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Delayed Contrast Extravasation MRI for Depicting Tumor and Non-Tumoral Tissues in Primary and Metastatic Brain Tumors

The current standard of care for newly diagnosed glioblastoma multiforme (GBM) is resection followed by radiotherapy with concomitant and adjuvant temozolomide. Recent studies suggest that nearly half of the patients with early radiological deterioration post treatment do not suffer from tumor recur...

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Autores principales: Zach, Leor, Guez, David, Last, David, Daniels, Dianne, Grober, Yuval, Nissim, Ouzi, Hoffmann, Chen, Nass, Dvora, Talianski, Alisa, Spiegelmann, Roberto, Cohen, Zvi R., Mardor, Yael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3522646/
https://www.ncbi.nlm.nih.gov/pubmed/23251672
http://dx.doi.org/10.1371/journal.pone.0052008
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author Zach, Leor
Guez, David
Last, David
Daniels, Dianne
Grober, Yuval
Nissim, Ouzi
Hoffmann, Chen
Nass, Dvora
Talianski, Alisa
Spiegelmann, Roberto
Cohen, Zvi R.
Mardor, Yael
author_facet Zach, Leor
Guez, David
Last, David
Daniels, Dianne
Grober, Yuval
Nissim, Ouzi
Hoffmann, Chen
Nass, Dvora
Talianski, Alisa
Spiegelmann, Roberto
Cohen, Zvi R.
Mardor, Yael
author_sort Zach, Leor
collection PubMed
description The current standard of care for newly diagnosed glioblastoma multiforme (GBM) is resection followed by radiotherapy with concomitant and adjuvant temozolomide. Recent studies suggest that nearly half of the patients with early radiological deterioration post treatment do not suffer from tumor recurrence but from pseudoprogression. Similarly, a significant number of patients with brain metastases suffer from radiation necrosis following radiation treatments. Conventional MRI is currently unable to differentiate tumor progression from treatment-induced effects. The ability to clearly differentiate tumor from non-tumoral tissues is crucial for appropriate patient management. Ten patients with primary brain tumors and 10 patients with brain metastases were scanned by delayed contrast extravasation MRI prior to surgery. Enhancement subtraction maps calculated from high resolution MR images acquired up to 75 min after contrast administration were used for obtaining stereotactic biopsies. Histological assessment was then compared with the pre-surgical calculated maps. In addition, the application of our maps for prediction of progression was studied in a small cohort of 13 newly diagnosed GBM patients undergoing standard chemoradiation and followed up to 19.7 months post therapy. The maps showed two primary enhancement populations: the slow population where contrast clearance from the tissue was slower than contrast accumulation and the fast population where clearance was faster than accumulation. Comparison with histology confirmed the fast population to consist of morphologically active tumor and the slow population to consist of non-tumoral tissues. Our maps demonstrated significant correlation with perfusion-weighted MR data acquired simultaneously, although contradicting examples were shown. Preliminary results suggest that early changes in the fast volumes may serve as a predictor for time to progression. These preliminary results suggest that our high resolution MRI-based delayed enhancement subtraction maps may be applied for clear depiction of tumor and non-tumoral tissues in patients with primary brain tumors and patients with brain metastases.
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spelling pubmed-35226462012-12-18 Delayed Contrast Extravasation MRI for Depicting Tumor and Non-Tumoral Tissues in Primary and Metastatic Brain Tumors Zach, Leor Guez, David Last, David Daniels, Dianne Grober, Yuval Nissim, Ouzi Hoffmann, Chen Nass, Dvora Talianski, Alisa Spiegelmann, Roberto Cohen, Zvi R. Mardor, Yael PLoS One Research Article The current standard of care for newly diagnosed glioblastoma multiforme (GBM) is resection followed by radiotherapy with concomitant and adjuvant temozolomide. Recent studies suggest that nearly half of the patients with early radiological deterioration post treatment do not suffer from tumor recurrence but from pseudoprogression. Similarly, a significant number of patients with brain metastases suffer from radiation necrosis following radiation treatments. Conventional MRI is currently unable to differentiate tumor progression from treatment-induced effects. The ability to clearly differentiate tumor from non-tumoral tissues is crucial for appropriate patient management. Ten patients with primary brain tumors and 10 patients with brain metastases were scanned by delayed contrast extravasation MRI prior to surgery. Enhancement subtraction maps calculated from high resolution MR images acquired up to 75 min after contrast administration were used for obtaining stereotactic biopsies. Histological assessment was then compared with the pre-surgical calculated maps. In addition, the application of our maps for prediction of progression was studied in a small cohort of 13 newly diagnosed GBM patients undergoing standard chemoradiation and followed up to 19.7 months post therapy. The maps showed two primary enhancement populations: the slow population where contrast clearance from the tissue was slower than contrast accumulation and the fast population where clearance was faster than accumulation. Comparison with histology confirmed the fast population to consist of morphologically active tumor and the slow population to consist of non-tumoral tissues. Our maps demonstrated significant correlation with perfusion-weighted MR data acquired simultaneously, although contradicting examples were shown. Preliminary results suggest that early changes in the fast volumes may serve as a predictor for time to progression. These preliminary results suggest that our high resolution MRI-based delayed enhancement subtraction maps may be applied for clear depiction of tumor and non-tumoral tissues in patients with primary brain tumors and patients with brain metastases. Public Library of Science 2012-12-14 /pmc/articles/PMC3522646/ /pubmed/23251672 http://dx.doi.org/10.1371/journal.pone.0052008 Text en © 2012 Zach et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Zach, Leor
Guez, David
Last, David
Daniels, Dianne
Grober, Yuval
Nissim, Ouzi
Hoffmann, Chen
Nass, Dvora
Talianski, Alisa
Spiegelmann, Roberto
Cohen, Zvi R.
Mardor, Yael
Delayed Contrast Extravasation MRI for Depicting Tumor and Non-Tumoral Tissues in Primary and Metastatic Brain Tumors
title Delayed Contrast Extravasation MRI for Depicting Tumor and Non-Tumoral Tissues in Primary and Metastatic Brain Tumors
title_full Delayed Contrast Extravasation MRI for Depicting Tumor and Non-Tumoral Tissues in Primary and Metastatic Brain Tumors
title_fullStr Delayed Contrast Extravasation MRI for Depicting Tumor and Non-Tumoral Tissues in Primary and Metastatic Brain Tumors
title_full_unstemmed Delayed Contrast Extravasation MRI for Depicting Tumor and Non-Tumoral Tissues in Primary and Metastatic Brain Tumors
title_short Delayed Contrast Extravasation MRI for Depicting Tumor and Non-Tumoral Tissues in Primary and Metastatic Brain Tumors
title_sort delayed contrast extravasation mri for depicting tumor and non-tumoral tissues in primary and metastatic brain tumors
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3522646/
https://www.ncbi.nlm.nih.gov/pubmed/23251672
http://dx.doi.org/10.1371/journal.pone.0052008
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