23Na-MRI of recurrent glioblastoma multiforme after intraoperative radiotherapy: technical note

Haneder, Stefan; Giordano, Frank A.; Konstandin, Simon; Brehmer, Stefanie; Buesing, Karen; Schmiedek, Peter; Schad, Lothar R.; Wenz, Frederik; Schoenberg, Stefan O.; Ong, Melissa

doi:10.1007/s00234-014-1468-2

Cited by 12 publications

(13 citation statements)

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“…Cell kill fraction would be the decrease in CVF during each treatment cycle. The tumor volume based on an automated threshold and the histograms of CVF derived using equation {4} within the threshold have been reported as a means of monitoring regional tumor responses on a time scale as short as a single cycle (e.g., Figure 1) [217,218]. These observational studies will need to be expanded into clinical trials to generalize the results and to validate the assumption that achieving a high cell kill prolongs survival, as required by the Prentice criteria for surrogate markers of outcome [219,220].…”

Section: 0 Sodium In Human Diseasementioning

confidence: 99%

Quantitative sodium MR imaging: A review of its evolving role in medicine

Thulborn

2018

NeuroImage

142

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Sodium magnetic resonance (MR) imaging in humans has promised metabolic information that can improve medical management in important diseases. This technology has yet to find a role in clinical practice, lagging proton MR imaging by decades. This review covers the literature that demonstrates that this delay is explained by initial challenges of low sensitivity at low magnetic fields and the limited performance of gradients and electronics available in the 1980s. These constraints were removed by the introduction of 3T and now ultrahigh (≥7T) magnetic field scanners with superior gradients and electronics for proton MR imaging. New projection pulse sequence designs have greatly improved sodium acquisition efficiency. The increased field strength has provided the expected increased sensitivity to achieve resolutions acceptable for metabolic interpretation even in small target tissues. Consistency of quantification of the sodium MR image to provide metabolic parametric maps has been demonstrated by several different pulse sequences and calibration procedures. The vital roles of sodium ion in membrane transport and the extracellular matrix will be reviewed to indicate the broad opportunities that now exist for clinical sodium MR imaging. The final challenge is for the technology to be supplied on clinical ≥3T scanners.

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Section: 0 Sodium In Human Diseasementioning

confidence: 99%

Quantitative sodium MR imaging: A review of its evolving role in medicine

Thulborn

2018

NeuroImage

142

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“…Sodium magnetic resonance imaging ( 23 Na MRI) provides information about physiological and biochemical processes related to cell vitality and viability that cannot be achieved by 1 H MRI alone. 1 23 Na MRI can enable the quantification of the tissue sodium concentration (TSC) [2][3][4] of the human brain and has been proposed previously for the diagnosis of pathologies defined by a change in cell behavior, vitality or density in pathologies, such as stroke, [5][6][7] malignant tumors [8][9][10][11] or multiple sclerosis. [12][13][14] Furthermore, additional applications of 23 Na MRI have emerged, for example, quantitative relaxometry and distinguishing between intracellular and extracellular space.…”

Section: Introductionmentioning

confidence: 99%

²³Na MRI in ischemic stroke: Acquisition time reduction using postprocessing with convolutional neural networks

et al. 2021

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Quantitative 23Na magnetic resonance imaging (MRI) provides tissue sodium concentration (TSC), which is connected to cell viability and vitality. Long acquisition times are one of the most challenging aspects for its clinical establishment. K‐space undersampling is an approach for acquisition time reduction, but generates noise and artifacts. The use of convolutional neural networks (CNNs) is increasing in medical imaging and they are a useful tool for MRI postprocessing. The aim of this study is 23Na MRI acquisition time reduction by k‐space undersampling. CNNs were applied to reduce the resulting noise and artifacts. A retrospective analysis from a prospective study was conducted including image datasets from 46 patients (aged 72 ± 13 years; 25 women, 21 men) with ischemic stroke; the 23Na MRI acquisition time was 10 min. The reconstructions were performed with full dataset (FI) and with a simulated dataset an image that was acquired in 2.5 min (RI). Eight different CNNs with either U‐Net–based or ResNet‐based architectures were implemented with RI as input and FI as label, using batch normalization and the number of filters as varying parameters. Training was performed with 9500 samples and testing included 400 samples. CNN outputs were evaluated based on signal‐to‐noise ratio (SNR) and structural similarity (SSIM). After quantification, TSC error was calculated. The image quality was subjectively rated by three neuroradiologists. Statistical significance was evaluated by Student’s t‐test. The average SNR was 21.72 ± 2.75 (FI) and 10.16 ± 0.96 (RI). U‐Nets increased the SNR of RI to 43.99 and therefore performed better than ResNet. SSIM of RI to FI was improved by three CNNs to 0.91 ± 0.03. CNNs reduced TSC error by up to 15%. The subjective rating of CNN‐generated images showed significantly better results than the subjective image rating of RI. The acquisition time of 23Na MRI can be reduced by 75% due to postprocessing with a CNN on highly undersampled data.

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Section: Introductionmentioning

confidence: 99%

“…Sodium ( 23 Na) MRI has been used within animal experiments ( Schepkin et al, 2005 , 2006 ) and mostly case reports ( Thulborn et al, 2009 ; Laymon et al, 2012 ; Haneder et al, 2015 ) to monitor treatment associated changes in GBM consecutive to CRT. Here, 23 Na MRI demonstrated promising features as it seems to offer complementary information to routine imaging modalities ( Laymon et al, 2012 ; Haneder et al, 2015 ; Regnery and Platt, 2021 ). Quite recently, an investigation of 23 Na MRI at 3 Tesla (T) in GBM patients suggested that the development of tissue sodium concentration (TSC) during CRT might reflect tumor cell kill ( Thulborn et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Assessment of Sodium MRI at 7 Tesla as Predictor of Therapy Response and Survival in Glioblastoma Patients

et al. 2021

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The purpose of this work was to prospectively investigate sodium (23Na) MRI at 7 Tesla (T) as predictor of therapy response and survival in patients with glioblastoma (GBM). Thus, 20 GBM patients underwent 23Na MRI at 7T before, immediately after and 6 weeks after chemoradiotherapy (CRT). The median tissue sodium concentration (TSC) inside the whole tumor excluding necrosis was determined. Initial response to CRT was assessed employing the updated response assessment in neuro-oncology working group (RANO) criteria. Clinical parameters, baseline TSC and longitudinal TSC differences were compared between patients with initial progressive disease (PD) and patients with initial stable disease (SD) using Fisher’s exact tests and Mann-Whitney-U-tests. Univariate proportional hazard models for progression free survival (PFS) and overall survival (OS) were calculated using clinical parameters and TSC metrics as predictor variables. The analyses demonstrated that TSC developed heterogeneously over all patients following CRT. None of the TSC metrics differed significantly between cases of initial SD and initial PD. Furthermore, TSC metrics did not yield a significant association with PFS or OS. Conversely, the initial response according to the RANO criteria could significantly predict PFS [univariate HR (95%CI) = 0.02 (0.0001–0.21), p < 0.001] and OS [univariate HR = 0.17 (0.04–0.65), p = 0.005]. In conclusion, TSC showed treatment-related changes in GBM following CRT, but did not significantly correlate with the initial response according to the RANO criteria, PFS or OS. In contrast, the initial response according to the RANO criteria was a significant predictor of PFS and OS. Future investigations need to elucidate the reasons for treatment-related changes in TSC and their clinical value for response prediction in glioblastoma patients receiving CRT.

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23Na-MRI of recurrent glioblastoma multiforme after intraoperative radiotherapy: technical note

Abstract: (23)Na-MRI provided similar information in the suspicious area compared to (18)F-FET-PET, exceeding conventional (1)H-MRI. Still, (23)Na-MRI remains an investigational technique, which is worth to be further evaluated.

Cited by 12 publications

References 25 publications

Quantitative sodium MR imaging: A review of its evolving role in medicine

Quantitative sodium MR imaging: A review of its evolving role in medicine

²³Na MRI in ischemic stroke: Acquisition time reduction using postprocessing with convolutional neural networks

Assessment of Sodium MRI at 7 Tesla as Predictor of Therapy Response and Survival in Glioblastoma Patients

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23Na-MRI of recurrent glioblastoma multiforme after intraoperative radiotherapy: technical note

Abstract: (23)Na-MRI provided similar information in the suspicious area compared to (18)F-FET-PET, exceeding conventional (1)H-MRI. Still, (23)Na-MRI remains an investigational technique, which is worth to be further evaluated.

Cited by 12 publications

References 25 publications

Quantitative sodium MR imaging: A review of its evolving role in medicine

Quantitative sodium MR imaging: A review of its evolving role in medicine

23Na MRI in ischemic stroke: Acquisition time reduction using postprocessing with convolutional neural networks

Assessment of Sodium MRI at 7 Tesla as Predictor of Therapy Response and Survival in Glioblastoma Patients

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²³Na MRI in ischemic stroke: Acquisition time reduction using postprocessing with convolutional neural networks