Multiparametric magnetic resonance imaging to differentiate high-grade gliomas and brain metastases

Purpose For chemotherapy to act synergistically and safely with radiation against high-grade gliomas, drugs must pass the endothelial junctions of the blood-tumor barrier (BTB) to reach all tumor cells, and should not pass the blood-brain barrier (BBB) to cause toxicity to normal brain. The objective of this study was to assess BBB/BTB status using magnetic resonance imaging (MRI) during a course of radiotherapy of high-grade gliomas. Patients and Methods Sixteen patients with grade 3 or 4 supratentorial malignant glioma receiving conformal radiotherapy (RT) underwent contrast-enhanced MRI before, during, and after completion of RT. A gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) uptake index was analyzed with respect to the tumor and RT dose received. Results In the nonenhanced tumor region, contrast uptake increased significantly after the receipt of approximately 10 Gy (P < .01), and reached a maximum after the receipt of approximately 30 Gy. In the initially contrast-enhanced tumor region, contrast uptake decreased over the course of RT and became significant after completion of RT in patients without progressive disease. The healthy brain showed only nonsignificant changes during and after irradiation. Conclusion Contrast MRI reveals increases in Gd-DTPA uptake in the initially nonenhanced tumor region but not in the remaining brain during the course of RT, suggesting opening of the BTB. This finding suggests that the effect of conformal radiation is more selective on the BTB than the BBB, and there may be a window extending from 1 week after the initiation of radiotherapy to 1 month after the completion of treatment during which a pharmaceutical agent has maximum access to high-grade gliomas.

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Evaluating changes in tumor volume using magnetic resonance imaging during the course of radiotherapy treatment of high-grade gliomas: Implications for conformal dose-escalation studies

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2004.10.010 ◽

2005 ◽

Vol 62 (2) ◽

pp. 328-332 ◽

Cited By ~ 18

Author(s):

Christina Tsien ◽

Diana Gomez-Hassan ◽

Randall K. Ten Haken ◽

Daniel Tatro ◽

L. Junck ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Dose Escalation ◽

Tumor Volume ◽

High Grade ◽

Resonance Imaging ◽

High Grade Gliomas ◽

Radiotherapy Treatment

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Prediction of High-grade Prostate Cancer Following Multiparametric Magnetic Resonance Imaging: Improving the Rotterdam European Randomized Study of Screening for Prostate Cancer Risk Calculators

European Urology ◽

10.1016/j.eururo.2018.07.031 ◽

2019 ◽

Vol 75 (2) ◽

pp. 310-318 ◽

Cited By ~ 37

Author(s):

Arnout R. Alberts ◽

Monique J. Roobol ◽

Jan F.M. Verbeek ◽

Ivo G. Schoots ◽

Peter K. Chiu ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Cancer Risk ◽

Randomized Study ◽

Prostate Cancer Risk ◽

High Grade ◽

Resonance Imaging ◽

Multiparametric Magnetic Resonance Imaging

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Extent of High-Grade Prostatic Adenocarcinoma in Multiparametric Magnetic Resonance Imaging–Targeted Biopsy Enhances Prediction of Pathologic Stage

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2020-0568-oa ◽

2021 ◽

Author(s):

Nathan Paulson ◽

Robin T. Vollmer ◽

Peter A. Humphrey ◽

Preston C. Sprenkle ◽

John Onofrey ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Prostatic Adenocarcinoma ◽

High Grade ◽

Targeted Biopsy ◽

Resonance Imaging ◽

Grade Group ◽

Multiparametric Magnetic Resonance Imaging ◽

Pathologic Stage ◽

Targeted Biopsies

Context.— Multiparametric magnetic resonance imaging (mpMRI) of prostate with targeted biopsy has enhanced detection of high-grade prostatic adenocarcinoma (HG PCa). However, utility of amount of HG PCa (Gleason pattern 4/5) in mpMRI-targeted biopsies versus standard 12-core biopsies in predicting adverse outcomes on radical prostatectomy (RP) is unknown. Objective.— To examine the utility of amount of HG PCa in mpMRI-targeted biopsies versus standard 12-core biopsies in predicting adverse RP outcomes. Design.— We performed a retrospective review of prostate biopsies, which had corresponding RP, 1 or more mpMRI-targeted biopsy, and grade group 2 disease or higher. For the 169 cases identified, total millimeters of carcinoma and HG PCa, and longest length HG PCa in a single core were recorded for 12-core biopsies and each set of mpMRI-targeted biopsies. For RP specimens, Gleason grade, extraprostatic extension, seminal vesicle involvement, and lymph node metastasis were recorded. The main outcome studied was prostate-confined disease at RP. A logistic regression model was used to test which pre-RP variables related to this outcome. Results.— Univariate analysis showed significant associations with adverse RP outcomes in 5 of 8 quantifiable variables; longest millimeter HG PCa in a single 12-core biopsy, highest grade group in any core, and total millimeter HG in mpMRI-targeted biopsies showed no statistical association (P = .54, P = .13, and P = .55, respectively). In multivariate analysis, total millimeter carcinoma in all cores, highest GrGrp in any core, and longest millimeter HG PCa in a single mpMRI-targeted core provided additional predictive value (P < .001, P = .004, and P = .03, respectively). Conclusions.— Quantitation of HG PCa in mpMRI-targeted biopsies provides additional value over 12-core biopsies alone in predicting nonorgan confined prostate cancer at RP. Linear millimeters of HG PCa in mpMRI-targeted biopsies is a significant parameter associated with higher pathologic stage and could be of value in risk models.

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