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Bendszus, M.

Publications and source records attributed to Bendszus, M..

4 recordsLinked to original sources

Generating Synthetic MR Perfusion Maps from DWI and FLAIR in Acute Ischemic Stroke using Deep Learning

BackgroundMagnetic resonance imaging (MRI) is critical for acute stroke triage, but time-consuming, and often requires contrast injection for perfusion imaging. This study aimed to synthesize T-map perfusion maps from routinely available, non-contrast DWI and FLAIR using deep generative models. We hypothesized that relevant perfusion information could be inferred from these modalities to streamline imaging and reduce reliance on dynamic susceptibility contrast perfusion. MethodsAcute MRI data from 355 patients with anterior circulation stroke, including dynamic susceptibility contrast perfusion, were retrospectively collected from two European centers (Heidelberg: 2010-2018; Bordeaux: 2021-2022). Six versions of a denoising diffusion probabilistic model (DDPM) and a GAN architecture were trained to generate synthetic T-max perfusion maps from DWI, FLAIR, and infarct core mask as inputs. Performance was assessed by comparing synthetic and ground truth T-max maps using image similarity metrics. Regions with T-max >6s were compared using Dice coefficients, and mismatch volume distributions were analyzed. An ablation study quantified the contribution of each input. ResultsThe best performance was achieved by a DDPM with a 2.5D architecture using DWI, FLAIR, infarct core mask, and a perfusion-weighted loss function. It produced synthetic perfusion T-max maps with high similarity to ground truth under 110 seconds. The model showed strong spatial overlap for T-max >6s regions in internal validation (average Dice = 0.82, SD = 0.08), and external validation average (Dice 0.59, SD = 0.13), respectively. Synthetic maps closely matched ground-truth mismatch distributions, capturing key perfusion patterns. The infarct core mask played a critical role in model performance, alongside DWI and FLAIR inputs. ConclusionsWe propose a non-invasive, scalable framework to generate synthetic T-max perfusion maps from non-contrast MRI. This approach could expand access to perfusion data in acute stroke, shorten imaging protocols, and accelerate treatment decisions by eliminating the need for contrast-enhanced acquisition. Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=200 SRC="FIGDIR/small/684079v2_ufig1.gif" ALT="Figure 1"> View larger version (94K): org.highwire.dtl.DTLVardef@164235forg.highwire.dtl.DTLVardef@14e5489org.highwire.dtl.DTLVardef@190214eorg.highwire.dtl.DTLVardef@17a9e3a_HPS_FORMAT_FIGEXP M_FIG C_FIG

neuroscience↗

Personalized Medicine for Meningiomas: Drug Screening on Tumor Organoids Exposes Therapeutic Vulnerabilities to HDAC1/2i Panobinostat

Managing aggressive meningiomas remains challenging due to limited treatment options besides surgical tumor removal and radiotherapy. To identify novel therapies for aggressive meningiomas, we established a multi-step drug screening workflow, focusing on targetable genes obtained from transcriptome data of highly aggressive grade 3 meningiomas. In vitro screening of 107 targeted drugs identified nine effective inhibitors. To study these drugs in a more natural environment, we established a standardized patient-derived tumor organoid (TO) model preserving accurately the original tissues genotype and phenotype. Individual drug responses were assessed in TOs from 60 molecularly characterized meningioma cases. Especially the FDA-approved epigenetic drug panobinostat demonstrated high antimeningioma efficacy in 70% of TOs, mediated through HDAC1/2 inhibition. In addition, treatment in an orthotopic in vivo model revealed a significantly improved survival. In a heavily pretreated patient suffering from an anaplastic meningioma, oral panobinostat treatment could delay the tumor growth rate. In search of the molecular mechanism underlying a potential intrinsic panobinostat resistance, we identified upregulation of the HDAC8-TGF{beta}-EMT axis in the TO model and subsequent HDAC8 depletion substantially increased the sensitivity to panobinostat. These data highlight the utility of personalized drug screenings on TOs to identify suitable drug targets and inhibitors for a more effective treatment of clinically aggressive meningiomas and help to advance our understanding of counteracting resistance mechanisms. One Sentence SummaryThis study provides strong in vitro, in vivo, ex vivo, and patient evidence for the efficacy of the HDACi panobinostat to treat clinically aggressive meningiomas and uncovered a potential intrinsic resistance mechanism by activation of the HDAC8-TGF{beta}-EMT axis.

cancer biology↗

An AI-based segmentation and analysis pipeline for high-field MR monitoring of cerebral organoids

BackgroundCerebral organoids simulate the structure and function of the developing human brain in vitro, offering a large potential for personalized therapeutic strategies. The enormous growth of this research area over the past decade with its capability for clinical translation makes a non-invasive, automated analysis pipeline of organoids highly desirable. PurposeThis work presents the first application of magnetic resonance imaging (MRI) for the non-invasive quantification and quality assessment of cerebral organoids using an automated analysis tool. Three specific objectives are addressed, namely organoid segmentation to investigate organoid development over time, global cysticity classification, and local cyst segmentation. MethodsNine wildtype cerebral organoids were imaged over nine weeks using high-field 9.4T MRI including a 3D T2*-w and 2D diffusion tensor imaging (DTI) sequence. This dataset was used to train a deep learning-based 3D U-Net for organoid and local cyst segmentation. For global cysticity classification, we developed a new metric, compactness, to separate low- and high-quality organoids. ResultsThe 3D U-Net achieved a Dice score of 0.92{+/-}0.06 (mean {+/-} SD) for organoid segmentation in the T2*-w sequence. For global cysticity classification, compactness separated low- and high-quality organoids with high accuracy (ROC AUC 0.98). DTI showed that low-quality organoids have a significantly higher diffusion than high-quality organoids (p < .001). For local cyst segmentation in T2*-w, the 3D U-Net achieved a Dice score of 0.63{+/-}0.15 (mean {+/-} SD). ConclusionWe present a novel non-invasive approach to monitor and analyze cerebral organoids over time using high-field MRI and state-of-the-art tools for automated image analysis, offering a comparative pipeline for personalized medicine. We show that organoid growth can be monitored reliably over time and low- and high-quality organoids can be separated with high accuracy. Local cyst segmentation is feasible but could be further improved in the future.

developmental biology↗

Reversible brain edema in experimental cerebral malaria is associated with transcellular blood-brain barrier disruption and delayed microhemorrhages

Brain swelling occurs in cerebral malaria (CM) and may either reverse or result in fatal outcome. It is currently unknown how brain swelling in CM reverses, as investigations have been hampered by inadequate animal models. In this study, we show that reversible brain swelling in experimental murine cerebral malaria (ECM) can be induced reliably after single vaccination with radiation-attenuated sporozoites as revealed by in vivo high-field (9.4T) magnetic resonance imaging. Our results provide evidence that parenchymal fluid increase and consecutive brain swelling results from transcellular blood-brain barrier disruption (BBBD), as revealed by electron microscopy. This mechanism enables reversal of brain swelling but does not prevent persistent focal brain damage, evidenced by microhemorrhages, in areas of most severe BBBD. In a cohort of 27 pediatric and adult CM patients (n=4 fatal, n=23 non-fatal) two out of four fatal CM patients (50%) and 8 out of 23 non-fatal CM patients (35%) showed microhemorrhages on MRI at clinical field strength of 1.5T, emphasizing the translational potential of the experimental model. Our data suggest that targeting transcellular BBBD may represent a promising adjunct therapeutic approach in cerebral brain swelling to reduce edema and may ultimately lead to a reduced permanent brain damage and a better longtime neurological outcome. Author summaryBrain swelling, which occurs in diseases such as cerebral malaria, is not necessarily fatal, and may reverse. Even upon reversal of brain swelling, neurological sequelae can still occur. The factors contributing to the reversibility of brain edema are not known, and treatment options remain therefore limited. Identifying the mechanisms leading to such reversibility could inform clinical management aimed at decreasing brain swelling and consecutive brain injury. Here we introduce a reproducible and simple animal model that allows comprehensive in vivo studies of reversible brain swelling in cerebral malaria at the peak of disease and upon recovery. We identify a specific type of blood-brain barrier disruption (BBBD) as a mechanism that occurs in brain swelling. We show that BBBD can reverse, but also highlight remaining brain damage in areas of most severe BBBD. As the ECM model introduced here bares crucial similarities to the CM in humans, our findings open strategies to study new therapeutic avenues and point to compounds that specifically target transcellular BBBD to reduce brain edema, and increase survival rates.

neuroscience↗