Cerebral perfusion imaging: Hypoxia-induced deoxyhemoglobin or gadolinium?

Sayin, Ece Su; Schulman, Jacob; Poublanc, Julien; Levine, Harrison T.; Venkatraghavan, Lakshmikumar; Uludağ, Kâmil; Duffin, James; Fisher, Joseph A.; Mikulis, David J.; Sobczyk, Olivia

doi:10.1101/2021.11.08.467772

Cited by 1 publication

(1 citation statement)

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“…Differential responses during separate oxygen and carbon dioxide modulation in the same tissue voxels may, in principle, hint at aberrant versus functional vasculature [ 201 ]. Interestingly, oxygen modulation has been also recently proposed as a means to study cerebral perfusion through rapid transient hemoglobin desaturation with the potential to substitute contrast-based perfusion [ 202 , 203 , 204 ] with advantages also relating to the avoidance of gadolinium contrast use [ 205 ], but application in the study of brain tumors is still lacking. Independently of these developments, the possibility of precise end-tidal oxygen modulation in isocapnic conditions has been preliminarily investigated as a means to provide a novel “imaging biomarker” to detail glioblastoma lesion microvascular features during BOLD imaging, exploiting hypoxia and hyperoxia as BOLD contrasts [ 206 ].…”

Section: Future Directionsmentioning

confidence: 99%

Hemodynamic Imaging in Cerebral Diffuse Glioma—Part B: Molecular Correlates, Treatment Effect Monitoring, Prognosis, and Future Directions

Stumpo

Guida

Bellomo

et al. 2022

Cancers

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Gliomas, and glioblastoma in particular, exhibit an extensive intra- and inter-tumoral molecular heterogeneity which represents complex biological features correlating to the efficacy of treatment response and survival. From a neuroimaging point of view, these specific molecular and histopathological features may be used to yield imaging biomarkers as surrogates for distinct tumor genotypes and phenotypes. The development of comprehensive glioma imaging markers has potential for improved glioma characterization that would assist in the clinical work-up of preoperative treatment planning and treatment effect monitoring. In particular, the differentiation of tumor recurrence or true progression from pseudoprogression, pseudoresponse, and radiation-induced necrosis can still not reliably be made through standard neuroimaging only. Given the abundant vascular and hemodynamic alterations present in diffuse glioma, advanced hemodynamic imaging approaches constitute an attractive area of clinical imaging development. In this context, the inclusion of objective measurable glioma imaging features may have the potential to enhance the individualized care of diffuse glioma patients, better informing of standard-of-care treatment efficacy and of novel therapies, such as the immunotherapies that are currently increasingly investigated. In Part B of this two-review series, we assess the available evidence pertaining to hemodynamic imaging for molecular feature prediction, in particular focusing on isocitrate dehydrogenase (IDH) mutation status, MGMT promoter methylation, 1p19q codeletion, and EGFR alterations. The results for the differentiation of tumor progression/recurrence from treatment effects have also been the focus of active research and are presented together with the prognostic correlations identified by advanced hemodynamic imaging studies. Finally, the state-of-the-art concepts and advancements of hemodynamic imaging modalities are reviewed together with the advantages derived from the implementation of radiomics and machine learning analyses pipelines.

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