inspected in the hospital imaging center from March 2010 to July 2011,All patients underwent CT perfusion scanning,reconstruction of CT perfusion images to measure the ROI of cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),and measure the microvessel density in pathologic specimens.Result: The mean value of CBF,CBV and PS were significantly higher in high-grade gliomas group than the group of low-grade gliomas,and the differences were statistically significant(P 0.01).Group of high-grade gliomas and low-grade gliomas group MTT had no significant difference between the mean value(P 0.05).Through spearman correlation analysis,the glioma CT perfusion rCBV values with MVD has a significant positive correlation(r=0.571,P0.05).Conclusion: The high-grade gliomas and low-grade gliomas CT perfusion imaging parameters has significant differences,There's a significant positive correlation between rCBV and MVD.
Cerebral blood volume
Mean transit time
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Objective To evaluate the feasibility of optimized scan protocol in whole-brain perfusion imaging with 320-MDCT scanner.Methods Twenty healthy volunteers were randomly divided into control group (13 patients) and test group (7 patients).The standard perfusion scan protocol (collecting 19 volumes)was applied in control group.The optimized perfusion CT scan protocol(collecting ll volumes)formulated by reducing scanning phases reasonably and changing the collection intervals was applied in test group.The regions of interest(ROI) with area of(20 ± 2)mm2 were located in the bilateral frontal white matter,parietal white matter,centrum semiovate,basal ganglia,occipital lobe and cerebellum.Bilateral perfusion values from ROI were measured,including cerebral blood volume(CBV),mean transit time (TTP),cerebral blood flow (CBF),mean transit time (MTT) and delay time (DT).Results Dose length product (DLP)and effective dose (ED)in optimized protocol were decreased 42.02％ as compared to control group.Every relative perfusion value of both sides from both groups were not statistically significant (P ＞ 0.05).Every relative perfusion parameters from individual territory in both groups showed no significant differences (P ＞ 0.05).Conclusions Using the optimized scan protocol,we could obtain the same whole-brain perfusion values could be obtained with the default standard protocol and less radiation dose.
Key words:
Tomography; Radiation dose; Whole brain CT perfusion; Scan protocol
Occipital lobe
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Fluid-attenuated inversion recovery
Stroke
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To determine the short-term prognostic value of Computed Tomography (CT) perfusion parameters in patients with advanced non-small cell lung cancer (NSCLC) after chemotherapy.A total of 60 patients with NSCLC who received concurrent radiotherapy and chemotherapy were enrolled. Before therapy, CT perfusion imaging was conducted to scan their local lesions. Then, the CT perfusion-associated parameters were recorded, and evaluated. According to the Response Evaluation Criteria in Solid Tumors (RECIST), 42 out of 60 patients had remission after chemotherapy. The blood flow (BF), blood volume (BV), and permeability surface (PS) of the two groups were analyzed before therapy, and factors and parameters affecting the efficacy of concurrent radiotherapy and chemotherapy were discussed.After chemotherapy, patients with remission showed lower BF, BV, and PS levels in pulmonary lesions than those without remission (all P<0.05). According to the 1-year follow-up results, 33 cases survived, and 27 cases died, and the survivors showed lower BF and PS levels than the dead (both P<0.05).Patients with lower BF and PS in CT perfusion parameters obtained better chemotherapy efficacy, so BF and PS can be adopted to predict the survival of patients.
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Objective To investigate the application value of three-dimensional arterial spin labeling in the preoperative glioma.Methods 45 patients with glioma proved by pathology(26cases of high grade and 19 cases of low)were setected and underwent the conventional MRI and 3D-ASL examination.We measured CBF value in the cerebral blood flow diagram,one was on the most obvious perfusion area of the solid part of tumors and another on the contralateral area.Then TBFmax/CBF contralateral ratio was calculated.We also observed the whole brain perfusion.Results We found that 45 cases were gained high quality whole brain perfusion maps.High grade gliomas in cerebral blood flow map were shown different degrees of highperfusion,low grade gliomas were presented with perfusion of normal or reduced.TBFmax/contralateral ratios in the high and low grade gliomas were 3.11±1.45 and 0.86±0.28,with significant difference between the two groups(P0.01).9cases of high grade gliomas appeared expansion vascular around the tumor,and the CBF value was risen.Conclusion We thought 3D-ASL could gain glioma perfusion information to determine the grade before preoperation and it was safe and noninvasive.And it could estimate the whole brain perfusion to help for formulating preoperative careful plan.
Arterial spin labeling
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In this study, we compared contrast-enhanced ultrasound perfusion imaging with magnetic resonance perfusion-weighted imaging or perfusion computed tomography for detecting normo-, hypo-, and nonperfused brain areas in acute middle cerebral artery stroke. We performed high mechanical index contrast-enhanced ultrasound perfusion imaging in 30 patients. Time-to-peak intensity of 10 ischemic regions of interests was compared to four standardized nonischemic regions of interests of the same patient. A time-to-peak >3 s (ultrasound perfusion imaging) or >4 s (perfusion computed tomography and magnetic resonance perfusion) defined hypoperfusion. In 16 patients, 98 of 160 ultrasound perfusion imaging regions of interests of the ischemic hemisphere were classified as normal, and 52 as hypoperfused or nonperfused. Ten regions of interests were excluded due to artifacts. There was a significant correlation of the ultrasound perfusion imaging and magnetic resonance perfusion or perfusion computed tomography (Pearson's chi-squared test 79.119, p < 0.001) (OR 0.1065, 95% CI 0.06-0.18). No perfusion in ultrasound perfusion imaging (18 regions of interests) correlated highly with diffusion restriction on magnetic resonance imaging (Pearson's chi-squared test 42.307, p < 0.001). Analysis of receiver operating characteristics proved a high sensitivity of ultrasound perfusion imaging in the diagnosis of hypoperfused area under the curve, (AUC = 0.917; p < 0.001) and nonperfused (AUC = 0.830; p < 0.001) tissue in comparison with perfusion computed tomography and magnetic resonance perfusion. We present a proof of concept in determining normo-, hypo-, and nonperfused tissue in acute stroke by advanced contrast-enhanced ultrasound perfusion imaging.
Contrast-enhanced ultrasound
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