Imaging in Brain Tumor - Diagnosis
Monday 20 April 2009
Room 311 16:30-18:30


Micheal D. Phillips and Brian D. Ross

16:30  140. Simultaneous MR and PET Imaging of Human Brain Tumors Using an Integrated MR-PET Scanner
    Ciprian Catana1, Thomas Benner1, Andre van der Kouwe1, Dominique L. Jennings1, Michael Hamm2, Poe-Jou Chen1,3, Ovidiu C. Andronesi1, Elizabeth R. Gerstner4, Larry Byars5, Christian Michel5, Josef Pfeuffer2, Matthias Schmand5, Bruce R. Rosen1, A. Gregory Sorensen1
MGH, Radiology, A.A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA; 2Siemens Medical Solutions USA Inc., Charlestown, MA, USA; 3Nuclear Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA; 4Massachusetts General Hospital, Boston, MA, USA; 5Siemens Medical Solutions USA Inc., Knoxville, TN, USA
    Magnetic resonance imaging (MRI) and positron emission tomography (PET) are widely used imaging technologies with both clinical and biomedical research applications. An MRI-compatible PET scanner prototype has been built for brain applications that allows data from both modalities to be acquired simultaneously. In this work, we demonstrate the feasibility of this combined system for performing simultaneous MR-PET data acquisition in brain tumor patients, including dynamic data acquisition.


16:42 141. Molecular Imaging of High-Grade Brain Tumors Using Endogenous Protein and Peptide-Based Contrast
    Zhibo Wen1, Shuguang Hu2, Fanheng Huang1, Peter C.M. van Zijl3,4, Jinyuan Zhou3,4
Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; 2Philips Healthcare, Guangzhou, Guangdong, China; 3Department of Radiology, Johns Hopkins University, Baltimore, MD, USA; 4F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
    Amide proton transfer (APT)-MRI is a chemical exchange saturation transfer (CEST) based approach in which the amide protons of endogenous proteins and peptides are irradiated to accomplish detection using the water signal. In this abstract, the APT approach was added to standard brain MRI for tumor patients at 3T. The initial results (n = 4) show that APT imaging can enhance noninvasive identification of tissue heterogeneity in high grade brain tumors.
16:54 142. Random Walk Model for Predicting Patterns of Microscopic Glioma Spread Using DTI: A Prospective Study
    AnithaPriya Krishnan1, Delphine Davis2, Paul Okunieff3, Walter O'Dell4
Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA; 2Departments of Imaging Sciences and Radiation Oncology, University of Rochester, Rochester, NY, USA; 3Department of Radiation Oncology, University of Rochester, Rochester, NY, USA; 4Departments of Radiation Oncology and Biomedical Engineering, University of Rochester, Rochester, NY, USA

Current methods for determining the treatment margins needed to encompass microscopic tumor spread for Stereotactic Radiotherapy (SRT) are inadequate as recurrences often occur at/near the boundary of the treatment margin. If our hypothesis that paths of elevated water diffusion along white matter tracts provide a preferred route for migration of tumor cells is correct, then future SRT plans would be modified accordingly to reduce the incidence of recurrence. Areas of high cell concentration as prospectively predicted by our random walk model based on MR DTI matched the subsequent appearance of secondary tumors in patients undergoing SRT for high-grade gliomas.



17:06 143. Contrast-Enhanced Three-Dimensional Whole-Brain Black-Blood Imaging for Efficient Detection of Small Metastases

Jaeseok Park1, Eung Yeop Kim1,2
Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea; 2Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea

    Contrast-enhanced three-dimensional T1-weighted MR imaging based on magnetization-prepared-rapid-gradient-recalled-echo (MP-RAGE), has been shown to be sensitive for the detection of small brain metastases due to the T1-shortening effect of contrast agent. However, since contrast agent remains in blood and tumors, and thus increases signal intensity in both parts, it is challenging to accurately detect the brain tumors using the conventional method. The purpose of this work was to develop a novel contrast-enhanced 3D whole-brain black-blood imaging method which enhances the signal intensity of brain tumor while selectively suppressing that of blood, and thus enhance the accuracy of diagnosis for small brain metastases.


17:18  144. New Diffusion Restriction Precedes the Development of Enhancing Tumor in Glioblastomas

Ajay Gupta1,2, Sahil Sood1,2, Robert Young2, Sasan Karimi2, Zhigang Zhang2, Andrei Holodny2
Weill Cornell Medical College, New York City, NY, USA; 2Memorial Sloan Kettering Cancer Center, New York City, NY, USA

    Assessment of glioma progression vs. stability or response has traditionally relied on typical MR imaging characteristics, such as changes in tumor size and extent of contrast enhancement. Finding earlier imaging biomarkers of glioma progression can have an enormous impact on clinical treatment decision-making. In this study, we demonstrate that in a subset of patients with GBM, new nonenhancing regions of restricted diffusion can predict the future development of enhancing tumor and tumor progression. This information may therefore be useful in guiding clinical decision making and treatment changes prior to the development of abnormal tumoral enhancement.


17:30 145. The Value of MRS Detectable Lipids as Prognostic Markers in Paediatric Brain Tumours
    Martin Wilson1,2, Carole Cummins2, Leslie MacPherson2, Yu Sun2,3, Kal Natarajan2, Nigel P. Davies2, Theo N. Arvanitis2,3, Risto A. Kauppinen4, Andrew C. Peet1,2
Cancer Sciences, University of Birmingham, Birmingham, West Midlands, UK; 2Oncology, Birmingham Children's Hospital Foundation Trust, Birmingham, West Midlands, UK; 3School of Electronic, Electrical & Computer Engineering, University of Birmingham, Birmingham, West Midlands, UK; 4Dartmouth Medial School, Dartmouth College, Hanover, NH, USA

Brain tumours are an important cause of childhood morbidity and mortality and new approaches to brain tumour assessment and therapy are a priority for cancer research. In this study, short-echo time single voxel in-vivo 1H MRS was used to investigate 121 pre-treatment peadiatric brain tumour cases. Patients were followed-up for period of up to 5 years and lipids were found to be predictive of long term survival.

17:42 146. Possibilistic Classification of Brain Tumors by MRS Based on Functional Data Analysis and Subpattern Discovery
    Juan M García-Gómez1, Irene Epifanio2, Margarida Julià-Sapé3,4, Daniel Monleón3,5, Javier Vicente1, Salvador Tortajada1, Elies Fuster1, Angel Moreno-Torres6, Andrew Peet7,8, Franklyn Howe9, Bernardo Celda3,10, Carles Arús3,4, Montserrat Robles1
ITACA-IBIME, Universidad Politécnica de Valencia, Valencia, Spain; 2Departament de Matemàtiques, Universitat Jaume I, Valencia, Spain; 3CIBER de Bioingeniería, Biomateriales y Nanomedicina, Spain; 4Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; 5Fundación de Investigación del Hospital Clínico Universitario de Valencia, Valencia, Spain; 6Research Department, Centre Diagnòstic Pedralbes, Barcelona, Spain; 7University of Birmingham, Birmingham, UK; 8Birmingham Children’s Hospital, Birmingham, UK; 9St George’s Hospital Medical School, London, UK; 10Departamento de Química-Física, Universitat de València, Valencia, Spain
    When designing a Clinical Decision Support System for Brain Tumors based on MRS, it would be of interest to deal with any prospective case. Besides, due to the possible acquisition artifacts, baseline differences, or molecular artifacts in MRS-SV, the in-vivo MRS pattern may be heterogeneous within each diagnostic class. We present a possibilistic classifier evaluated on the largest multicenter database of MRS of brain tumors available to us based on FDA and subpattern analysis. It overperformed the classical approaches. The detected in-vivo MR spectral pattern subtypes could be useful for the interpretation of the natural heterogeneity of the diagnoses.


17:54 147.

Development of an MR Spectroscopic Index to Differentiate Tumor from Treatment Induced Gliosis

    Radhika Srinivasan1, Jan Wooten1, Jason C. Crane1, Soonmee Cha11, Suzanne Chang1, Scott Vandenberg1, John Kurhanewicz1, Sarah J. Nelson1
1UCSF, San Francisco, CA, USA
    The goal of this study was to identify MR spectroscopic (MRS) markers that are likely to be able to differentiate active tumor from treatment induced gliosis. This is an important problem because while tumor regions should be included in follow-up treatment plans, regions represented by gliosis should be left untouched since these areas represent areas of normal brain that are influenced by treatment. Typically high choline levels are used to indicate tumor presence. The challenge in differentiating tumor from gliosis using this metric is that both of them could result in elevated levels of choline. To evaluate strategies to resolve this ambiguity we first determine the characteristic MR Spectroscopic markers that differentiate tumors from gliosis using High Resolution Magic Angle Spectroscopy (HR-MAS) of samples that are confirmed to belong to either tumor or gliosis using histopathology. The specific markers derived from this study are evaluated by ex-vivo HR-MAS of biopsies from within tumor regions in patients with newly diagnosed GBM. Finally these markers are evaluated against known MR markers of tumor presence from in-vivo 3T MR data. Following these studies the development of a suitable MRS index that has the potential to differentiate tumor from gliosis will be presented.
18:06 148. Targeted Use of 1H-MRS Is as Accurate as Histology in the Diagnosis of Glioblastoma Multiforme
    Greg Fellows1, Alan James Wright2, Naomi Sibtain3, Philip Rich4, Kirstie S. Opstad2, Dominick J.O McIntyre5, Brian Anthony Bell1, John Griffiths5, Franklyn Arron Howe6
Academic Neurosurgery Unit, St. George's University of London, London, UK; 2Basic Medical Sciences, St. George's University of London, London, UK; 3Neuroradiology, King’s College Hospital NHS Trust, London, UK; 4Neuroradiology, St. George's Hospital NHS Trust, London, UK; 5CRUK Cambridge Research Institute, Cambridge, UK; 6Cardiac and Vascular Sciences, St. George's University of London, London, UK
    Oncological practice requires histopathological confirmation of glioblastoma multiforme (GBM) prior to radiotherapy. If lesion location or patient health precludes surgical debulking prior to treatment, then 1H MRS could provide a clinically useful alternative diagnosis to biopsy. 89 patients’ with 1H-MRS, CT and MRI were evaluated neuroradiologically and spectroscopically. Of patients selected on clinical and neuroradiological grounds for diagnostic biopsy alone, there was 100% concordance between a spectroscopy and histopathological diagnosis of GBM. We propose a 1H MRS protocol for accurate diagnosis of a subset of GBM patients for which a surgical procedure and treatment delay could be avoided.
18:18 149. Sodium MRI and 1H MRS in the Diagnosis and Monitoring of Primary Brain Tumors
    Fernando Emilio Boada1, Yongxian Qian1, Denise Davis1, Frank Lieberman2, Ronald Hamilton3, Arlan Mintz4, Eric Schwartz1
Radiology, University of Pittsburgh, Pittsburgh, PA, USA; 2Neuro-oncology, University of Pittsburgh, Pittsburgh, PA, USA; 3Neuropathology, University of Pittsburgh, Pittsburgh, PA, USA; 4Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA

In this abstract we perform concurrent proton MRS and sodium MRI of primary brain tumor at 3 Tesla and evaluate the use of the two techniques with regards to ease of use, reproducibility and the correlation between their findings across tumor types.