Differentiation between vasogenic edema and infiltrative tumor in patients with high‐grade gliomas using texture patch‐based analysis

Artzi, Moran; Liberman, Gilad; Blumenthal, Deborah T.; Aizenstein, Orna; Bokstein, Felix; Bashat, Dafna Ben

doi:10.1002/jmri.25939

Cited by 37 publications

(29 citation statements)

References 37 publications

(49 reference statements)

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“…The finding of elevated absolute qT1‐difference values in the edema region stands in line with the results of several previous MRI and MRS studies that also show changes for different MR parameters beyond the enhancing part of glioblastomas: a stripe‐like pattern of regional CBV increase was found in a defined region adjacent to the contrast‐enhancing tumor, which then transformed into enhancing tumor tissue in the follow‐up; the VOI analysis of BOLD‐based relative oxygen extraction fraction (rOEF) maps revealed potentially hypoxic tumor regions with high rOEF in the nonenhancing infiltration zone; peritumoral fiber structures showed significant decreases of N‐acetyl‐aspartate concentrations and fiber densities when compared with the contralateral side . Further studies based on a combination of dynamic contrast enhanced (DCE) and dynamic susceptibility contrast (DSC) MRI or using machine‐learning algorithms on a set of different MRI modalities suggest that these techniques are promising candidates for distinguishing between vasogenic edema and tumor‐containing edema, which appear similar in conventional MRI. The method presented here reveals a new biological aspect of peritumoral alterations in glioblastomas and may thus help with this differentiation, which is important for therapy response assessment.…”

Section: Discussionmentioning

confidence: 99%

Quantitative T1 mapping indicates tumor infiltration beyond the enhancing part of glioblastomas

et al. 2019

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The aim of this study was to evaluate whether maps of quantitative T1 (qT1) differences induced by a gadolinium-based contrast agent (CA) are better suited than conventional T1-weighted (T1w) MR images for detecting infiltration inside and beyond the peritumoral edema of glioblastomas. Conventional T1w images and qT1 maps were obtained before and after gadolinium-based CA administration in 33 patients with glioblastoma before therapy. The following data were calculated: (i) absolute qT1-difference maps (qT1 pre-CA -qT1 post-CA), (ii) relative qT1-difference maps, (iii) absolute and (iv) relative differences of conventional T1w images acquired preand post-CA. The values of these four datasets were compared in four different regions: (a) the enhancing tumor, (b) the peritumoral edema, (c) a 5 mm zone around the pathology (defined as the sum of regions a and b), and (d) the contralateral normal appearing brain tissue. Additionally, absolute qT1-difference maps (displayed with linear gray scaling) were visually compared with respective conventional difference images. The enhancing tumor was visible both in the difference of conventional preand post-CA T1w images and in the absolute qT1-difference maps, whereas only the latter showed elevated values in the peritumoral edema and in some cases even beyond. Mean absolute qT1-difference values were significantly higher (P < 0.01) in the enhancing tumor (838 ± 210 ms), the peritumoral edema (123 ± 74 ms) and in the 5 mm zone around the pathology (81 ± 31 ms) than in normal appearing tissue (32 ± 35 ms). In summary, absolute qT1-difference maps-in contrast to the difference of T1w images-of untreated glioblastomas appear to be able to visualize CA leakage, and thus might indicate tumor cell infiltration in the edema region and beyond. Therefore, the absolute qT1-difference maps are potentially useful for treatment planning. K E Y W O R D Sgadolinium-based contrast agent, glioblastoma, infiltration, longitudinal relaxation time T1, quantitative MRI, quantitative T1-difference maps, edema

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Section: Discussionmentioning

confidence: 99%

Quantitative T1 mapping indicates tumor infiltration beyond the enhancing part of glioblastomas

et al. 2019

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“…Further studies used at higher order tractography at higher 3-T scanner combined with other advanced MR sequences will improve the results. [30][31][32][33][34]…”

Section: Discussionmentioning

confidence: 99%

Interobserver Agreement of White Matter Tract Involvement in Gliomas with Diffusion Tensor Tractography

Razek

El-Serougy

Ezzat

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Aim To assess with diffusion tensor tractography (DTT) the interobserver agreement of white matter tract involvement in patients with gliomas. Patient and Methods A prospective study was conducted on 35 patients (21 male, 14 female; age: 2–71 years) with gliomas that underwent DTT. Two independent readers assessed the patterns of involvement of the corticospinal tract, corpus callosum, optic radiation, and fasciculi as normal, edematous, displaced, infiltrated, or disrupted. Results Overall interobserver agreement of involvement of the white matter tracts was excellent (κ = 0.93; 95% confidence interval [CI], 0.91–0.95; p = 0.001). Interobserver agreement was excellent for involvement of corticospinal tracts (κ = 0.81; 95% CI, 0.57–1.00; p = 0.001), corpus callosum (κ = 0.91; 95% CI, 0.75–1.00; p = 0.001), optic radiation (κ = 0.77; 95% CI, 0.53–0.98; p = 0.001), and fasciculi (κ = 0.912; 95% CI, 0.81–0.99; p = 0.001. The interobserver agreement was excellent for tract edema (κ = 0.81; 95% CI, 0.57–1.00; p = 0.001), tract displacement (κ = 0.91; 95% CI, 0.75–1.00; p = 0.001), tract disruption (κ = 0.81; 95% CI, 0.57–1.00; p = 0.001), and good for tract infiltration (κ = 0.77; 95% CI, 0.53–0.98; p = 0.001). The interobserver agreement was excellent for white matter tract involvement in patients with low-grade gliomas (κ = 0.81; 95% CI, 0.57–1.00; p = 0.001) and high-grade gliomas (κ = 0.91; 95% CI, 0.75–1.00; p = 0.001). Conclusion DTT is a reliable and reproducible method for assessment of white matter tract involvement in patients with low- and high-grade gliomas.

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“…This study not only showed the differentiation between the two different brain pathologies evaluated (meningioma and GBM) but also suggests a differentiation between the edema around both intracranial tumors. Edema surrounding GBM is known to contain both vasogenic and tumor cell infiltration while edema surrounding meningioma is a vasogenic type without tumor cell infiltration [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…GBM is the most malignant (WHO grade IV) form of intracranial tumor. Its histological characteristics are quite noticeable, with the presence of dead cells (necrotic tissue) and increased blood vessel density around the tumor [ 3 , 5 - 6 ]. Most cases of meningioma, on the other hand, involve benign tumors, many of which contain calcifications, cysts, or concentrated clusters of blood vessels.…”

Section: Introductionmentioning

confidence: 99%

Multiparametric Magnetic Resonance Imaging in the Assessment of Primary Brain Tumors Through Radiomic Features: A Metric for Guided Radiation Treatment Planning

Florez

Nichols

Parker

et al. 2018

Cureus

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PurposeThe definition of radiotherapy target volume is a critical step in treatment planning for all tumor sites. Conventional magnetic resonance imaging (MRI) pulse sequences are used for the definition of the gross target volume (GTV) and the contouring of glioblastoma multiforme (GBM) and meningioma. We propose the use of multiparametric MRI combined with radiomic features to improve the texture-based differentiation of tumor from edema for GTV definition and to differentiate vasogenic from tumor cell infiltration edema.MethodsTwenty-five patients with brain tumor and peritumoral edema (PTE) were assessed. Of the enrolled patients, 17 (63 ± 10 years old, six female and 11 male patients) were diagnosed with GBM and eight (64 ± 14 years old, five female and three male patients) with meningioma. A 3 Tesla (3T) MRI scanner was used to scan patients using a 3D multi-echo Gradient Echo (GRE) sequence. After the acquisition process, two experienced neuroradiologists independently used an in-house semiautomatic algorithm to conduct a segmentation of two regions of interest (ROI; edema and tumor) in all patients using functional MRI sequences, apparent diffusion coefficient (ADC), and dynamic contrast-enhanced MRI (DCE-MRI), as well as anatomical MRI sequences—T1-weighted, T2-weighted and fluid-attenuated inversion recovery (FLAIR). Radiomic (computer-extracted texture) features were extracted from all ROIs through different approaches, including first-, second-, and higher-order statistics, both with and without normalization, leading to the calculation of around 300 different texture parameters for each ROI. Based on the extracted parameters, a least absolute shrinkage and selection operator (LASSO) analysis was used to isolate the parameters that best differentiated edema from tumors while irrelevant parameters were discarded.Results and conclusionsThe parameters chosen by LASSO were used to perform statistical analyses which allowed identification of the variables with the best discriminant ability in all scenarios. Receiver operating characteristic results showcase both the best single discriminator and the discriminant capacity of the model using all variables selected by LASSO. Excellent results were obtained for patients with GBM with all MRI sequences, with and without normalization; a T1-weighted sequence postcontrast (T1W+C) with normalization offered the best tumor classification (area under the curve, AUC > 0.97). For patients with meningioma, a good model of tumor classification was obtained through the T1-weighted sequence (T1W) without normalization (AUC > 0.71). However, there was no agreement between the results of both radiologists for some MRI sequences analyzed for patients with GBM and meningioma. In conclusion, a small subset of radiomic features showed an excellent ability to distinguish edema from tumor tissue through its most discriminating features.

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Differentiation between vasogenic edema and infiltrative tumor in patients with high‐grade gliomas using texture patch‐based analysis

Abstract: 1 Technical Efficacy Stage 4 J. Magn. Reson. Imaging 2018.

Cited by 37 publications

References 37 publications

Quantitative T1 mapping indicates tumor infiltration beyond the enhancing part of glioblastomas

Quantitative T1 mapping indicates tumor infiltration beyond the enhancing part of glioblastomas

Interobserver Agreement of White Matter Tract Involvement in Gliomas with Diffusion Tensor Tractography

Multiparametric Magnetic Resonance Imaging in the Assessment of Primary Brain Tumors Through Radiomic Features: A Metric for Guided Radiation Treatment Planning

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