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Rachel W Chan¹, Liam SP Lawrence², Hany Soliman³, Mark Ruschin⁴, James Stewart⁴, Aimee Theriault⁴, Chia-Lin Tseng⁵, Sten Myrehaug³, Jay Detsky⁴, Pejman J Maralani⁶, Hanbo Chen⁴, Brandon Tran², Mary Jane Lim-Fat⁷, Sunit Das⁸, Greg J Stanisz^1,2,9, Arjun Sahgal⁴, and Angus Z Lau^1
1Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada, ²Medical Biophysics, University of Toronto, Toronto, ON, Canada, ³Sunnybrook Health Sciences Centre, Toronto, ON, Canada, ⁴Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, ⁵Department of Radiation Oncolog, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, ⁶Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, ⁷Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada, ⁸Department of Surgery, St. Michael’s Hospital, Toronto, ON, Canada, ⁹Department of Neurosurgery and Paediatric Neurosurgery, Medical University, Lublin, Poland

Keywords: Tumors, CEST & MT, Radiotherapy

In biopsy-only glioblastoma patients scanned and treated on a 1.5T MR-Linac, this study quantifies the relationship between the quantitative magnetization transfer (qMT) semi-solid fraction and enhancing regions seen on post-contrast T₁-weighted imaging on follow-up MRI scans. Metrics were computed to assess the spatial overlap between low semi-solid fraction regions and enhancing regions. In certain patients, the low semi-solid fraction region at the time of treatment correlated with enhancing region at follow up imaging. Our results suggest reduced semi-solid fraction values precede tumour progression, which could be used for guiding dose adaptation in radiation therapy.

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Ulrich Katscher¹ and Khin Khin Tha^2
1Philips Research Europe, Hamburg, Germany, ²Hokkaido University, Sapporo, Japan

Keywords: Tumors, Brain

Strong mutual relation is observed between tissue electrical conductivity, water content, and sodium concentration. However, it was recently reported that the relation between conductivity and water content might hold only for healthy tissue but be violated in tumors. It was furthermore reported that water content relates only to free sodium, while conductivity additionally relates also to sodium bound to proteins. A discrepancy between water content and conductivity might thus indicate protein concentration. The current study confirms this hypothesis by comparing the discrepancy between water content and conductivity with Amide Proton Transfer imaging as a marker of protein concentration.

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Manuela Moretto¹, Beatrice Federica Luciani¹, Francesca Saviola¹, Stefano Tambalo¹, Luca Zigiotto^2,3, Donna Gift Cabalo^1,4, Luciano Annicchiarico^2,3, Martina Venturini^2,3, Silvio Sarubbo^2,3, and Jorge Jovicich^1
1Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy, ²Department of Neuroscience, Division of Neurosurgery, S.Chiara Hospital, APSS Trento, Trento, Italy, ³Structural and Functional Connectivity Lab, S.Chiara Hospital, APSS Trento, Trento, Italy, ⁴Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada

Keywords: Tumors, fMRI (resting state), Brain Connectivity

Resting-state functional MRI (rs-fMRI) has been proposed as a non-invasive technique for the presurgical mapping of functional networks, in contrast to intraoperative Direct Electrical Stimulation (DES) mapping. While previous studies have investigated the agreement between a predefined DES atlas and resting-state networks in low-grade glioma patients, here we exploit patient-specific DES points and the ReStNeuMap tool to investigate the agreement between sensorimotor, language and speech-articulation networks in a cohort of high- and low-grade glioma patients. We found a good overlap between ReStNeuMap-derived networks and DES points, while low spatial similarity between networks and functional connectivity maps derived from DES.

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Seyma Alcicek^1,2,3,4, Michael W. Ronellenfitsch^2,3,4,5, Dennis C. Thomas^1,2,3,4, Joachim P. Steinbach^2,3,4,5, Vincent Prinz⁶, Marie-Thérèse Forster⁶, Elke Hattingen^1,2,3,4, Ulrich Pilatus^1,2,3,4, and Katharina J. Wenger^1,2,3,4
1Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany, ²University Cancer Center Frankfurt (UCT), Frankfurt am Main, Germany, ³Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany, ⁴German Cancer Research Center (DKFZ) Heidelberg, Germany and German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt am Main, Germany, ⁵Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany, ⁶Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany

Keywords: Tumors, Spectroscopy

Glutamate metabolism plays a significant role in glioma invasion and growth and may lead to glioma-associated epileptic discharges and excitotoxicity. In in vivo MR spectroscopy, the molecular similarity of glutamate and glutamine results in overlapped, hence indistinguishable, spectral peaks and hinders their quantification. Here, we propose the use of J-modulation at optimum echo time for accurate and separate quantification of glutamate and glutamine. To study the reproducibility of this approach, in vivo MRSI sLASER measurement at 120 ms echo time was evaluated in three healthy subjects in two separate sessions, and the findings are reported.

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Qinyuan Zhang¹, Jianing Li¹, Yun Su¹, Zhuoheng Yan¹, Zhixuan Hu¹, Weike Zeng¹, Mengzhu Wang², Xu Yan², Jiaji Mao¹, and Jun Shen^1
1Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China, ²MR Scientific Marketing, Siemens Healthineers Ltd, Guangzhou, China

Keywords: Tumors, Diffusion/other diffusion imaging techniques

A fractional order calculus model (FROC) holds promise in differentiating tumor-infiltrated edema from pure vasogenic edema of brain tumors. This study used a q-space Cartesian grid sampling scheme, diffusion spectrum imaging, in patients with high-grade gliomas, meningiomas and brain metastases to generate FROC-based parameters, including D, β and μ. The μ showed the best individual parameter performance in differentiating tumor-infiltrated edema from pure vasogenic edema.

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Takahiro Sanada¹, Shota Yamamoto^1,2, Mio Sakai³, Toru Umehara^2,4, Hirotaka Sato^1,5, Masato Saito¹, Nobuyuki Mitsui¹, Satoru Hiroshima¹, Ryogo Anei⁶, Yonehiro Kanemura⁷, Mishie Tanino⁸, Katsuyuki Nakanishi³, Haruhiko Kishima², and Manabu Kinoshita^1,9
1Neurosurgery, Asahikawa Medical University, Asahikawa, Japan, ²Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan, ³Diagnostic Radiology, Osaka International Cancer Institute, Osaka, Japan, ⁴Neurosurgery, Hanwa Memorial Hospital, Osaka, Japan, ⁵Neurosurgery, Japanese Red Cross Kitami Hospital, Kitami, Japan, ⁶Neurosugery, Moriyama Hospital, Asahikawa, Japan, ⁷Biomedical Research and Innovation, Institute for Clinical Research, National Hospital Organization Osaka National Hospital, Osaka, Japan, ⁸Diagnostic Pathology, Asahikawa Medical University, Asahikawa, Japan, ⁹Neurosugery, Osaka International Cancer Institute, Osaka, Japan

Keywords: Tumors, Radiomics

The current study aimed to test whether the ratio of T1-weighted to T2-weighted signal intensity (rT1/T2) derived from conventional MRI could act as a surrogate relaxation time predictive of IDH mutation status in histologically lower-grade gliomas. The findings showed that rT1/T2 strongly correlates with T1- and T2-relaxation times in histologically LrGGs. The mean value of rT1/T2 was able to discriminate IDHwt and IDHmt tumors in two domestic cohorts, with statistical significance. However, this result was not validated in the original TCIA/TCGA cohort due to the wide variety of imaging characteristics in the cohort. 

Bao Wang¹, Yuan Yao¹, Jingzhen He¹, and Dmytro Pylypenko^2
1Radiology, Qilu Hospital of Shandong University, Jinan, China, ²GE Healthcare, Beijing, China

Keywords: Tumors, DSC & DCE Perfusion

This study aimed to explore performances of parameters derived from DCE-MRI with multiple pharmacokinetic models regarding this differential diagnosis, as well as overall performances of models. Eighty-eight patients with suspected GBM and SBM underwent DCE-MRI in this study. Peritumoral v_p from shutter-speed model achieved the best single-parameter’s performance. Additionally, shutter-speed model achieved the highest overall separating performance. Shutter-speed is the recommended DCE-MRI pharmacokinetic model for differential diagnosis between GBM and SBM. 

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Sanghoon Kim¹ and Alexander Lin^1
1BWH, Boston, MA, United States

Keywords: Tumors, Quantitative Imaging, Sodium Imaging

▶︎ MR has been commonly used for the brain tumor patient monitoring. However, most of the MR images does not provide quantitative physiologic information, which can be ambiguous with longitudinal monitoring.

▶︎ Sodium MR imaging can quantitatively provide tumor cell viability information.

▶︎ This presentation introduces a brain tumor patient’s longitudinal quantitative sodium imaging report.

▶︎ Potentially, this quantitative report can be attributed to the tumor patient’s treatment plan.

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Lavanya Yegnaraman¹, Natesan Chidambaranathan¹, Adhityan Rajendran², Rashmi Rao³, Manikandan Mariyapillai³, and Narayana Krishna Rolla^3
1Radiodiagnosis, Apollo Hospitals Chennai, Chennai, India, ²Radiology, Apollo Hospitals, Chennai, India, ³Philips India Ltd, Gurgaon, India

Keywords: Tumors, CEST & MT, amide proton transfer

The utility of Amide Proton Transfer weighted imaging in preoperative grading of gliomas was studied. 64 patients with various primary intraaxial tumours were included in the study. Mean APTw was able to differentiate between IDH mutant grade 2 and grade 3 gliomas (astrocytomas and oligodendrogliomas) with statistical significance (p<0.05). APTw imaging can well delineate between the tumour core and the tumour periphery and the difference in the APT means between the two regions is statistically significant. APTw imaging also identifies grade 3 tumours misclassified as grade 2 on other sequences.

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Saket Patel¹, Nathaniel Kim¹, Thasin Peyear¹, and Kayvan R Keshari^1
1Radiology, Memorial Sloan Kettering Cancer Center, Manhattan, NY, United States

Keywords: Tumors, Deuterium, DMI, HP, Metabolism, Probes, Imaging agent

A chemical synthesis of C-4 deuterated ascorbic acid as a potential new deuterium metabolic imaging marker for in vivo VitC metabolism. Additionally, we have developed new HP methods for Vit C as well as its oxidized analogue, DHA, to be used as a 13C HP MRS substrates. Furthermore, deuteration increases the 13C T1 of HP DHA and improved polarization from optimized HP formulations along with enhanced 13C T1 will result in better quantification of oxidative stress in vivo. The aim is to implement both DMI and HP MRS in brain tumor models to understand the anticancer activity of VitC.

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Seyma Alcicek^1,2,3,4, Iris Divé^2,3,4,5, Ulrich Pilatus^1,2,3,4, Vincent Prinz⁶, Joachim P. Steinbach^2,3,4,5, Marie-Thérèse Forster⁶, Elke Hattingen^1,2,3,4, Michael W. Ronellenfitsch^2,3,4,5, and Katharina J. Wenger^1,2,3,4
1Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany, ²University Cancer Center Frankfurt (UCT), Frankfurt am Main, Germany, ³Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany, ⁴German Cancer Research Center (DKFZ) Heidelberg, Germany and German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt am Main, Germany, ⁵Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany, ⁶Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany

Keywords: Tumors, Spectroscopy

Nutritional interventions such as fasting are currently under evaluation as anti-cancer treatment. In glioma patient cohorts, the feasibility and safety of fasting in addition to antitumor treatment has been shown. However, it is still unclear whether fasting exerts effects on the glioma tumor tissue at all, and whether fasting causes metabolic or immunological changes in the glioma microenvironment that could be exploited therapeutically. This is a report on the metabolic flexibility of tumor cells induced by a fasting cycle of 72 hours prior to biopsy or resection analyzed by MR-Spectroscopy (MRS) as part of the ERGO3-trial.

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Jian Ming Teo^1,2, Jason M Johnson³, Halyna Pokhylevych³, Kinsey Lano³, Ping Hou¹, Xinzeng Wang⁴, and Ho-Ling Liu^1
1Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States, ²The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States, ³Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States, ⁴GE Healthcare, Houston, TX, United States

Keywords: Tumors, DSC & DCE Perfusion, Gliomas

Vessel Size Imaging was performed on twenty-five glioma patients to obtain voxel-wise relative vessel size index and peak shift maps. This study aimed to investigate if relative vessel size index and difference in peak shift between lesion vs normal appearing white matter voxels will assist in differentiating pseudoprogression vs tumor recurrence for post-treatment gliomas. It was shown that AUC and accuracy increases when incorporating rVSI and difference in peak shift.

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tianwei song¹, yanan zhang¹, chen zhou¹, and Junchao Qian^1
1Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230031, P. R. China, Hefei, China

Keywords: Tumors, Blood vessels

Glioblastoma (GBM) is a highly invasive and vascularized primary malignant brain tumor. Glutamine synthetase (GS) could induce vessel sprouting through the improvement of endothelial cell migration in inflammatory diseases. MR vessel size imaging was supposed to visualize angiogenesis potentially in the brain. In the study we research the role of GS on neovascularization in glioma by in vivo vessel size imaging. Our results indicate that the vascular changes mainly occur in the tumor center and significant decreases of microvascular density values in the MSO group compared to the control. GS inhibitor could be a potential drug to treat glioma.

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Natalie Julie Serkova¹, Paula Araya², Sharon Cain³, Jenna Steiner¹, Kelly Sullivan⁴, and Joaquin Espinoza^2
1Radiology, University of Colorado Anschutz, Aurora, CO, United States, ²Pharmacology, University of Colorado Anschutz, Aurora, CO, United States, ³Biochemistry, Chaminade University of Honolulu, Honolulu, HI, United States, ⁴Pediatrics, University of Colorado Anschutz, Aurora, CO, United States

Keywords: Tumors, Animals, Down Syndrome

Gliomas are exceedingly rare in Down Syndrome (DS). This study characterizes metabolic biomarkers and structural differences in the brains of mouse DS models and compare them to glioma models. Analysis of the age-dependent differences in the metabolic profile was carried out by 1H-NMR metabolomics and compartmental brain volumes of mouse brains were assessed from T2-weighted MRI. A significant age-dependent neuronal loss in the cortex and hippocampus, with a hyperventricular profile, was observed in DS mice. Highly decreased lactate and amino acid concentrations were observed in DS, in contrast to glioma extracts, indicative of decreased metabolic dependency on glycolysis and proteolysis. 

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Michelle Zalles¹, F William Schuler¹, Jorge de la Cerda¹, Alia Khaled¹, Sanhita Sinharay², and Mark D Pagel^1
1Cancer Systems Imaging, UT MD Anderson Cancer Center, Houston, TX, United States, ²Center for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, India

Keywords: Cancer, CEST & MT, pH imaging

The treatment of glioblastoma potentially causes tumor necrosis, which has reduced glycolytic metabolism.  AcidoCEST MRI measures tumor acidosis caused by tumor glycolysis.  Our study demonstrated that acidoCEST MRI, a molecular imaging method that measures tumor extracellular pH, can detect a decrease in pHe < 7.0 for tumors that resisted radiotherapy or were untreated, and can detect an increase in pHe > 7.0 for tumors that were successfully treated or showed evidence for necrosis. 

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Natasha Najam¹, Sam Jiang¹, Huijun Liao¹, and Alexander Peter Lin^1
1Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital / Harvard Medical School, Boston, MA, United States

Keywords: Tumors, Spectroscopy, chemotherapy, normal-appearing brain

Patients that undergo chemotherapy have been shown to develop cognitive dysfunction after treatment.  Previous studies have shown changes in white matter metabolism; however, few have examined grey matter metabolism.  Our results show that glutamate, glutathione, creatine, N-acetylaspartate, and myoinositol were reduced in the posterior cingulate in tumor patients that underwent chemotherapy when compared to healthy controls.  The effect of radiotherapy was also examined but did not show metabolic differences.

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Jiayu Xiao¹, Yang Chen¹, Jason Ye², Zhehao Hu¹, Anthony Christodoulou³, Mark Shiroshi¹, Debiao Li³, and Zhaoyang Fan^1,2,4
1Radiology, Keck School of Medicine of USC, Los Angeles, CA, United States, ²Radiation Oncology, Keck School of Medicine of USC, Los Angeles, CA, United States, ³Cedars-Sinai Medical Center, Los Angeles, CA, United States, ⁴Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States

Keywords: Tumors, DSC & DCE Perfusion

Brain tumors represent a great therapeutic challenge and tend to impact blood brain barrier (BBB) integrity, angiogenesis, and vascularity. Dynamic contrast-enhanced (DCE) MRI is widely used to quantify BBB permeability and dynamic susceptibility contrast MRI (DSC) is used to quantify cerebral perfusion. We incorporated the newly developed MR multitasking-based dynamic imaging for cerebrovascular evaluation (MT-DICE) technique to achieve simultaneous DCE and DSC acquisition with a single-dose injection. MT-DICE could quantify DCE and DSC parameters with good inter-reader agreement in patients with brain tumors. The intratumoral enhanced region showed more severe BBB disruption and higher perfusion than the peritumoral T2-hyperintense regions.

Yuxia Liang¹, Yuhan Ren², Yu Shang³, Xiang Liu³, Maode Wang³, Ming Zhang³, and Chen Niu^4
1The first affiliated hospital of Xi'an Jiaotong University, Xi'An, China, ²Hospital of Stomatology Xi'an Jiaotong University, Xi'an, China, ³The first affiliated hospital of Xi'an Jiaotong University, Xi'an, China, ⁴The first affiliated hospital of Xi'an Jiaotong University, XI'an, China

Keywords: Tumors, Diffusion Tensor Imaging, glioma

Isocitrate dehydrogenase (IDH) is critical to prognosis of glioma. While, reliable techniques for preoperative assessment of IDH status remain scarce. In this study, we investigated mean diffusivity (MD) and anisotropy fraction (FA) using Diffusion Tensor Imaging (DTI) combined with the clinical features to predict IDH status. Our results found significant differences in FA_mean/FA_nawm, MD_min, NLR, and age between IDH mutant and IDH wild groups. The model incorporating FA_mean/FA_nawm, MD_min, NLR, and age predicted IDH status with area under ROC curve of 0.85, 95% CI: 74.3%~95.7%. Our findings suggested that DTI combined with clinical features can non-invasively prediction of IDH status.