scholarly journals NI-01 Usefulness of preoperative evaluation of glioma elasticity by the magnetic resonance elastography

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii12-ii13
Author(s):  
Shinichiro Koizumi ◽  
Kazuhiko Kurozumi
Keyword(s):  
Elastic Modulus ◽  
Magnetic Resonance ◽  
Preoperative Evaluation ◽  
Tumor Resection ◽  
High Grade Glioma ◽  
Magnetic Resonance Elastography ◽  
Low Grade ◽  
Intracranial Tumors ◽  
Grade 3 ◽  
Malignant Grade

Abstract Introduction: The elasticity of intracranial tumors is difficult to assess non-invasively because the lesion is surrounded by the skull. Therefore, intracranial tumors have not been verified before surgery in terms of elastic modulus. Magnetic resonance elastography (MRE) is an epoch-making method capable of non-invasively imaging the elasticity of internal organs. We have examined the elasticity of meningiomas and pituitary adenomas and reported their usefulness. This time, we measured the glioma elasticity and verified usefulness of MRE. Method: Twenty-four gliomas (mean age 51.8±15.7 years, male: female = 17: 7) who underwent tumor resection after MRE imaging from July 2017 to May 2020 were targeted. The average elasticity was measured as an evaluation of tumor elastic modulus by MRE. Gliomas were divided into a low-grade glioma group (LGG: Grade 1, 2) and a high-grade glioma group (HGG: Grade 3, 4). Then, a comparative statistical study was conducted. Results: The average values of the average elasticity of LGG group (9 cases) and HGG group (15 cases) were 1.8±0.8 kPa and 2.5±0.8 kPa, respectively. The average elasticity was significantly higher in the HGG group (p=0.023). In the ROC analysis, the cutoff value was 2.1 kPa (sensitivity 70%, specificity 70%). Therefore, it was suggested that the tumor is likely to be HGG when the average elasticity is 2.1 kPa or more. Discussion: The glioma elasticity by preoperative MRE was significantly higher in the HGG group. Based on actual surgical experience, the tumor seems to be hard in the HGG group, and it was judged to be consistent with this our MRE research. The preoperative evaluation of glioma elasticity by MRE was considered useful, and it might help in planning a surgical strategy considering malignant grade.

scholarly journals Efficiency of High and Standard b Value Diffusion-Weighted Magnetic Resonance Imaging in Grading of Gliomas

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Mansour Al-Agha ◽  
Khaled Abushab ◽  
Khetam Quffa ◽  
Samy Al-Agha ◽  
Yasser Alajerami ◽  
...  
Keyword(s):  
Preoperative Evaluation ◽  
Area Under The Curve ◽  
Region Of Interest ◽  
High Grade Glioma ◽  
B Value ◽  
Response To Therapy ◽  
Low Grade ◽  
Roc Curve Analysis ◽  
Diffusion Weighted ◽  
Adc Values

Background. Glioma is the most common fatal malignant tumor of the CNS. Early detection of glioma grades based on diffusion-weighted imaging (DWI) properties is considered one of the most recent noninvasive promising tools in the assessment of glioma grade and could be helpful in monitoring patient prognosis and response to therapy. Aim. This study aimed to investigate the accuracy of DWI at both standard and high b values (b = 1000 s/mm2 and b = 3000 s/mm2) to distinguish high-grade glioma (HGG) from low-grade glioma (LGG) in clinical practice based on histopathological results. Materials and Methods. Twenty-three patients with glioma had DWI at l.5 T MR using two different b values (b = 1000 s/mm2 and b = 3000 s/mm2) at Al-Shifa Medical Complex after obtaining ethical and administrative approvals, and data were collected from March 2019 to March 2020. Minimum, maximum, and mean of apparent diffusion coefficient (ADC) values were measured through drawing region of interest (ROI) on a solid part at ADC maps. Data were analyzed by using the MedCalc analysis program, version 19.0.4, receiver operating characteristic (ROC) curve analysis was done, and optimal cutoff values for grading gliomas were determined. Sensitivity and specificity were also calculated. Results. The obtained results showed the ADCmean, ADCratio, ADCmax, and ADCmin were performed to differentiate between LGG and HGG at both standard and high b values. Moreover, ADC values were inversely proportional to glioma grade, and these differences are more obvious at high b value. Minimum ADC values using standard b value were 1.13 ± 0.17 × 10−3 mm2/s, 0.89 ± 0.85 × 10−3 mm2/s, and 0.82 ± 0.17 × 10−3 mm2/s for grades II, III, and IV, respectively. Concerning high b value, ADCmin values were 0.76 ± 0.07 × 10−3 mm2/s, 0.61 ± 0.01 × 10−3 mm2/s, and 0.48 ± 0.07 × 10−3 mm2/s for grades II, III, and IV, respectively. ADC values were inversely correlated with results of glioma grades, and the correlation was stronger at ADC3000 (r = −0.722, P≤0.001). The ADC3000 achieved the highest diagnostic accuracy with an area under the curve (AUC) of 0.618, 100% sensitivity, 85.7% specificity, and 85.7% accuracy for glioma grading at a cutoff point of ≤0.618 × 10−3 mm2/s. The high b value showed stronger agreement with histopathology compared with standard b value results (k = 0.89 and 0.79), respectively. Conclusion. The ADC values decrease with an increase in tumor cellularity. Meanwhile, high b value provides better tissue contrast by reflecting more tissue diffusivity. Therefore, ADC-derived parameters at high b value are more useful in the grading of glioma than those obtained at standard b value. They might be a better surrogate imaging sequence in the preoperative evaluation of gliomas.

Prophylactic antiepileptic drug administration following brain tumor resection: results of a recent AANS/CNS Section on Tumors survey

2016 ◽  
Vol 126 (6) ◽  
pp. 1772-1778 ◽  
Author(s):  
Michael C. Dewan ◽  
Reid C. Thompson ◽  
Steven N. Kalkanis ◽  
Fred G. Barker ◽  
Constantinos G. Hadjipanayis
Keyword(s):  
Brain Tumor ◽  
Clinical Decision Making ◽  
Tumor Resection ◽  
High Grade Glioma ◽  
Clinical Decision ◽  
Low Grade ◽  
Seizure Prophylaxis ◽  
Tumor Pathology ◽  
Conflicting Evidence ◽  
Brain Tumor Resection

OBJECTIVEAntiepileptic drugs (AEDs) are often administered prophylactically following brain tumor resection. With conflicting evidence and unestablished guidelines, however, the nature of this practice among tumor surgeons is unknown.METHODSOn November 24, 2015, a REDCap (Research Electronic Database Capture) survey was sent to members of the AANS/CNS Section on Tumors to query practice patterns.RESULTSResponses were received from 144 individuals, including 18.8% of board-certified neurosurgeons surveyed (across 86 institutions, 16 countries, and 5 continents). The majority reported practicing in an academic setting (85%) as a tumor specialist (71%). Sixty-three percent reported always or almost always prescribing AED prophylaxis postoperatively in patients with a supratentorial brain tumor without a prior seizure history. Meanwhile, 9% prescribed occasionally and 28% rarely prescribed AED prophylaxis. The most common agent was levetiracetam (85%). The duration of seizure prophylaxis varied widely: 25% of surgeons administered prophylaxis for 7 days, 16% for 2 weeks, 21% for 2 to 6 weeks, and 13% for longer than 6 weeks. Most surgeons (61%) believed that tumor pathology influences epileptogenicity, with high-grade glioma (39%), low-grade glioma (31%), and metastases (24%) carrying the greatest seizure risk. While the majority used prophylaxis, 62% did not believe or were unsure if prophylactic AEDs reduced seizures postoperatively. The vast majority (82%) stated that a well-designed randomized trial would help guide their future clinical decision making.CONCLUSIONSWide knowledge and practice gaps exist regarding the frequency, duration, and setting of AED prophylaxis for seizure-naive patients undergoing brain tumor resection. Acceptance of universal practice guidelines on this topic is unlikely until higher-level evidence supporting or refuting the value of modern seizure prophylaxis is demonstrated.

scholarly journals Non-invasive characterization of intracranial tumors by magnetic resonance elastography

2013 ◽  
Vol 15 (8) ◽  
pp. 085024 ◽  
Author(s):  
M Simon ◽  
J Guo ◽  
S Papazoglou ◽  
H Scholand-Engler ◽  
C Erdmann ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Elastography ◽  
Intracranial Tumors ◽  
Non Invasive

scholarly journals Three-Year Survival Rate in All Kinds of Glioma Tumors in One Institution, Iran, 2001-2010

2020 ◽  
Vol 6 (2) ◽  
pp. 67-72
Author(s):  
Masih Rezaee ◽  
◽  
Bahram Amin Mansour ◽  
Keyword(s):  
Survival Rate ◽  
Survival Rates ◽  
Tumor Resection ◽  
High Grade Glioma ◽  
Good Prognosis ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Diffuse Astrocytoma ◽  
And Gender ◽  
Glioma Tumors

Background and Aim: The survival rate of brain tumors has not yet been reported in Iran. The purpose of this study, given the lack of such information, was to evaluate the 3-year survival rate in patients with all kinds of glioma tumors. Methods and Materials/Patients: This study was descriptive and retrospective, including 222 patients who had been diagnosed clinically with one type of glioma tumor and admitted to Al-Zahra hospital, Isfahan, Iran during 2001-2010. All patients (for minors, their parents) were contacted by phone. They were asked about the 3-year survival rate following their tumor resection surgery. Data such as patient’s age on admission, gender, histological diagnosis of tumor, and treatment regimen (surgical/non-surgical, radiation, and/or chemotherapy) were collected from medical records. The 3-year survival rate and frequency of each tumor based on age and gender were measured. Results: The 3-year survival rates for Glioblastoma Multiform (GBM) and anaplastic astrocytoma were 8.7% and 0%, respectively following surgery and chemo-radiation. These tumors were categorized as high-grade glioma with poor prognosis. The 3-year survival rate for diffuse astrocytoma, low-grade oligodendroglioma, low-grade ependymoma, and pilocytic astrocytoma following surgery and radiation were 100%, 95.2%, 100%, and 100%, respectively. These tumors were categorized as low-grade glioma, which has a good prognosis. Conclusion: In this study, the 3-year survival rate in patients with low-grade glioma following surgery and radiation was almost 100%. In contrast, the 3-year survival rate in patients with highgrade glioma following surgery and chemo-radiation was almost 0%.

scholarly journals Deep Learning Radiomics to Predict PTEN Mutation Status From Magnetic Resonance Imaging in Patients With Glioma

2021 ◽  
Vol 11 ◽  
Author(s):  
Hongyu Chen ◽  
Fuhua Lin ◽  
Jinming Zhang ◽  
Xiaofei Lv ◽  
Jian Zhou ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Characteristic Curve ◽  
Predictive Performance ◽  
High Grade Glioma ◽  
Low Grade ◽  
Resonance Imaging ◽  
Mutation Status ◽  
Phosphatase And Tensin Homolog ◽  
Tensin Homolog

ObjectivesPhosphatase and tensin homolog (PTEN) mutation is an indicator of poor prognosis of low-grade and high-grade glioma. This study built a reliable model from multi-parametric magnetic resonance imaging (MRI) for predicting the PTEN mutation status in patients with glioma.MethodsIn this study, a total of 244 patients with glioma were retrospectively collected from our center (n = 77) and The Cancer Imaging Archive (n = 167). All patients were randomly divided into a training set (n = 170) and a validation set (n = 74). Three models were built from preoperative MRI for predicting PTEN status, including a radiomics model, a convolutional neural network (CNN) model, and an integrated model based on both radiomics and CNN features. The performance of each model was evaluated by accuracy and the area under the receiver operating characteristic curve (AUC).ResultsThe CNN model achieved an AUC of 0.84 and an accuracy of 0.81, which performed better than did the radiomics model, with an AUC of 0.83 and an accuracy of 0.66. Combining radiomics with CNN will further benefit the predictive performance (accuracy = 0.86, AUC = 0.91).ConclusionsThe combination of both the CNN and radiomics features achieved significantly higher performance in predicting the mutation status of PTEN in patients with glioma than did the radiomics or the CNN model alone.

scholarly journals Harnessing brain waves: a review of brain magnetic resonance elastography for clinicians and scientists entering the field

2021 ◽  
Vol 94 (1119) ◽  
pp. 20200265
Author(s):  
Arvin Arani ◽  
Armando Manduca ◽  
Richard L Ehman ◽  
John Huston III
Keyword(s):  
Magnetic Resonance ◽  
Intracranial Pressure ◽  
Demyelinating Disease ◽  
Neurological Diseases ◽  
Magnetic Resonance Elastography ◽  
Intracranial Tumors ◽  
Clinical Role ◽  
Parameter Estimations ◽  
Neuroscience Research

Brain magnetic resonance elastography (MRE) is an imaging technique capable of accurately and non-invasively measuring the mechanical properties of the living human brain. Recent studies have shown that MRE has potential to provide clinically useful information in patients with intracranial tumors, demyelinating disease, neurodegenerative disease, elevated intracranial pressure, and altered functional states. The objectives of this review are: (1) to give a general overview of the types of measurements that have been obtained with brain MRE in patient populations, (2) to survey the tools currently being used to make these measurements possible, and (3) to highlight brain MRE-based quantitative biomarkers that have the highest potential of being adopted into clinical use within the next 5 to 10 years. The specifics of MRE methodology strategies are described, from wave generation to material parameter estimations. The potential clinical role of MRE for characterizing and planning surgical resection of intracranial tumors and assessing diffuse changes in brain stiffness resulting from diffuse neurological diseases and altered intracranial pressure are described. In addition, the emerging technique of functional MRE, the role of artificial intelligence in MRE, and promising applications of MRE in general neuroscience research are presented.

scholarly journals Magnetic resonance diffusion and perfusion for differentiation of low grade from high grade glioma

2015 ◽  
Vol 4 (1) ◽  
pp. 15
Author(s):  
Radoslav Georgiev ◽  
Boyan Balev ◽  
Ara Kaprelyan ◽  
Marianna Novakova
Keyword(s):  
Magnetic Resonance ◽  
High Grade Glioma ◽  
Low Grade ◽  
High Grade

scholarly journals Metabolic approach for tumor delineation in glioma surgery: 3D MR spectroscopy image–guided resection

2016 ◽  
Vol 124 (6) ◽  
pp. 1585-1593 ◽  
Author(s):  
Jie Zhang ◽  
Dong-Xiao Zhuang ◽  
Cheng-Jun Yao ◽  
Ching-Po Lin ◽  
Tian-Liang Wang ◽  
...  
Keyword(s):  
Mr Spectroscopy ◽  
Tumor Resection ◽  
Three Dimensional ◽  
High Grade Glioma ◽  
Radiotherapy Planning ◽  
Low Grade ◽  
Structural Imaging ◽  
Glioma Surgery ◽  
Extensive Resection ◽  
Glioma Resection

OBJECT The extent of resection is one of the most essential factors that influence the outcomes of glioma resection. However, conventional structural imaging has failed to accurately delineate glioma margins because of tumor cell infiltration. Three-dimensional proton MR spectroscopy (1H-MRS) can provide metabolic information and has been used in preoperative tumor differentiation, grading, and radiotherapy planning. Resection based on glioma metabolism information may provide for a more extensive resection and yield better outcomes for glioma patients. In this study, the authors attempt to integrate 3D 1H-MRS into neuronavigation and assess the feasibility and validity of metabolically based glioma resection. METHODS Choline (Cho)–N-acetylaspartate (NAA) index (CNI) maps were calculated and integrated into neuronavigation. The CNI thresholds were quantitatively analyzed and compared with structural MRI studies. Glioma resections were performed under 3D 1H-MRS guidance. Volumetric analyses were performed for metabolic and structural images from a low-grade glioma (LGG) group and high-grade glioma (HGG) group. Magnetic resonance imaging and neurological assessments were performed immediately after surgery and 1 year after tumor resection. RESULTS Fifteen eligible patients with primary cerebral gliomas were included in this study. Three-dimensional 1H-MRS maps were successfully coregistered with structural images and integrated into navigational system. Volumetric analyses showed that the differences between the metabolic volumes with different CNI thresholds were statistically significant (p < 0.05). For the LGG group, the differences between the structural and the metabolic volumes with CNI thresholds of 0.5 and 1.5 were statistically significant (p = 0.0005 and 0.0129, respectively). For the HGG group, the differences between the structural and metabolic volumes with CNI thresholds of 0.5 and 1.0 were statistically significant (p = 0.0027 and 0.0497, respectively). All patients showed no tumor progression at the 1-year follow-up. CONCLUSIONS This study integrated 3D MRS maps and intraoperative navigation for glioma margin delineation. Optimum CNI thresholds were applied for both LGGs and HGGs to achieve resection. The results indicated that 3D 1H-MRS can be integrated with structural imaging to provide better outcomes for glioma resection.

Temporoinsular Glioma Resection under Awake Mapping: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (1) ◽  
pp. E54-E54 ◽  
Author(s):  
Fangyuan Gong ◽  
N U Farrukh Hameed ◽  
Zeyang Li ◽  
Nijiati Kudulaiti ◽  
Jie Zhang ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Memory Loss ◽  
Motor Evoked Potential ◽  
Motor Deficits ◽  
Resonance Spectroscopy ◽  
Low Grade ◽  
Precentral Gyrus ◽  
Patient Consent

Abstract Temporoinsular gliomas are frequently large-sized tumors that require meticulous planning to ensure maximum surgical resection and minimal neurologic deficits in patients. Here, we demonstrate our technique encompassing multi-modal imaging guidance and awake brain mapping which enables maximum safe resection of such tumors. The patient, a 39-yr-old man, presented with depression and memory loss for 18 mo. Preoperative magnetic resonance imaging (MRI; MAGNETOM Verio, Siemens) revealed a nonenhancing lesion in the left dominant temporoinsular lobe. Three-dimensional magnetic resonance spectroscopy was used to analyze the choline/N-acetyl-aspartate index which suggested a low-grade glioma diagnosis. Informed patient consent was obtained. After craniotomy, the mouth motor, speech arrest, and word generation areas were mapped via direct cortical stimulation under awake mapping. A strip electrode was placed across the precentral gyrus for continuous motor evoked potential monitoring. Cortical incisions were made in nonfunctional cortical areas and tumor was resected in the temporal lobe. Following this, tumor at the inferior insular zone was carefully debunked with Cavitron Ultrasonic Surgical Aspirator (Integra Lifescience) also through the temporal window. The hippocampus was preserved since it was not invaded by tumor. Subcortical mapping combined with Diffuse Tensor Imaging tractography-based navigation (Medtronic lnc.) was performed to localize the motor and language pathways. Intraoperative MRI evaluation showed tumor resection extent of 95%. Pathological and molecular analysis revealed a diagnosis of Grade II IDH-mutant oligodendroglioma. After surgery the patient was administered chemotherapy (Temozolomide). He recovered without language or motor deficits.

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