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1.
Brain ; 146(3): 865-872, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36694943

RESUMO

The blood-brain barrier (BBB) protects the brain but is also an important obstacle for the effective delivery of therapeutics in Alzheimer's disease and other neurodegenerative disorders. Transcranial magnetic resonance-guided focused ultrasound (MRgFUS) has been shown to reversibly disrupt the BBB. However, treatment of diffuse regions across the brain along with the effect on Alzheimer's disease relevant pathology need to be better characterized. This study is an open-labelled single-arm trial (NCT04118764) to investigate the feasibility of modulating BBB permeability in the default mode network and the impact on cognition, amyloid and tau pathology as well as BBB integrity. Nine participants [mean age 70.2 ± 7.2 years, mean Mini-Mental State Examination (MMSE) 21.9] underwent three biweekly procedures with follow-up visits up to 6 months. The BBB permeability of the bilateral hippocampi, anterior cingulate cortex and precuneus was transiently increased without grade 3 or higher adverse events. Participants did not experience worsening trajectory of cognitive decline (ADAS-cog11, MMSE). Whole brain vertex-based analysis of the 18F-florbetaben PET imaging demonstrated clusters of modest SUVR reduction in the right parahippocampal and inferior temporal lobe. However, CSF and blood biomarkers did not demonstrate any amelioration of Alzheimer's disease pathology (P-tau181, amyloid-ß42/40 ratio), nor did it show persistent BBB dysfunction (plasma PDGFRbeta and CSF-to-plasma albumin ratio). This study provides neuroimaging and fluid biomarker data to characterize the safety profile of MRgFUS BBB modulation in neurodegeneration as a potential strategy for enhanced therapeutic delivery.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Humanos , Pessoa de Meia-Idade , Idoso , Barreira Hematoencefálica/patologia , Rede de Modo Padrão/metabolismo , Rede de Modo Padrão/patologia , Proteínas tau/metabolismo , Disfunção Cognitiva/patologia , Tomografia por Emissão de Pósitrons/métodos , Biomarcadores , Espectroscopia de Ressonância Magnética , Peptídeos beta-Amiloides
2.
J Neurooncol ; 162(1): 119-128, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36914878

RESUMO

INTRODUCTION: Various treatment options exist to salvage stereotactic radiosurgery (SRS) failures for brain metastases, including repeat SRS and hypofractionated SRS (HSRS). Our objective was to report outcomes specific to salvage HSRS for brain metastases that failed prior HSRS/SRS. METHODS: Patients treated with HSRS to salvage local failures (LF) following initial HSRS/SRS, between July 2010 and April 2020, were retrospectively reviewed. The primary outcomes were the rates of LF, radiation necrosis (RN), and symptomatic radiation necrosis (SRN). Univariable (UVA) and multivariable (MVA) analyses using competing risk regression were performed to identify predictive factors for each endpoint. RESULTS: 120 Metastases in 91 patients were identified. The median clinical follow up was 13.4 months (range 1.1-111.1), and the median interval between SRS courses was 13.1 months (range 3.0-56.5). 115 metastases were salvaged with 20-35 Gy in 5 fractions and the remaining five with a total dose ranging from 20 to 24 Gy in 3-fractions. 67 targets (56%) were postoperative cavities. The median re-treatment target volume and biological effective dose (BED10) was 9.5 cc and 37.5 Gy, respectively. The 6- and 12- month LF rates were 18.9% and 27.7%, for RN 13% and 15.6%, and for SRN were 6.1% and 7.0%, respectively. MVA identified larger re-irradiation volume (hazard ratio [HR] 1.02, p = 0.04) and shorter interval between radiosurgery courses (HR 0.93, p < 0.001) as predictors of LF. Treatment of an intact target was associated with a higher risk of RN (HR 2.29, p = 0.04). CONCLUSION: Salvage HSRS results in high local control rates and toxicity rates that compare favorably to those single fraction SRS re-irradiation experiences reported in the literature.


Assuntos
Neoplasias Encefálicas , Lesões por Radiação , Radiocirurgia , Humanos , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Estudos Retrospectivos , Terapia de Salvação , Neoplasias Encefálicas/secundário , Lesões por Radiação/etiologia , Necrose/etiologia , Resultado do Tratamento
3.
J Neurooncol ; 164(3): 597-605, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37707752

RESUMO

PURPOSE: To investigate the changes in apparent diffusion coefficient (ADC) within incrementally-increased margins beyond the gross tumor volume (GTV) on post-operative radiation planning MRI and their prognostic utility in glioblastoma. METHODS: Radiation planning MRIs of adult patients with newly diagnosed glioblastoma from 2017 to 2020 were assessed. The ADC values were normalized to contralateral normal white matter (nADC). Using 1 mm isotropic incremental margin increases from the GTV, the nADC values were calculated at each increment. Age, ECOG performance status, extent of resection and MGMT promoter methylation status were obtained from medical records. Using univariate and multivariable Cox regression analysis, association of nADC to progression-free and overall survival (PFS, OS) was assessed at each increment. RESULTS: Seventy consecutive patients with mean age of 53.6 ± 10.3 years, were evaluated. The MGMT promoter was methylated in 31 (44.3%), unmethylated in 36 (51.6%) and unknown in 3 (4.3%) patients. 11 (16%) underwent biopsy, 41 (44%) subtotal resection and 18 (26%) gross total resection. For each 1 mm increase in distance from GTV, the nADC decreased by 0.16% (p < 0.0001). At 1-5 mm increment, the nADC was associated with OS (p < 0.01). From 6 to 11 mm increment the nADC was associated with OS with the p-value gradually increasing from 0.018 to 0.046. nADC was not associated with PFS. CONCLUSION: The nADC values at 1-11 mm increments from the GTV margin were associated with OS. Future prospective multicenter studies are needed to validate the findings and to pave the way for the utilization of ADC for margin reduction in radiation planning.


Assuntos
Neoplasias Encefálicas , Glioblastoma , Adulto , Humanos , Pessoa de Meia-Idade , Glioblastoma/diagnóstico por imagem , Glioblastoma/genética , Glioblastoma/radioterapia , Carga Tumoral , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/radioterapia , Imagem de Difusão por Ressonância Magnética , Prognóstico , Estudos Retrospectivos
4.
J Neurooncol ; 159(3): 705-712, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35999435

RESUMO

OBJECTIVE: Gamma Knife Icon-based hypofractionated stereotactic radiosurgery (GKI-HSRS) is a novel technical paradigm in the treatment of brain metastases that allows for both the dosimetric benefits of the GKI stereotactic radiosurgery (SRS) platform as well as the biologic benefits of fractionation. We report mature local control and adverse radiation effect (ARE) outcomes following 5 fraction GKI-HSRS for intact brain metastases. METHODS: Patients with intact brain metastases treated with 5-fraction GKI-HSRS were retrospectively reviewed. Survival, local control, and adverse radiation effect rates were determined. Univariable and multivariable regression (MVA) were performed on potential predictive factors. RESULTS: Two hundred and ninety-nine metastases in 146 patients were identified. The median clinical follow-up was 10.7 months (range 0.5-47.6). The median total dose and prescription isodose was 27.5 Gy (range, 20-27.5) in 5 daily fractions and 52% (range, 45-93), respectively. The median overall survival (OS) was 12.7 months, and the 1-year local failure rate was 15.2%. MVA identified a total dose of 27.5 Gy vs. ≤ 25 Gy (hazard ratio [HR] 0.59, p = 0.042), and prior chemotherapy exposure (HR 1.99, p = 0.015), as significant predictors of LC. The 1-year ARE rate was 10.8% and the symptomatic ARE rate was 1.8%. MVA identified a gross tumor volume of ≥ 4.5 cc (HR 7.29, p < 0.001) as a significant predictor of symptomatic ARE. CONCLUSION: Moderate total doses in 5 daily fractions of GKI-HSRS were associated with high rates of LC and a low incidence of symptomatic ARE.


Assuntos
Produtos Biológicos , Neoplasias Encefálicas , Radiocirurgia , Fracionamento da Dose de Radiação , Humanos , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
5.
J Neurooncol ; 160(1): 265-272, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36203028

RESUMO

PURPOSE: To provide evidence towards a quantitative response assessment framework incorporating MRI-based linear measurements for spinal metastasis that predicts outcome following stereotactic body radiation therapy (SBRT). METHODS: Adult patients with de novo spinal metastases treated with SBRT between 2008 and 2018 were retrospectively assessed. The metastatic lesions involving the pedicles, articular processes, lamina, transverse process, spinous process and vertebral body at leach level were measured separately using linear measurements on pre- and all post-SBRT MRIs. The outcome was segment-specific progression (SSP) using SPINO guidelines which was dated to the first clinical documentation of progression, or the date of the associated MRI if imaging was the reason for progression. Random forest analysis for variable selection and recursive partitioning analysis for SSP probability prediction were used. RESULTS: Five Hundred Ninety-three spinal levels (323 patients) from 4081 MRIs were evaluated. The appearance of new T1 hypointensity and increase in Bilsky grade had an odds ratio (OR) of 33.5 and 15.5 for SSP, respectively. Compared to baseline, an increase of > 3 mm in any lesion dimension, combined with a 1.67-fold increase in area, had an OR of 4.6 for SSP. The sensitivity, specificity, positive predictive value, negative predictive value, balanced accuracy and area under the curve of the training model were 96.7%, 89.6%, 28.6%, 99.8%, 93.2% and 0.905 and of the test model were 91.3%, 89.3%, 27.1% 99.6%, 90.3% and 0.933, respectively. CONCLUSION: With further refinement and validation in prospective multicentre studies, MRI-based linear measurements can help predict response assessment in SBRT-treated spinal metastases.


Assuntos
Radiocirurgia , Neoplasias da Coluna Vertebral , Adulto , Humanos , Radiocirurgia/métodos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/secundário , Estudos Prospectivos , Estudos Retrospectivos , Imageamento por Ressonância Magnética
6.
Ann Neurol ; 86(6): 975-980, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31525269

RESUMO

It is currently unclear whether the glymphatic system, a brain-wide interstitial fluid-cerebrospinal fluid exchange described in rodents, exists in humans. Focal blood-brain barrier disruption using magnetic resonance-guided focused ultrasound allows parenchymal penetration of gadobutrol contrast, creating an opportunity to study glymphatics in vivo noninvasively. We describe patterns of contrast distribution in the perivascular space, subarachnoid space, and space surrounding large veins draining toward the dural sinuses on fluid-attenuated inversion recovery in subjects with Alzheimer disease and amyotrophic lateral sclerosis. This is the first evidence suggesting glymphatic efflux persists in humans. It's relevance to proteinopathies and drug delivery is discussed. ANN NEUROL 2019;86:975-980.


Assuntos
Doença de Alzheimer/diagnóstico por imagem , Esclerose Lateral Amiotrófica/diagnóstico por imagem , Barreira Hematoencefálica/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Sistema Glinfático/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Idoso , Doença de Alzheimer/fisiopatologia , Esclerose Lateral Amiotrófica/fisiopatologia , Barreira Hematoencefálica/fisiologia , Encéfalo/fisiologia , Feminino , Sistema Glinfático/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade
7.
J Magn Reson Imaging ; 51(3): 657-674, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31566852

RESUMO

The use of magnetic resonance imaging (MRI) is increasing globally, and MRI safety issues regarding medical devices, which are constantly being developed or upgraded, represent an ongoing challenge for MRI personnel. To assist the MRI community, a panel of 10 radiologists with expertise in MRI safety from nine high-volume academic centers formed, with the objective of providing clarity on some of the MRI safety issues for the 10 most frequently questioned devices. Ten device categories were identified. The panel reviewed the literature, including key MRI safety issues regarding screening and adverse event reports, in addition to the manufacturer's Instructions For Use. Using a Delphi-inspired method, 36 practical recommendations were generated with 100% consensus that can aid the clinical MRI community. Level of Evidence: 5 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:657-674.


Assuntos
Imageamento por Ressonância Magnética , Consenso , Imageamento por Ressonância Magnética/efeitos adversos
8.
J Neurooncol ; 149(2): 305-314, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32860571

RESUMO

INTRODUCTION: This study proposes contouring recommendations for radiation treatment planning target volumes and organs-at-risk (OARs) for both low grade and high grade gliomas. METHODS: Ten cases consisting of 5 glioblastomas and 5 grade II or III gliomas, including their respective gross tumor volume (GTV), clinical target volume (CTV), and OARs were each contoured by 6 experienced neuro-radiation oncologists from 5 international institutions. Each case was first contoured using only MRI sequences (MRI-only), and then re-contoured with the addition of a fused planning CT (CT-MRI). The level of agreement among all contours was assessed using simultaneous truth and performance level estimation (STAPLE) with the kappa statistic and Dice similarity coefficient. RESULTS: A high level of agreement was observed between the GTV and CTV contours in the MRI-only workflow with a mean kappa of 0.88 and 0.89, respectively, with no statistically significant differences compared to the CT-MRI workflow (p = 0.88 and p = 0.82 for GTV and CTV, respectively). Agreement in cochlea contours improved from a mean kappa of 0.39 to 0.41, to 0.69 to 0.71 with the addition of CT information (p < 0.0001 for both cochleae). Substantial to near perfect level of agreement was observed in all other contoured OARs with a mean kappa range of 0.60 to 0.90 in both MRI-only and CT-MRI workflows. CONCLUSIONS: Consensus contouring recommendations for low grade and high grade gliomas were established using the results from the consensus STAPLE contours, which will serve as a basis for further study and clinical trials by the MR-Linac Consortium.


Assuntos
Glioblastoma/diagnóstico por imagem , Glioblastoma/patologia , Imageamento por Ressonância Magnética/métodos , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Planejamento da Radioterapia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Braquiterapia , Consenso , Seguimentos , Glioblastoma/radioterapia , Humanos , Aceleradores de Partículas , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Carga Tumoral , Fluxo de Trabalho
9.
Can J Neurol Sci ; 47(4): 479-485, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32138792

RESUMO

BACKGROUND AND PURPOSE: Large prospective observational studies have cast doubt on the common assumption that endovascular thrombectomy (EVT) is superior to intravenous thrombolysis for patients with acute basilar artery occlusion (BAO). The purpose of this study was to retrospectively review our experience for patients with BAO undergoing EVT with modern endovascular devices. METHODS: All consecutive patients undergoing EVT with either a second-generation stent retriever or direct aspiration thrombectomy for BAO at our regional stroke center from January 1, 2013 to March 1, 2019 were included. The primary outcome measure was functional outcome at 1 month using the modified Rankin Scale (mRS) score. Multivariable logistic regression was used to assess the association between patient characteristics and dichotomized mRS. RESULTS: A total of 43 consecutive patients underwent EVT for BAO. The average age was 67 years with 61% male patients. Overall, 37% (16/43) of patients achieved good functional outcome. Successful reperfusion was achieved in 72% (31/43) of cases. The median (interquartile range) stroke onset to treatment time was 420 (270-639) minutes (7 hours) for all patients. The procedure-related complication rate was 9% (4/43). On multivariate analysis, posterior circulation Alberta stroke program early computed tomography score and Basilar Artery on Computed Tomography Angiography score were associated with improved functional outcome. CONCLUSION: EVT appears to be safe and feasible in patients with BAO. Our finding that time to treatment and successful reperfusion were not associated with improved outcome is likely due to including patients with established infarcts. Given the variability of collaterals in the posterior circulation, the paradigm of utilizing a tissue window may assist in patient selection for EVT. Magnetic resonance imaging may be a reasonable option to determine the extent of ischemia in certain situations.


Assuntos
Artéria Basilar/diagnóstico por imagem , Artéria Basilar/cirurgia , Procedimentos Endovasculares/tendências , Trombectomia/tendências , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/cirurgia , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombectomia/métodos , Resultado do Tratamento
10.
Can J Neurol Sci ; 47(2): 160-166, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31779719

RESUMO

PURPOSE: The aim was to assess the ability of post-treatment diffusion-weighted imaging (DWI) to predict 90-day functional outcome in patients with endovascular therapy (EVT) for large vessel occlusion in acute ischemic stroke (AIS). METHODS: We examined a retrospective cohort from March 2016 to January 2018, of consecutive patients with AIS who received EVT. Planimetric DWI was obtained and infarct volume calculated. Four blinded readers were asked to predict modified Rankin Score (mRS) at 90 days post-thrombectomy. RESULTS: Fifty-one patients received endovascular treatment (mean age 65.1 years, median National Institutes of Health Stroke Scale (NIHSS) 18). Mean infarct volume was 43.7 mL. The baseline NIHSS, 24-hour NIHSS, and the DWI volume were lower for the mRS 0-2 group. Also, the thrombolysis in cerebral infarction (TICI) 2b/3 rate was higher in the mRS 0-2 group. No differences were found in terms of the occlusion level, reperfusion technique, or recombinant tissue plasminogen activator use. There was a significant association noted between average infarct volume and mRS at 90 days. On multivariable analysis, higher infarct volume was significantly associated with 90-day mRS 3-5 when adjusted to TICI scores and occlusion location (OR 1.01; CI 95% 1.001-1.03; p = 0.008). Area under curve analysis showed poor performance of DWI volume reader ability to qualitatively predict 90-day mRS. CONCLUSION: The subjective impression of DWI as a predictor of clinical outcome is poorly correlated when controlling for premorbid status and other confounders. Qualitative DWI by experienced readers both overestimated the severity of stroke for patients who achieved good recovery and underestimated the mRS for poor outcome patients. Infarct core quantitation was reliable.


Assuntos
Encéfalo/diagnóstico por imagem , Procedimentos Endovasculares , Estado Funcional , AVC Isquêmico/cirurgia , Trombectomia , Idoso , Imagem de Difusão por Ressonância Magnética , Feminino , Fibrinolíticos/uso terapêutico , Humanos , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Ativador de Plasminogênio Tecidual/uso terapêutico
11.
Neurocrit Care ; 32(1): 206-216, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31549351

RESUMO

BACKGROUND: Predicting neurological outcome in comatose survivors of cardiac arrest relies on clinical findings, radiological and neurophysiological test results. To evaluate the predictive accuracy of brain computed tomography (CT) and magnetic resonance imaging (MRI) for prognostication of neurological outcomes after cardiac arrest. METHODS: We searched MEDLINE (database inception to August 2018) and included all observational cohort studies or randomized controlled trials including adult (16 years or older) survivors of cardiac arrest which evaluated the diagnostic accuracy of CT or MRI for predicting neurologic outcome or mortality. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. All review stages were conducted independently by 2 reviewers, and where possible data were pooled using bivariate meta-analysis. The main outcome was to evaluate the of accuracy of CT and MRI in neuroprognostication of patients after cardiac arrest. RESULTS: We included 44 studies that examined brain CT (n = 24) or MRI (n = 21) in 4008 (n per study, 9-398) patients. Decreased grey to white matter ratio on CT (20 studies) was useful for predicting poor neurological outcome (sensitivity 0.44, 95% CI 0.29-0.60; specificity 0.97, 95% CI 0.93-0.99; positive likelihood ratio [LR+] 13.8, 95% CI 6.9-27.7). Similarly, diffusion-weighted imaging (DWI) on MRI (16 studies; sensitivity 0.77, 95% CI 0.65-0.85; specificity 0.92, 95% CI 0.85-0.96; LR+ 9.2, 95% CI 5.2-16.4) and DWI and fluid-attenuated inversion recovery (FLAIR) MRI (4 studies, sensitivity 0.70, 95% CI 0.43-0.88; specificity 0.95, 95% CI 0.79-0.99; LR+ 13.4, 95% CI 3.5-51.2) were useful for predicting poor neurological outcomes. We found marked heterogeneity in timing of radiological examinations and neurological assessments relative to the cardiac arrest. CONCLUSION: Decreased grey to white matter ratio on CT and DWI or DWI and FLAIR on MRI are useful adjuncts for predicting poor early neurological outcome after cardiac arrest.


Assuntos
Encéfalo/diagnóstico por imagem , Parada Cardíaca/fisiopatologia , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Coma/diagnóstico por imagem , Coma/etiologia , Coma/fisiopatologia , Imagem de Difusão por Ressonância Magnética , Substância Cinzenta/diagnóstico por imagem , Parada Cardíaca/complicações , Parada Cardíaca/terapia , Humanos , Hipóxia-Isquemia Encefálica/etiologia , Hipóxia-Isquemia Encefálica/fisiopatologia , Imageamento por Ressonância Magnética , Neuroimagem , Prognóstico , Tomografia Computadorizada por Raios X , Substância Branca/diagnóstico por imagem
12.
Neuroimage ; 200: 275-280, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31254646

RESUMO

MR-guided focused ultrasound (MRgFUS) can temporarily permeabilize the blood-brain barrier (BBB), noninvasively, to allow therapeutics access to the central nervous system. However, its secondary and potential neuromodulation effects are not well understood. We aimed to characterize the functional impact of MRgFUS BBB opening in human subjects, based on the phase I trial in patients with Alzheimer's disease. We analyzed for changes in bilateral frontoparietal networks in resting state functional MRI from five subjects after BBB opening in the right frontal lobe. We found a transient functional connectivity decrease within only the ipsilateral frontoparietal network that was recovered by the next day. Additionally, baseline to month three comparisons did not reveal any significant differences from matched-controls from the Alzheimer's Disease Neuroimaging Initiative. Overall, MRgFUS may transiently affect neurologic function, but the functional organization is restored at one day and remains unchanged at three months. This first in human data has implications for the development of MRgFUS as a drug delivery platform to pathologic brain tissue and potential use for non-invasive neuromodulation.


Assuntos
Doença de Alzheimer/fisiopatologia , Barreira Hematoencefálica/fisiopatologia , Conectoma , Rede Nervosa/fisiopatologia , Lobo Parietal/fisiopatologia , Córtex Pré-Frontal/fisiopatologia , Ultrassonografia Doppler Transcraniana , Idoso , Doença de Alzheimer/diagnóstico por imagem , Barreira Hematoencefálica/diagnóstico por imagem , Ensaios Clínicos Fase I como Assunto , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Rede Nervosa/diagnóstico por imagem , Lobo Parietal/diagnóstico por imagem , Córtex Pré-Frontal/diagnóstico por imagem , Fatores de Tempo
14.
NMR Biomed ; 30(11)2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28686319

RESUMO

Blood temperature is a key determinant of tissue temperature and can be altered under normal physiological states, such as exercise, in diseases such as stroke or iatrogenically in therapies which modulate tissue temperature, such as therapeutic hypothermia. Currently available methods for the measurement of arterial and venous temperatures are invasive and, for small animal models, are impractical. Here, we present a methodology for the measurement of intravascular and tissue temperature by magnetic resonance imaging (MRI) using the lanthanide agent TmDOTMA- (DOTMA, tetramethyl-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid; Tm, thulium). The approach makes use of phase-sensitive imaging measurements, combined with spectrally selective excitation, to monitor the temperature-dependent shift in the resonance of proton nuclei associated with water and with methyl groups of TmDOTMA- . Measurements were first made in a flow phantom modelling diastolic blood flow in the mouse aorta or inferior vena cava (IVC) and imaged using 7-T preclinical MRI with a custom-built surface coil. Flowing and static fluid temperatures agreed to within 0.12°C for these experiments. Proof-of-concept experiments were also performed on three healthy adult mice, demonstrating temperature measurements in the aorta, IVC and kidney following a bolus injection of contrast agent. A small (0.7-1°C), but statistically significant, higher kidney temperature compared with the aorta (p = 0.002-0.007) and IVC (p = 0.003-0.03) was shown in all animals. These findings demonstrate the feasibility of the technique for in vivo applications and illustrate how the technique could be used to explore the relationship between blood and tissue temperature for a wide range of applications.


Assuntos
Imageamento por Ressonância Magnética/métodos , Termometria , Animais , Circulação Sanguínea , Camundongos , Compostos de Amônio Quaternário , Temperatura
15.
J Neurooncol ; 134(2): 433-441, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28674974

RESUMO

Radiation necrosis is a serious potential adverse event of stereotactic radiosurgery that cannot be reliably differentiated from recurrent tumor using conventional imaging techniques. Intravoxel incoherent motion (IVIM) is a magnetic resonance imaging (MRI) based method that uses a diffusion-weighted sequence to estimate quantitative perfusion and diffusion parameters. This study evaluated the IVIM-derived apparent diffusion coefficient (ADC) and perfusion fraction (f), and compared the results to the gold standard histopathological-defined outcomes of radiation necrosis or recurrent tumor. Nine patients with ten lesions were included in this study; all lesions exhibited radiographic progression after stereotactic radiosurgery for brain metastases that subsequently underwent surgical resection due to uncertainty regarding the presence of radiation necrosis versus recurrent tumor. Pre-surgical IVIM was performed to obtain f and ADC values and the results were compared to histopathology. Five lesions exhibited pathological radiation necrosis and five had predominantly recurrent tumor. The IVIM perfusion fraction reliably differentiated tumor recurrence from radiation necrosis (fmean = 10.1 ± 0.7 vs. 8.3 ± 1.2, p = 0.02; cutoff value of 9.0 yielding a sensitivity/specificity of 100%/80%) while the ADC did not distinguish between the two (ADCmean = 1.1 ± 0.2 vs. 1.2 ± 0.4, p = 0.6). IVIM shows promise in differentiating recurrent tumor from radiation necrosis for brain metastases treated with radiosurgery, but needs to be validated in a larger cohort.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia , Angiografia por Ressonância Magnética , Necrose/diagnóstico por imagem , Lesões por Radiação/diagnóstico por imagem , Radiocirurgia/efeitos adversos , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/efeitos da radiação , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Diagnóstico Diferencial , Progressão da Doença , Feminino , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/patologia , Lesões por Radiação/etiologia , Lesões por Radiação/patologia
16.
J Neurooncol ; 135(1): 119-127, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28669014

RESUMO

Intravoxel incoherent motion (IVIM) is a magnetic resonance imaging (MRI) technique that is seeing increasing use in neuro-oncology and offers an alternative to contrast-enhanced perfusion techniques for evaluation of tumor blood volume after stereotactic radiosurgery (SRS). To date, IVIM has not been validated against contrast enhanced techniques for brain metastases after SRS. In the present study, we measure blood volume for 20 brain metastases (15 patients) at baseline, 1 week and 1 month after SRS using IVIM and dynamic contrast enhanced (DCE)-MRI. Correlation between blood volume measurements made with IVIM and DCE-MRI show poor correlation at baseline, 1 week, and 1 month post SRS (r = 0.33, 0.14 and 0.30 respectively). At 1 week after treatment, no significant change in tumor blood volume was found using IVIM or DCE-MRI (p = 0.81 and 0.41 respectively). At 1 month, DCE-MRI showed a significant decrease in blood volume (p = 0.0002). IVIM, on the other hand, demonstrated the opposite effect and showed a significant increase in blood volume at 1 month (p = 0.03). The results of this study indicate that blood volume measured with IVIM and DCE-MRI are not equivalent. While this may relate to differences in the type of perfusion information each technique is providing, it could also reflect a limitation of tumor blood volume measurements made with IVIM after SRS. IVIM measurements of tumor blood volume in the month after SRS should therefore be interpreted with caution.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia , Encéfalo/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Idoso , Idoso de 80 Anos ou mais , Volume Sanguíneo , Determinação do Volume Sanguíneo/métodos , Encéfalo/fisiopatologia , Encéfalo/efeitos da radiação , Neoplasias Encefálicas/fisiopatologia , Neoplasias Encefálicas/secundário , Circulação Cerebrovascular , Meios de Contraste , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiocirurgia , Fatores de Tempo , Resultado do Tratamento
17.
Future Oncol ; 13(1): 77-91, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27523190

RESUMO

Due to increased effectiveness of cancer treatments and increasing survival rates, metastatic disease has become more frequent compared to the past, with the spine being the most common site of bony metastases. Diagnostic imaging is an integral part of screening, diagnosis and follow-up of spinal metastases. In this article, we review the principles of multimodality imaging for tumor detection with respect to their value for diagnosis and stereotactic body radiation therapy planning for spinal metastases. We will also review the current international consensus agreement for stereotactic body radiation therapy planning, and the role of imaging in achieving the best possible treatment plan.


Assuntos
Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/secundário , Humanos , Imagem Multimodal/métodos , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador , Resultado do Tratamento
20.
Sleep Med ; 112: 191-193, 2023 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-39492246

RESUMO

Virchow-Robin spaces (VRS) are perivascular spaces that have been associated with impaired glymphatic function, poor sleep quality and sleep disorders. These spaces are also associated with neurological impairment. We report a case of a young adult male who presented with severe untreated sleep apnea, shift-work disorder, and excessive asymmetric periodic limb movements disorder in association with a prominent radiologically-identified VRS in the contralateral basal ganglia. This case illustrates the complex "chicken and egg" association between impaired sleep, the development of VRS, and subsequent sleep disorder most likely attributable to the development of this perivascular abnormality.

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