Finding the anaplastic focus in diffuse gliomas: The value of Gd-DTPA enhanced MRI, FET-PET, and intraoperative, ALA-derived tissue fluorescence

Ewelt, Christian; Floeth, Frank; Felsberg, Jörg; Steiger, Hans Jakob; Sabel, Michael; Langen, Karl‐Josef; Stoffels, Gabriele; Stummer, Walter

doi:10.1016/j.clineuro.2011.03.008

Cited by 154 publications

(143 citation statements)

References 31 publications

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“…Recent studies investigating 5-ALA fluorescence in low-grade gliomas have shown positivity without use of any magnification in only 17% (n = 1/6) of patients, 44 whereas a positive rate of 100% (n = 10/10) could be demonstrated with the use of confocal microscopy. 33,35 Ewelt et al 10 found 7.7% (n = 1/13) and Widhalm et al 48 found no focal 5-ALA fluorescence in WHO Grade II tumors (n = 0/8). The authors of smaller series reported a lack of 5-ALA fluorescence in low-grade gliomas.…”

Section: -Ala Fluorescence In Primary Brain Tumorsmentioning

confidence: 99%

Use of fluorescence to guide resection or biopsy of primary brain tumors and brain metastases

Marbacher

Klinger

Schwyzer

et al. 2014

FOC

141

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Object The accurate discrimination between tumor and normal tissue is crucial for determining how much to resect and therefore for the clinical outcome of patients with brain tumors. In recent years, guidance with 5-aminolevulinic acid (5-ALA)–induced intraoperative fluorescence has proven to be a useful surgical adjunct for gross-total resection of high-grade gliomas. The clinical utility of 5-ALA in resection of brain tumors other than glioblastomas has not yet been established. The authors assessed the frequency of positive 5-ALA fluorescence in a cohort of patients with primary brain tumors and metastases. Methods The authors conducted a single-center retrospective analysis of 531 patients with intracranial tumors treated by 5-ALA–guided resection or biopsy. They analyzed patient characteristics, preoperative and postoperative liver function test results, intraoperative tumor fluorescence, and histological data. They also screened discharge summaries for clinical adverse effects resulting from the administration of 5-ALA. Intraoperative qualitative 5-ALA fluorescence (none, mild, moderate, and strong) was documented by the surgeon and dichotomized into negative and positive fluorescence. Results A total of 458 cases qualified for final analysis. The highest percentage of 5-ALA–positive fluorescence in open resection was found in glioblastomas (96%, n = 99/103). Among other tumors, 5-ALA–positive fluorescence was detected in 88% (n = 21/32) of anaplastic gliomas (WHO Grade III), 40% (n = 8/19) of low-grade gliomas (WHO Grade II), no (n = 0/3) WHO Grade I gliomas, and 77% (n = 85/110) of meningiomas. Among metastases, the highest percentage of 5-ALA–positive fluorescence was detected in adenocarcinomas (48%, n = 13/27). Low rates or absence of positive fluorescence was found among pituitary adenomas (8%, n = 1/12) and schwannomas (0%, n = 0/7). Biopsies of high-grade primary brain tumors showed positive rates of fluorescence similar to those recorded for open resection. No clinical adverse effects associated with use of 5-ALA were observed. Only 1 patient had clinically silent transient elevation of liver enzymes. Conclusions Study findings suggest that the administration of 5-ALA as a surgical adjunct for resection and biopsy of primary brain tumors and brain metastases is safe. In light of the high rate of positive fluorescence in high-grade gliomas other than glioblastomas, meningiomas, and a variety of metastatic cancers, 5-ALA seems to be a promising tool for enhancing intraoperative identification of neoplastic tissue and optimizing the extent of resection.

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Section: -Ala Fluorescence In Primary Brain Tumorsmentioning

confidence: 99%

Use of fluorescence to guide resection or biopsy of primary brain tumors and brain metastases

Marbacher

Klinger

Schwyzer

et al. 2014

FOC

141

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“…According to the World Health Organization (WHO) (1), they are characterized by low tumor cell density, absence of angiogenesis, and low proliferation rates (WHO grade II). However, at the microscopic level, LGGs may harbor anaplastic tumor cell foci, which may lead to rapid malignant transformation (2,3). In anaplastic gliomas (WHO grade III), increased cellularity and proliferation are found.…”

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confidence: 99%

Focal Changes in Diffusivity on Apparent Diffusion Coefficient MR Imaging and Amino Acid Uptake on PET Do Not Colocalize in Nonenhancing Low-Grade Gliomas

Rahm

Boxheimer

Bruehlmeier³

et al. 2014

J Nucl Med

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Low-grade gliomas (LGGs) may harbor malignant foci, which are characterized by increased tumor cellularity and angiogenesis. We used diffusion-weighted MR imaging (apparent diffusion coefficient [ADC]) and PET with the amino acid O-(2-18 F-fluorethyl)-L-tyrosine ( 18 F-FET) to search for focal changes of diffusion (ADC) and amino acid uptake and to investigate whether focal changes in these parameters colocalize within LGGs. Methods: We retrospectively selected 18 patients with nonenhancing LGG. All patients had undergone 18 F-FET PET and MR imaging for preoperative evaluation or for therapy monitoring in recurrent or progressive LGG. Region-of-interest analysis was performed to compare 18 F-FET uptake and ADC values in areas with focal intratumoral maximum metabolic activity and diffusion restriction and between tumor and normal brain. 18 F-FET uptake was normalized to the mean cerebellar uptake (ratio). ADC values were also compared with the 18 F-FET uptake on a voxel-by-voxel basis across the whole tumor. Results: The mean focal maximum (mean ± SD, 1.69 ± 0.85) and global 18 F-FET uptake in tumors (1.14 ± 0.41) exceeded that of normal cortex (0.85 ± 0.09) and cerebrospinal fluid (0.82 ± 0.20). ADC values in the area with most restricted diffusion (1.07 ± 0.22 · 10 −3 mm 2 /s) and in the whole tumor (1.38 ± 0.27 · 10 −3 mm 2 /s) were in the range between normal cortex (0.73 ± 0.06 · 10 −3 mm 2 /s) and cerebrospinal fluid (2.84 ± 0.09 · 10 −3 mm 2 /s). 18 F-FET uptake did not correlate with corresponding (colocalizing) ADC values, either in the area with focal maximum metabolic activity or in the area with most restricted diffusion or in the whole tumor. Conclusion: There is no congruency between 18 F-FET uptake and diffusivity in nonenhancing LGG. Diffusion restriction in these tumors most likely represents changes in brain and tumor cell densities as well as alteration of water distribution and is probably not directly correlated with the density of tumor cells.

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“…Both beams are overlapped spatially and temporally, and interact with the samples through a laser scanning microscope. In most cases, the Stokes beam is modulated at radio frequencies (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) where the noise spectrum of the laser has reached a shotnoise°oor. After the sample, the pump beam is ltered out and sent to the photodiode (PD), and the SRL signal is demodulated by a lock-in amplier.…”

Section: Instrumentations Of Srs Microscopymentioning

confidence: 99%

Stimulated Raman scattering microscopy for rapid brain tumor histology

Yang

Chen

2017

J. Innov. Opt. Health Sci.

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Rapid histology of brain tissues with su±cient diagnostic information has the great potential to aid neurosurgeons during operations. Stimulated Raman Scattering (SRS) microscopy is an emerging label-free imaging technique, with the intrinsic chemical resolutions to delineate brain tumors from normal tissues without the need of time-consuming tissue processing. Growing number of studies have shown SRS as a \virtual histology" tool for rapid diagnosis of various types of brain tumors. In this review, we focus on the basic principles and current developments of SRS microscopy, as well as its applications for brain tumor imaging.

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Finding the anaplastic focus in diffuse gliomas: The value of Gd-DTPA enhanced MRI, FET-PET, and intraoperative, ALA-derived tissue fluorescence

Cited by 154 publications

References 31 publications

Use of fluorescence to guide resection or biopsy of primary brain tumors and brain metastases

Use of fluorescence to guide resection or biopsy of primary brain tumors and brain metastases

Focal Changes in Diffusivity on Apparent Diffusion Coefficient MR Imaging and Amino Acid Uptake on PET Do Not Colocalize in Nonenhancing Low-Grade Gliomas

Stimulated Raman scattering microscopy for rapid brain tumor histology

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