Tractographie par IRM de diffusion : algorithmes, validation, reproductibilité et applications

La tractographie gagne de plus en plus en importance dans les études cliniques car elle est l'unique modalité d'imagerie en mesure de caractériser in vivo l'architecture et l'intégrité des fibres de la substance blanche. Toutefois, la disponibilité croissante de modèles de diffusion et d'algorithmes de tractographie rend le choix d'une méthode de reconstruction de fibres difficile. Plus important encore, les performances et la reproductibilité de chaque méthode peuvent varier. Cette dernière considération souligne la difficulté de validation des méthodes de tractographie étant donné qu'aucune réalité terrain n'est disponible. Dans ce travail de thèse, nous avons dans un premier temps implémenté et intégré quatre différents algorithmes de tractographie par Imagerie de Tenseur de Diffusion à un logiciel de neuroimagerie. Trois déterministes et un autre probabiliste. Ensuite, nous avons étudié la validation de ces algorithmes sur des données fantôme qui simule une réalité terrain, offrant différentes configurations complexes de fibres. La reproductibilité des algorithmes implémentés a été étudiée sur des données réelles, chez 12 sujets sains en variant la résolution angulaire et en prenant comme faisceau test, le faisceau corticospinal. Les résultats obtenus ont montré une meilleure reproductibilité de l'algorithme probabiliste en conjonction avec une haute résolution angulaire. Enfin, sachant que dans certaines maladies, l'asymétrie entre les faisceaux concernés devrait être différente de celle des sujets sains, nous avons utilisé l'algorithme le plus reproductible pour examiner chez des sujets sains les degrés d'asymétries macro et microstructurale du faisceau corticospinal.Tractography is gaining increasing importance in clinical studies because it is the only imaging modality able to characterize in vivo the architecture and integrity of white matter fibers. However, the increasing availability of diffusion models and tractography algorithms makes the choice of a fiber reconstruction method difficult. More important, the performance and reproducibility of each method can vary. This last observation underscores the difficulty of validating tractography methods since no ground truth is available. In this work, we initially implemented and integrated four different Diffusion Tensor Imaging tractography algorithms in neuroimaging software. Three deterministic and one probabilistic. Next, we studied the validation of these algorithms on phantom data which simulates a given ground truth, offering various complex configurations of fibers. The reproducibility of the implemented algorithms has been studied on real data, in 12 healthy subjects by varying the angular resolution and taking as tractus test, the corticospinal tract. The results showed a better reproducibility of the probabilistic algorithm in conjunction with high angular resolution. Finally, in some diseases, the asymmetry between the tractus involved should be different from that of healthy subjects, we used the most reproducible algorithm to investigate in healthy subjects the levels of macro and microstructural asymmetries in the corticospinal tract

Quantitative evaluation of 10 tractography algorithms on a realistic diffusion MR phantom.

International audienceAs it provides the only method for mapping white matter fibers in vivo, diffusion MRI tractography is gaining importance in clinical and neuroscience research. However, despite the increasing availability of different diffusion models and tractography algorithms, it remains unclear how to select the optimal fiber reconstruction method, given certain imaging parameters. Consequently, it is of utmost importance to have a quantitative comparison of these models and algorithms and a deeper understanding of the corresponding strengths and weaknesses. In this work, we use a common dataset with known ground truth and a reproducible methodology to quantitatively evaluate the performance of various diffusion models and tractography algorithms. To examine a wide range of methods, the dataset, but not the ground truth, was released to the public for evaluation in a contest, the "Fiber Cup". 10 fiber reconstruction methods were evaluated. The results provide evidence that: 1. For high SNR datasets, diffusion models such as (fiber) orientation distribution functions correctly model the underlying fiber distribution and can be used in conjunction with streamline tractography, and 2. For medium or low SNR datasets, a prior on the spatial smoothness of either the diffusion model or the fibers is recommended for correct modelling of the fiber distribution and proper tractography results. The phantom dataset, the ground truth fibers, the evaluation methodology and the results obtained so far will remain publicly available on: http://www.lnao.fr/spip.php?rubrique79 to serve as a comparison basis for existing or new tractography methods. New results can be submitted to [email protected] and updates will be published on the webpage

Tractographie par IRM de diffusion (algorithmes, validation, reproductibilité et applications)

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Arterial Spin Labeling Perfusion in Pediatric Brain Tumors: A Review of Techniques, Quality Control, and Quantification

International audienceArterial spin labeling (ASL) is a magnetic resonance imaging (MRI) technique for measuring cerebral blood flow (CBF). This noninvasive technique has added a new dimension to the study of several pediatric tumors before, during, and after treatment, be it surgery, radiotherapy, or chemotherapy. However, ASL has three drawbacks, namely, a low signal-to-noise-ratio, a minimum acquisition time of 3 min, and limited spatial summarize current resolution. This technique requires quality control before ASL-CBF maps can be extracted and before any clinical investigations can be conducted. In this review, we describe ASL perfusion principles and techniques, summarize the most recent advances in CBF quantification, report technical advances in ASL (resting-state fMRI ASL, BOLD fMRI coupled with ASL), set out guidelines for ASL quality control, and describe studies related to ASL-CBF perfusion and qualitative and semi-quantitative ASL weighted-map quantification, in healthy children and those with pediatric brain tumors

Pseudoprogression in Glioblastoma: Role of Metabolic and Functional MRI-Systematic Review

Background: Glioblastoma is the most frequent malignant primitive brain tumor in adults. The treatment includes surgery, radiotherapy, and chemotherapy. During follow-up, combined chemoradiotherapy can induce treatment-related changes mimicking tumor progression on medical imaging, such as pseudoprogression (PsP). Differentiating PsP from true progression (TP) remains a challenge for radiologists and oncologists, who need to promptly start a second-line treatment in the case of TP. Advanced magnetic resonance imaging (MRI) techniques such as diffusion-weighted imaging, perfusion MRI, and proton magnetic resonance spectroscopic imaging are more efficient than conventional MRI in differentiating PsP from TP. None of these techniques are fully effective, but current advances in computer science and the advent of artificial intelligence are opening up new possibilities in the imaging field with radiomics (i.e., extraction of a large number of quantitative MRI features describing tumor density, texture, and geometry). These features are used to build predictive models for diagnosis, prognosis, and therapeutic response. Method: Out of 7350 records for MR spectroscopy, GBM, glioma, recurrence, diffusion, perfusion, pseudoprogression, radiomics, and advanced imaging, we screened 574 papers. A total of 228 were eligible, and we analyzed 72 of them, in order to establish the role of each imaging modality and the usefulness and limitations of radiomics analysis

A review of long-term deficits in memory systems following radiotherapy for pediatric posterior fossa tumor

International audienceIntroduction: In recent years, progress in pediatric posterior fossa tumor (PFT) treatments has improved survival rates. However, the majority of survivors present neurocognitive sequelae that impact academic achievement.Methods: This review examines the literature from 2000 to 2020 on long-term outcomes in different memory systems for survivors of pediatric PFT, considering the impact of radiotherapy which is a well-known prognostic factor for global neurocognitive function.Results: Of the 43 articles selected, 31 explored working memory, 19 episodic memory, 9 semantic memory and 2 procedural memory. Irradiated survivors had scores of <-2 standard deviation (SD) (n = 4 studies/25) or between -2SD and -1SD (n = 7 studies/25) for working memory; <-1SD for anterograde memory (n = 11/13), with a progressive decline in these two memory systems; <-1SD (n = 4/7) in semantic memory, and a deficit in perceptual-motor procedural learning (n = 1/1). Reducing craniospinal irradiation dose, limiting tumor bed boosts, and using proton therapy seem to have had a beneficial effect with better preservation of the memory score and a reduction in the decline over time. Non-irradiated survivors had memory systems that were less affected, with preservation of anterograde memory and maintenance of long-term stability.Conclusion: Memory deficits are a core feature in survivors of pediatric PFT, especially when treatment requires radiotherapy. To limit these effects, dose constraints for specific brain areas involved in memory should be defined. During long-term follow-up, specific attention is essential to identify these deficits in order to limit their impact on the quality of life

Glioblastoma Stem-like Cell Detection Using Perfusion and Diffusion MRI

Purpose: With current gold standard treatment, which associates maximum safe surgery and chemo-radiation, the large majority of glioblastoma patients relapse within a year in the peritumoral non contrast-enhanced region (NCE). A subpopulation of glioblastoma stem-like cells (GSC) are known to be particularly radio-resistant and aggressive, and are thus suspected to be the cause of these relapses. Previous studies have shown that their distribution is heterogeneous in the NCE compartment, but no study exists on the sensitivity of medical imaging for localizing these cells. In this work, we propose to study the magnetic resonance (MR) signature of these infiltrative cells. Methods: In the context of a clinical trial on 16 glioblastoma patients, relative Cerebral Blood Volume (rCBV) and Apparent Diffusion Coefficient (ADC) were measured in a preoperative diffusion and perfusion MRI examination. During surgery, two biopsies were extracted using image-guidance in the hyperintensities-FLAIR region. GSC subpopulation was quantified within the biopsies and then cultivated in selective conditions to determine their density and aggressiveness. Results: Low ADC was found to be a good predictor of the time to GSC neurospheres formation in vitro. In addition, GSCs were found in higher concentrations in areas with high rCBV. Conclusions: This study confirms that GSCs have a critical role for glioblastoma aggressiveness and supports the idea that peritumoral sites with low ADC or high rCBV should be preferably removed when possible during surgery and targeted by radiotherapy

Glioblastoma Stem-like Cell Detection Using Perfusion and Diffusion MRI

HTE program Moglimaging (Plan Cancer, Aviesan)/InsermInternational audiencePurpose: With current gold standard treatment, which associates maximum safe surgery and chemo-radiation, the large majority of glioblastoma patients relapse within a year in the peritumoral non contrast-enhanced region (NCE). A subpopulation of glioblastoma stem-like cells (GSC) are known to be particularly radio-resistant and aggressive, and are thus suspected to be the cause of these relapses. Previous studies have shown that their distribution is heterogeneous in the NCE compartment, but no study exists on the sensitivity of medical imaging for localizing these cells. In this work, we propose to study the magnetic resonance (MR) signature of these infiltrative cells.Methods: In the context of a clinical trial on 16 glioblastoma patients, relative Cerebral Blood Volume (rCBV) and Apparent Diffusion Coefficient (ADC) were measured in a preoperative diffusion and perfusion MRI examination. During surgery, two biopsies were extracted using image-guidance in the hyperintensities-FLAIR region. GSC subpopulation was quantified within the biopsies and then cultivated in selective conditions to determine their density and aggressiveness.Results: Low ADC was found to be a good predictor of the time to GSC neurospheres formation in vitro. In addition, GSCs were found in higher concentrations in areas with high rCBV.Conclusions: This study confirms that GSCs have a critical role for glioblastoma aggressiveness and supports the idea that peritumoral sites with low ADC or high rCBV should be preferably removed when possible during surgery and targeted by radiotherapy

Response Assessment in Neuro-Oncology criteria, contrast enhancement and perfusion MRI for assessing progression in glioblastoma

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Impact of a pediatric posterior fossa tumor and its treatments on motor procedural learning

International audienceIntroduction: Posterior fossa tumor (PFT) survivors have difficulty learning new skills. Procedural memory is a skill learning system that allows, through training, the automatization of procedures and progressive improvement of performance. It underlies most of the motor procedures in everyday life that we perform automatically, such as riding a bike or writing. Motor procedural memory is divided into two components: motor sequence learning involving mainly cortico-striatal networks, and motor adaptation involving mainly cortico-cerebellar networks. The aim of this work was to explore the impact of a tumor and its treatment during childhood on procedural learning hypothesizing that sequence learning would be impaired in PFT survivors who have been treated with radiotherapy, whereas motor adaptation would be impaired in all PFT survivors.Method: 22 irradiated survivors of PFT, 17 non-irradiated survivors and 21 healthy controls from the IMPALA study (NCT04324450) performed a motor sequence learning task and a motor adaptation task. Doses received by striatal and cerebellar structures were reported from the initial dosimetry plans.Results: Sequence learning was preserved in both tumor groups, but at the individual level 7/22 irradiated, and 4/17 non-irradiated participants failed to learn the motor sequence. Motor adaptation was impaired in both tumor groups, predominantly in the irradiated group.Conclusion: This study sheds new light on the long-term impact of PFT treatments in childhood on a rarely-studied part of memory, which is perceptual-motor procedural learning. Our results suggest that the cerebellum and striatum could be considered as organs at risk with regard to procedural learning