Portable Intraoperative Computed Tomography Scan in Image-Guided Surgery for Brain High-grade Gliomas: Analysis of Technical Feasibility and Impact on Extent of Tumor Resection

2015 ◽  
Vol 12 (1) ◽  
pp. 19-30 ◽  
Author(s):  
Giuseppe MV Barbagallo ◽  
Stefano Palmucci ◽  
Massimiliano Visocchi ◽  
Sabrina Paratore ◽  
Giancarlo Attinà ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Residual Tumor ◽  
High Grade ◽  
Resonance Imaging ◽  
Technical Feasibility ◽  
Intraoperative Computed Tomography ◽  
Guided Surgery ◽  
Image Guided ◽  
Group A ◽  
Group B

Abstract BACKGROUND Intraoperative magnetic resonance imaging is the gold standard among image-guided techniques for glioma surgery. Scant data are available on the role of intraoperative computed tomography (i-CT) in high-grade glioma (HGG) surgery. OBJECTIVE To verify the technical feasibility and usefulness of portable i-CT in image-guided surgical resection of HGGs. METHODS This is a retrospective series control analysis of prospectively collected data. Twenty-five patients (Group A) with HGGs underwent surgery using i-CT and 5-aminolevulinic acid (5-ALA) fluorescence. A second cohort of 25 patients (Group B) underwent 5-ALA fluorescence–guided surgery but without i-CT. We used a portable 8-slice CT scanner and, in both groups, neuronavigation. Extent of tumor resection (ETOR) and pre- and postoperative Karnofsky performance status (KPS) scores were measured; the impact of i-CT on overall survival (OS) and progression-free survival (PFS) was also analyzed. RESULTS In 8 patients (32%) in Group A, i-CT revealed residual tumor, and in 4 of them it helped to also resect pathological tissue detached from the main tumor. EOTR in these 8 patients was 97.3% (96%-98.6%). In Group B, residual tumor was found in 6 patients, whose tumor's mean resection was 98% (93.5-99.7). The Student t test did not show statistically significant differences in EOTR in the 2 groups. The KPS score decreased from 67 to 69 after surgery in Group A and from 74 to 77 in Group B (P = .07 according to the Student t test). Groups A and B did not show statistically significant differences in OS and PFS (P = .61 and .46, respectively, by the log-rank test). CONCLUSION No statistically significant differences in EOTR, KPS, PFS, and OS were observed in the 2 groups. However, i-CT helped to verify EOTR and to update the neuronavigator with real-time images, as well as to identify and resect pathological tissue in multifocal tumors. i-CT is a feasible and effective alternative to intraoperative magnetic resonance imaging. Portable i-CT can provide useful real-time information during brain surgery and can be easily introduced in neurosurgical theaters in daily practice.

scholarly journals Radiopharmaceutical and Eu3+ doped gadolinium oxide nanoparticles mediated triple-excited fluorescence imaging and image-guided surgery

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaojing Shi ◽  
Caiguang Cao ◽  
Zeyu Zhang ◽  
Jie Tian ◽  
Zhenhua Hu
Keyword(s):  
Fluorescent Probes ◽  
Signal Intensity ◽  
Tumor Imaging ◽  
Tumor Resection ◽  
Optical Signal ◽  
Gadolinium Oxide ◽  
Image Guided Surgery ◽  
Guided Surgery ◽  
Image Guided ◽  
The Impact

AbstractCerenkov luminescence imaging (CLI) is a novel optical imaging technique that has been applied in clinic using various radionuclides and radiopharmaceuticals. However, clinical application of CLI has been limited by weak optical signal and restricted tissue penetration depth. Various fluorescent probes have been combined with radiopharmaceuticals for improved imaging performances. However, as most of these probes only interact with Cerenkov luminescence (CL), the low photon fluence of CL greatly restricted it’s interaction with fluorescent probes for in vivo imaging. Therefore, it is important to develop probes that can effectively convert energy beyond CL such as β and γ to the low energy optical signals. In this study, a Eu3+ doped gadolinium oxide (Gd2O3:Eu) was synthesized and combined with radiopharmaceuticals to achieve a red-shifted optical spectrum with less tissue scattering and enhanced optical signal intensity in this study. The interaction between Gd2O3:Eu and radiopharmaceutical were investigated using 18F-fluorodeoxyglucose (18F-FDG). The ex vivo optical signal intensity of the mixture of Gd2O3:Eu and 18F-FDG reached 369 times as high as that of CLI using 18F-FDG alone. To achieve improved biocompatibility, the Gd2O3:Eu nanoparticles were then modified with polyvinyl alcohol (PVA), and the resulted nanoprobe PVA modified Gd2O3:Eu (Gd2O3:Eu@PVA) was applied in intraoperative tumor imaging. Compared with 18F-FDG alone, intraoperative administration of Gd2O3:Eu@PVA and 18F-FDG combination achieved a much higher tumor-to-normal tissue ratio (TNR, 10.24 ± 2.24 vs. 1.87 ± 0.73, P = 0.0030). The use of Gd2O3:Eu@PVA and 18F-FDG also assisted intraoperative detection of tumors that were omitted by preoperative positron emission tomography (PET) imaging. Further experiment of image-guided surgery demonstrated feasibility of image-guided tumor resection using Gd2O3:Eu@PVA and 18F-FDG. In summary, Gd2O3:Eu can achieve significantly optimized imaging property when combined with 18F-FDG in intraoperative tumor imaging and image-guided tumor resection surgery. It is expected that the development of the Gd2O3:Eu nanoparticle will promote investigation and application of novel nanoparticles that can interact with radiopharmaceuticals for improved imaging properties. This work highlighted the impact of the nanoprobe that can be excited by radiopharmaceuticals emitting CL, β, and γ radiation for precisely imaging of tumor and intraoperatively guide tumor resection.

Inflammatory Atrophy of the Prostate

2003 ◽  
Vol 127 (7) ◽  
pp. 840-844 ◽  
Author(s):  
Athanase Billis ◽  
Luis A. Magna
Keyword(s):  
Chronic Inflammation ◽  
Intraepithelial Neoplasia ◽  
Prostatic Intraepithelial Neoplasia ◽  
Common Finding ◽  
High Grade ◽  
Group A ◽  
Prostatic Atrophy ◽  
Group B ◽  
Inflammation Group ◽  
Topographical Relation

Abstract Context.—Recently, prostatic atrophy associated with chronic inflammation has been linked to carcinoma either directly or indirectly by first developing into high-grade prostatic intraepithelial neoplasia. Objective.—The purpose of our study was to test this hypothesis in autopsies. Design.—A step section method was used to cut the posterior lobe in coronal planes at intervals of 0.3 to 0.5 cm in 100 consecutive autopsies of men older than 40 years. Prostatic atrophy was classified as simple, hyperplastic (or postatrophic hyperplasia), and sclerotic and was analyzed for the presence of chronic inflammation. Prostatic atrophy without (group A) and with inflammation (group B) was correlated with the following variables: age, race, histologic (incidental) carcinoma, high-grade prostatic intraepithelial neoplasia, and extent of both these lesions. Results.—Of the 100 prostates examined, 12%, 22% and 66%, respectively, had no atrophy, atrophy without inflammation (group A), and atrophy with inflammation (group B). There was no statistically significant difference between groups A and B for age (P = .55), race (P = .89), presence of histologic (incidental) carcinoma (P = .89), extensive carcinoma (P = .43), presence of high-grade prostatic intraepithelial neoplasia (P = .65), extensive high-grade intraepithelial neoplasia (P = .30), or subtypes of prostatic atrophy. Neither a topographical relation nor a morphologic transition was seen between prostatic atrophy and histologic carcinoma or high-grade intraepithelial neoplasia. Sclerotic atrophy either alone or combined with other subtypes was more frequent in the group with inflammation. A striking morphologic finding was a topographical relation of focal inflammation with sclerotic atrophy in areas with erosion of the epithelium. Conclusions.—Inflammatory prostatic atrophy does not appear to be associated with histologic (incidental) carcinoma or high-grade intraepithelial neoplasia. One possible cause of inflammatory infiltrate associated with prostatic atrophy may be the extravasated prostatic secretions, which were noted in areas of eroded epithelium, a common finding in the sclerotic type of prostatic atrophy.

Disruption of the Finger Flexor Pulley System in Elite Rock Climbers

1998 ◽  
Vol 26 (5) ◽  
pp. 651-655 ◽  
Author(s):  
Markus Gabl ◽  
Christoph Rangger ◽  
Martin Lutz ◽  
Christian Fink ◽  
Ansgar Rudisch ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Nonoperative Treatment ◽  
Proximal Interphalangeal Joint ◽  
Magnetic Resonance Images ◽  
Resonance Imaging ◽  
Pulley System ◽  
Group A ◽  
Complete Disruption ◽  
Group B

We treated 13 elite rock climbers for isolated disruptions of the pulleys of the long fingers. Diagnosis and treatment were based on the clinical finding of bowstringing, which was confirmed by magnetic resonance imaging. Eight patients had bowstringing indicating incomplete disruption of the major pulley A2 and were treated nonoperatively (group A). Five patients showed bowstringing indicating complete disruption of the pulley A2. After failed nonoperative treatment, the pulleys were reconstructed (group B). The mechanism of injury and clinical and subjective results were evaluated. At a 31-month follow-up (range, 18 to 43 months), loss of extension in the proximal interphalangeal joint measured 5.6° (range, 0° to 10°) in group A and 4° (range, 0° to 10°) in group B. Circumference of the finger section was increased 4.2 mm in group A (range, 0 to 10 mm) and 4.8 mm in group B (range, 0 to 10 mm). Grip strength decreased 20 N in group A (range, 10 to 50 N) and 12 N in group B (range, 10 to 30 N). Four patients in group A and one in group B had bowstringing at clinical evaluation. On follow-up magnetic resonance images, bowstringing remained unchanged in group A but was reduced in all patients in group B. Good subjective results were seen in both groups.

scholarly journals Transcranial versus Endoscopic Transsphenoidal Approaches in Management of Recurrent Giant Pituitary Adenomas

2020 ◽  
Vol 8 (B) ◽  
pp. 273-280
Author(s):  
Mohamed Ismail ◽  
Omar Abdel Aleem Abdel Moneim Ragab ◽  
Mohamed M. Salama ◽  
Basim M. Ayoub ◽  
Wael Elmahdy
Keyword(s):  
Clinical Outcome ◽  
Pituitary Adenomas ◽  
Tumor Resection ◽  
Transsphenoidal Approach ◽  
Subtotal Resection ◽  
Visual Improvement ◽  
Group A ◽  
Transcranial Approach ◽  
Giant Pituitary Adenomas ◽  
Group B

AIM: The aim of this study was to compare the transcranial and the endoscopic transsphenoidal approaches for patients with recurrent giant pituitary adenomas as regards the extent of tumor resection and the clinical outcome. METHODS: The study included 21 patients with recurrent giant pituitary adenomas divided into two groups; Group A included nine patients operated on by transcranial approaches and Group B included 12 patients operated on by the endoscopic transsphenoidal approach. Both groups were compared as regards the extent of tumor resection and the post-operative clinical outcome, particularly the visual and endocrinological outcomes, in addition to morbidity and mortality. RESULTS: There was a higher incidence of total and near-total resection in Group B (41.7%) and a higher incidence of subtotal resection in Group A (55.6%). The incidence of visual improvement was higher in Group B (55.6%) than in Group A (28.6%). Post-operative biochemical remission was achieved in 100% of Group B patients and in 50% of Group A patients with functioning adenomas. The incidence of post-operative complications was higher in Group A (77.8%) than in Group B (50%). CONCLUSION: The endoscopic transsphenoidal approach for recurrent giant pituitary adenomas is associated with a higher extent of tumor resection, better rates of visual improvement and endocrinological remission, and lower incidence of complications. The transcranial approach should be reserved for some adenomas with marked lateral or anterior extensions, fibrous tumors, and after the failure of the endoscopic transsphenoidal approach.

scholarly journals Microsurgical Treatment of Symptomatic Vestibular Schwannomas in Patients Under 40: Different Results Before and After Age of 30

2021 ◽  
Author(s):  
Luciano Mastronardi ◽  
Alberto Campione ◽  
Guglielmo Cacciotti ◽  
Ettore Carpineta ◽  
Carlo Giacobbo Scavo ◽  
...  
Keyword(s):  
Tumor Volume ◽  
Case Series ◽  
Residual Tumor ◽  
Young Group ◽  
Study Cohort ◽  
Consecutive Series ◽  
Total Resection ◽  
Group A ◽  
Group B ◽  
Age Range

Abstract Background: In 10-15% of cases of vestibular schwannoma (VS) age at diagnosis is 40 years or less. Little is known about the differences in natural history, surgical findings and postoperative outcomes of such younger patients as compared to those of greater age. Objectives : To analyze clinical and surgical and imaging data of a consecutive series of n=50 patients with unilateral sporadic VS, aged 40 years or younger – separated in a very young group (15-30 years) and a moderately young group (31-40 years). Study design: Retrospective case series Methods: 50 consecutive patients under 40 years of age underwent microsurgical resection of unilateral sporadic VS via the retrosigmoid approach. The study cohort was subdivided into two groups according to the age range: Group A, age range 15-30 years (n=23 patients) and Group B, age range 31-40 years (n=27 patients). The adherence of VS capsule to surrounding nervous structures and the tendency of the tumors to bleed were evaluated by reviewing video records; the course of the FN in relation to the tumor’s surface was assessed in each case. Microsurgical removal of tumor was classified as total (T), near total (residual tumor volume <5%), subtotal (residual tumor volume 5-10%) or partial (residual tumor volume >10%). Results: Mean tumor size of entire cohort was 2,53 (range: 0,6-5,8) cm: 2,84 cm in Group A and 2,36 cm in Group B (p=NS). Facial nerve course and position within the cerebellopontine angle did not differ significantly between the two groups. At 6-month follow-up, FN functional outcome was: HBI-II in 69,5% in Group A, versus 96,3% in Group B (p<,001). Hearing preservation was achieved in 60,0% of patients of Group A and in 58,3% of Group B (p=NS). Total and near-total resection was feasible in 95,6% of cases of Group A and in 88,9% of Group B (p=NS). Tumor capsule was tightly adherent to nervous structures in 69,6% patients of Group A and in 22,2% of Group B (p<,05). Significant bleeding was encountered in 56,5% of Group A tumors, and in 29,6% of Group B tumors (p<,01).Conclusions: Microsurgery of VS in patients aged 40 or less is associated with good functional results, and with high rates of total and near total tumor removal. Patients <30 years of age have more adherent tumor capsules. Furthermore, their tumors exhibit a tendency to larger sizes, to hypervascularization, to profuse intraoperative bleeding and they present worse long-term functional FN results when compared to patients in their fourth decade of life. Our limited experience seems to suggest that a near total resection in very young VS patients with large tumors should be preferred in adherent and hypervascularized cases, in order to maximize resection and preserve function.

scholarly journals DCE-MRI of esophageal carcinoma using star-VIBE compared with conventional 3D-VIBE

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
He-Ping Deng ◽  
Xue-Ming Li ◽  
Liu Yang ◽  
Yi Wang ◽  
Shao-Yu Wang ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Free Breathing ◽  
Sequence Group ◽  
Resonance Imaging ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Group A ◽  
Group B

AbstractTo investigate the value of the star-VIBE sequence in dynamic contrast-enhanced magnetic resonance imaging of esophageal carcinoma under free breathing conditions. From February 2019 to June 2020, 60 patients with esophageal carcinoma were prospectively enrolled to undergo dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with the K-space golden-angle radial stack-of-star acquisition scheme (star-VIBE) sequence (Group A) or conventional 3D volumetric-interpolated breath-hold examination (3D-VIBE) sequence (Group B), completely randomized grouping. The image quality of DCE-MRI was subjectively evaluated at five levels and objectively evaluated according to the image signal-to-noise ratio (SNR) and contrast-noise ratio (CNR). The DCE-MRI parameters of volume transfer constant (Ktrans), rate constant (Kep) and vascular extracellular volume fraction (Ve) were calculated using the standard Tofts double-compartment model in the post-perfusion treatment software TISSUE 4D (Siemens). Each group included 30 randomly selected cases. There was a significant difference in subjective classification between the groups (35.90 vs 25.10, p = 0.009). The study showed that both the SNR and CNR of group A were significantly higher than those of group B (p = 0.004 and < 0.001, respectively). There was no significant difference in Ktrans, Kep or Ve between the groups (all p > 0.05). The star-VIBE sequence can be applied in DCE-MRI examination of esophageal carcinoma, which can provide higher image quality than the conventional 3D-VIBE sequence in the free breathing state.

Comparison of neoadjuvant paclitaxel and carboplatin with neoadjuvant letrozole in postmenopausal patients with receptor-positive locally advanced breast cancer (LABC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 608-608
Author(s):  
D. Sinha ◽  
A. K. Bahadur ◽  
K. Singh ◽  
A. K. Rathi
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Residual Tumor ◽  
Complete Response ◽  
Neoadjuvant Hormonal Therapy ◽  
Co Morbidity ◽  
Group A ◽  
Group B

608 Background: For the treatment of LABC using a regimen with the highest likelihood of shrinking the tumor should improve the outcome. Paclitaxel was the first taxane to show activity in breast cancer. The advent of endocrine therapy in the neoadjuvant setting allows downstaging of tumors with less morbidity. The aromatase inhibitors are now the treatment of choice in neoadjuvant setting for elderly patients with estrogen receptor-positive breast cancer. Methods: This prospective, randomized, comparative study assessed the effect of three cycles of neoadjuvant chemotherapy vs. three months of neoadjuvant hormonal therapy in terms of loss of clinical and pathological primary tumor size. Inclusion criteria required postmenopausal patients with non-metastatic, ER and/or PR positive LABC with no co-morbidity. Forty eligible patients were randomly assigned into 2 groups of 20 patients each: Group A treated with 3 cycles of 3 weekly injections of paclitaxel (175 mg/m2) and carboplatin (AUC 6) assessed after each cycle; group B received oral Letrozole 2.5mg once daily for 3 months assessed every 4 weeks. Surgery was done and primary specimen was pathologically examined. Results: Clinically mean loss in primary residual tumor compared to volume at presentation in group A vs. group B at 1st review was 45% vs. 35% (p: 0.536), 63% vs. 57% at second (p: 0.176), and 71% vs. 74% at third review (p: 0.062).Clinical complete response (WHO criteria) and stable disease each were seen in 14% in either group of patients (p: 0.632), partial response in 65% group A and in 72% group B (p: 0.117); no progressive disease was seen in either. All patients underwent surgery. The mean pathological primary cell kill in group A vs. group B was 81% vs.78 %(p:0.918). Resected nodes were pathologically positive for tumor in 47% group A and 60% group B patients (p: 0.269). Conclusions: Neoadjuvant hormonal therapy using oral Letrozole in receptor positive LABC in post menopausal women is as effective as three weekly paclitaxel and carboplatin in downstaging the tumor. No significant financial relationships to disclose.

Identification of Numerical Chromosomal Changes Detected by Interphase Fluorescence In Situ Hybridization in High-Grade Prostate Intraepithelial Neoplasia as a Predictor of Carcinoma

2002 ◽  
Vol 126 (2) ◽  
pp. 165-169
Author(s):  
Jaudah Al-Maghrabi ◽  
Lada Vorobyova ◽  
A. Toi ◽  
William Chapman ◽  
Maria Zielenska ◽  
...  
Keyword(s):  
In Situ Hybridization ◽  
Chromosomal Abnormalities ◽  
Intraepithelial Neoplasia ◽  
High Grade ◽  
Prostate Intraepithelial Neoplasia ◽  
Group A ◽  
Chromosomal Changes ◽  
Group B

Abstract Context.—High-grade prostate intraepithelial neoplasia (HPIN) is the most likely precursor of prostate cancer. The condition of many patients with a diagnosis of HPIN in prostate needle core biopsy could, if left untreated, progress to invasive cancer. Currently there is no available clinical, immunohistochemical, or morphologic criteria that are predictive of this progression. Objective.—To determine whether chromosomal instability in these precursor lesions could increase their predictive value for cancer detection. Design.—Dual-color interphase fluorescence in situ hybridization analysis was performed on archived prostate needle core biopsies from 54 patients with initial diagnosis of isolated HPIN and follow-up of 3 years or more. We used commercially available centromere probes for chromosomes 4, 7, 8, and 10. We had interpretable results in 44 patients as follows: (1) group A: 24 HPIN patients with persistent HPIN and/or benign lesions in the follow-up biopsies, and (2) group B: 20 HPIN patients with progression to prostate carcinoma. Results.—Twenty-five percent of the patients in group B displayed numeric chromosomal aberrations. Only 8.3% of the patients from group A had chromosomal abnormalities (P = .1). The observed overall chromosomal changes in HPIN were higher than those in normal or hyperplastic epithelium, with a statistically significant difference (P &lt; .05). All aberrations were detected in the form of chromosomal gain. Overall, the commonest aberration was gain of chromosome 8, followed by gains of chromosomes 7 and 10. Conclusion.—These results indicated that although no single numeric chromosomal abnormality could be assigned as a predictor of HPIN progression to carcinoma, the overall level of numeric chromosomal abnormalities shows a trend of elevation in HPIN patients whose condition subsequently progressed to carcinoma.

Application of Gold Nanoparticles in Magnetic Resonance Imaging for Targeted Diagnosis and Treatment of Breast Cancer

2021 ◽  
Vol 13 (9) ◽  
pp. 1595-1602
Author(s):  
Yuli Wu ◽  
Junwei Song ◽  
Shengcui Liu ◽  
Xianglei Wei ◽  
Weiwei Chen
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance Imaging ◽  
Targeted Therapy ◽  
Magnetic Resonance ◽  
Diagnosis And Treatment ◽  
Control Group ◽  
Breast Cancer Patients ◽  
Resonance Imaging ◽  
Group A ◽  
Group B

This study aimed to explore the application of super paramagnetic gold magnetic nanoparticles (Au-M-NPs) in the magnetic resonance imaging (MRI) images for targeted diagnosis and treatment of breast cancer. The reducibility of ethylene glycol to ferric chloride (FeCl3) was adopted to synthesize the Au-M-NPs by solvothermal method by taking acetic acid as the base source and trisodium citrate as the stabilizer. Besides, the synthesized Au-M-NPs were applied in the MRI images for targeted therapy of breast cancer. Patients from a blank group (group A), a control group (group B), and an experimental group (group C) received the traditional clinical diagnosis treatment, MRI diagnosis, and Au-M-NPs targeted therapy with MRI in turn. The results showed that the prepared Au-M-NPs were featured with small particle size and good dispersibility, and were monodispersive after surface modification. The intraoperative blood loss of patients from group A (115.3±9.33 mL) and group B (94.6±9.72 mL) was obviously higher than the loss of group C (68.4±8.7 mL) (P < 0.05). The drainage volume of patients from group B (162.4±12.3 mL) and group C (131.9±11.8 mL) decreased sharply after surgery compared with group A (193.7±11.8 mL), and that in group C was the lowest (P < 0.05). The proportion of local recurrence in patients from group B (12.3%) and group C (6.4%) dropped steeply in contrast to the proportion of group A (13.2%) (P < 0.05). The proportion of tumor metastasis in patients from group B (11.2%) and group C (8.4%) was greatly lower than that of group A (14.8%) (P < 0.05). In conclusion, the application of Au-M-NPs in the diagnosis and treatment of breast cancer with MRI could effectively reduce the incidence of intraoperative and postoperative adverse reactions.

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