Semiautomated Volumetric Measurement on Postcontrast MR Imaging for Analysis of Recurrent and Residual Disease in Glioblastoma Multiforme

Chow, Daniel; Qi, Jing; Guo, X. Edward; Miloushev, Vesselin Z.; Iwamoto, Fábio M.; Bruce, Jeffrey N.; Lassman, Andrew B.; Schwartz, Lawrence H.; Lignelli, Angela; Zhao, Binsheng; Filippi, Christopher G.

doi:10.3174/ajnr.a3724

Cited by 61 publications

(68 citation statements)

References 26 publications

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“…Increased interest in semiautomated computer segmentation in the analysis of brain tumors, coupled with validation, may circumvent some subjectivity in delineating the image-definable components of glial tumors. 39 Standardization of segmentation techniques is expected to improve the utility of quantitative measurements. Furthermore, in most studies, a range of values was observed among patients.…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of Diffusion Metrics for the Prediction of Tumor Grade in Gliomas

Miloushev

Chow

Filippi

2014

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Meta-Analysis of Diffusion Metrics for the Prediction of Tumor Grade in Gliomas

Miloushev

Chow

Filippi

2014

AJNR Am J Neuroradiol

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“…Briefly, this semi-automated algorithm combines the region-based active contours and a level set approach and has been shown to provide for reproductive assessment of enhancing tumor burden in postoperative GBM patients. 8 All measurements were performed with correlation to precontrast T1 images to avoid T1 shortening effects from postsurgical changes (for example, blood products).…”

Section: Radiographic Imaging and Assessment Of Extent Of Resectionmentioning

confidence: 99%

Aggressive resection at the infiltrative margins of glioblastoma facilitated by intraoperative fluorescein guidance

Neira

Ung

Sims

et al. 2017

Journal of Neurosurgery

126

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ABBREVIATIONS 5-ALA = 5-aminolevulinic acid; BBB = blood-brain barrier; CE = contrast enhancing; CUMC = Columbia University Medical Center; EOR = extent of resection; GBM = glioblastoma; GTR = gross-total resection; HGG = high-grade glioma; n-ANOVA = multiway ANOVA; NCE = non-contrast enhancing; OS = overall survival; PFS = progression-free survival; PPV = positive predictive value; ROI = region of interest; STR = subtotal resection; UD = undetermined; WHO = World Health Organization; Y560 = YELLOW 560. OBJECTIVE Extent of resection is an important prognostic factor in patients undergoing surgery for glioblastoma (GBM). Recent evidence suggests that intravenously administered fluorescein sodium associates with tumor tissue, facilitating safe maximal resection of GBM. In this study, the authors evaluate the safety and utility of intraoperative fluorescein guidance for the prediction of histopathological alteration both in the contrast-enhancing (CE) regions, where this relationship has been established, and into the non-CE (NCE), diffusely infiltrated margins. METHODS Thirty-two patients received fluorescein sodium (3 mg/kg) intravenously prior to resection. Fluorescence was intraoperatively visualized using a Zeiss Pentero surgical microscope equipped with a YELLOW 560 filter. Stereotactically localized biopsy specimens were acquired from CE and NCE regions based on preoperative MRI in conjunction with neuronavigation. The fluorescence intensity of these specimens was subjectively classified in real time with subsequent quantitative image analysis, histopathological evaluation of localized biopsy specimens, and radiological volumetric assessment of the extent of resection. RESULTS Bright fluorescence was observed in all GBMs and localized to the CE regions and portions of the NCE margins of the tumors, thus serving as a visual guide during resection. Gross-total resection (GTR) was achieved in 84% of the patients with an average resected volume of 95%, and this rate was higher among patients for whom GTR was the surgical goal (GTR achieved in 93.1% of patients, average resected volume of 99.7%). Intraoperative fluorescein staining correlated with histopathological alteration in both CE and NCE regions, with positive predictive values by subjective fluorescence evaluation greater than 96% in NCE regions. CONCLUSIONS Intraoperative administration of fluorescein provides an easily visualized marker for glioma pathology in both CE and NCE regions of GBM. These findings support the use of fluorescein as a microsurgical adjunct for guiding GBM resection to facilitate safe maximal removal. SUBMITTEDhttps://thejns.org/doi/abs/10.3171/2016.7.JNS16232

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“…Various imaging techniques of transformation, filtering and segmentation 11,12 allow us to analyze MRI in a comprehensive approach beyond eyesight. Jones et al 13 applied whole-brain diffusion tensor imaging segmentation to delineate tumour volume and improved the accuracy of diagnosis, while Chow et al 14 used reliable semi-automated segmentation to monitor tumour progression in patients with GBM. Furthermore, computerassisted assessment could identify GBM molecular subtypes even without biopsy.…”

Section: Introductionmentioning

confidence: 99%

Segmentation of peritumoral oedema offers a valuable radiological feature of cerebral metastasis

Zhou¹,

Yang²,

Yao³

et al. 2016

BJR

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Chengcheng Zhou and Zixiao Yang contributed equally to this study.Objective: Peritumoral oedema (PTO) is commonly observed on MRI in malignant brain tumours including brain metastasis (bMET) and glioblastoma multiforme (GBM). This study aimed to differentiate bMET from GBM by comparing the volume ratio of PTO to tumour lesion (R vol ).Methods: 56 patients with solitary bMET or GBM were enrolled, and MRI was analyzed by a semi-automatic methodology based on MATLAB (Mathworks, Natick, MA). The PTO volume (V oedema ) was segmented for quantification using T 2 fluid-attenuated inversion-recovery images, while the tumour volume was quantified with enhanced T 1 images. The quantitative volume of the tumour, PTO and the ratio of PTO to tumour were interpreted using SPSS® (IBM Corp., New York, NY; formerly SPSS Inc., Chicago, IL) by considering different locations and pathologies. Results: The tumour volumes of supratentorial GBM, supratentorial bMET (supra-bMET) and infratentorial bMET were 32.22 6 21.9, 18.45 6 17.28 and 11.40 6 5.63 ml, respectively. The corresponding V oedema were 44.08 6 25.84, 73.20 6 40.35 and 23.74 6 7.78 ml, respectively. The V oedema difference between supratentorial and infratentorial lesions is significant (p-value 5 0.002). SuprabMET has a smaller tumour volume (p-value 5 0.032), but a larger PTO (p-value 5 0.007). The ratio of V oedema to the tumour volume in bMET is statistically higher than that in GBM (p-value 5 0.015). The cut-off ratio for identifying bMET from GBM is 3.9, with a specificity and sensitivity of 90.0% and 68.8%, respectively. Conclusion: Segmentation is an efficient method to quantify irregular PTO. bMET possesses more extensive oedema with smaller tumour volume than does GBM. The R vol is a valuable index to distinguish bMET from GBM. Advances in knowledge: This study presents a new method for the quantitation of PTO to differentiate bMET from GBM.

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Semiautomated Volumetric Measurement on Postcontrast MR Imaging for Analysis of Recurrent and Residual Disease in Glioblastoma Multiforme

Cited by 61 publications

References 26 publications

Meta-Analysis of Diffusion Metrics for the Prediction of Tumor Grade in Gliomas

Meta-Analysis of Diffusion Metrics for the Prediction of Tumor Grade in Gliomas

Aggressive resection at the infiltrative margins of glioblastoma facilitated by intraoperative fluorescein guidance

Segmentation of peritumoral oedema offers a valuable radiological feature of cerebral metastasis

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