Cristina Lavini

Publications (38) View all

• Article: Model-based, semiquantitative and time intensity curve shape analysis of dynamic contrast-enhanced MRI: a comparison in patients undergoing antiangiogenic treatment for recurrent glioma.

  Cristina Lavini, Joost J C Verhoeff, Charles B Majoie, Lukas J A Stalpers, Dick J Richel, Mario Maas
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  ABSTRACT: To compare time intensity curve (TIC)-shape analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) data with model-based analysis and semiquantitative analysis in patients with high-grade glioma treated with the antiangiogenic drug bevacizumab. Fifteen patients had a pretreatment and at least one posttreatment DCE-MRI. We applied a pixel-by-pixel TIC shape analysis, where TICs are classified into five different types according to their shape, and calculated the occurrence of each TIC type in the region of interest (ROI). The results were compared to the pharmacokinetic model (PKM) parameters K(trans) , K(ep) , V(e) , and V(i) , and with the semiquantitative parameters maximum enhancement (ME) and initial slope of increase (ISI). The relative amount of type 2 and 4 TIC shape significantly correlated with the parameter K(ep) but not with K(trans) or V(e) . The PKM parameter V(e) and the semiquantitative parameters ME and ISI showed significant changes after treatment. None of the TIC shapes individually showed significant changes. The semiquantitative parameters ME and ISI are more sensitive to the effect of the bevacizumab than K(trans) and V(e) . The pixel-by-pixel TIC shape analysis parameters are not sensitive to the effect of bevacizumab, although they can be seen as surrogates for the PKM parameter K(ep) .
  Journal of Magnetic Resonance Imaging 09/2011; 34(6):1303-12. · 2.70 Impact Factor
• Article: Upper and extra-motoneuron involvement in early motoneuron disease: a diffusion tensor imaging study.

  Maaike M van der Graaff, Caroline A Sage, Matthan W A Caan, Erik M Akkerman, Cristina Lavini, Charles B Majoie, Aart J Nederveen, Aeilko H Zwinderman, Frans Vos, Frans Brugman, Leonard H van den Berg, Maarten C de Rijk, Pieter A van Doorn, Wim Van Hecke, Ronald R Peeters, Wim Robberecht, Stefan Sunaert, Marianne de Visser
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  ABSTRACT: Motoneuron disease is a term encompassing three phenotypes defined largely by the balance of upper versus lower motoneuron involvement, namely amyotrophic lateral sclerosis, primary lateral sclerosis and progressive muscular atrophy. However, neuroradiological and pathological findings in these phenotypes suggest that degeneration may exceed the neuronal system upon which clinical diagnosis is based. To further delineate the phenotypes within the motoneuron disease spectrum, this controlled study assessed the upper- and extra-motoneuron white matter involvement in cohorts of patients with motoneuron disease phenotypes shortly after diagnosis by comparing diffusion tensor imaging data of the different cohorts to those of healthy controls and directly between the motoneuron disease phenotypes (n = 12 for each cohort). Furthermore, we acquired follow-up data 6 months later to evaluate fractional anisotropy changes over time. Combined use of diffusion tensor tractography of the corticospinal tract and whole-brain voxel-based analysis allowed for comparison of the sensitivity of these techniques to detect white matter involvement in motoneuron disease. The voxel-based analysis demonstrated varying extents of white matter involvement in different phenotypes of motoneuron disease, albeit in quite similar anatomical locations. In general, fractional anisotropy reductions were modest in progressive muscular atrophy and most extensive in primary lateral sclerosis. The most extensive patterns of fractional anisotropy reduction were observed over time in the voxel-based analysis, indicating progressive extra-motor white matter degeneration in limb- and bulbar onset amyotrophic lateral sclerosis and in progressive muscular atrophy. The observation of both upper motor and extra-motoneuron involvement in all phenotypes of motoneuron disease shortly after diagnosis suggests that these are all part of a single spectrum of multisystem neurodegenerative disease. Voxel-based analysis was more sensitive to detect longitudinal changes than diffusion tensor tractography of the corticospinal tract. Voxel-based analyses may be particularly valuable in the evaluation of motor and extra-motor white matter involvement in the early symptomatic stages of motoneuron disease, and for monitoring the spread of pathology over time.
  Brain 02/2011; 134(Pt 4):1211-28. · 9.46 Impact Factor
• Source

  Available from: uva.nl

  Article: Reproducibility of the gadolinium concentration measurements and of the fitting parameters of the vascular input function in the superior sagittal sinus in a patient population.

  Cristina Lavini, Joost J C Verhoeff
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  ABSTRACT: It is widely recognised that the measurement of the arterial input function (AIF) is a key issue and a major source of errors in the pharmacokinetic modelling of dynamic, contrast-enhanced magnetic resonance imaging (DCE-MRI) data, and the modality of the AIF determination is still a matter of debate. In this study we addressed the problem of the intrinsic variability of the AIF within the imaged volume of a DCE-MRI scan by systematically investigating the change in the concentration of contrast agent over time and the fit parameters of the derived vascular input function (VIF) obtained from the superior sagittal sinus (SSS) of a patient population that was scanned longitudinally during treatment for high grade glioma. From a total of 82 scanning sessions, we compared the results obtained with three different DCE-MRI protocols and between two different fitting functions. We applied a correction algorithm to the measured concentration-time curves to minimize the effect of the low temporal resolution on the VIF, and investigated the effect of this algorithm on the reproducibility. Finally, where possible, we compared the signal obtained in the SSS to the signal obtained in the middle cerebral artery. We found a good intrapatient reproducibility of both the measured gadolinium concentrations and VIF parameters, and that the variation of the parameters due to slice location within a patient was significantly lower than the intra patient variation. Intrapatient, interscan differences were significantly less marked than inter-patient differences showing a good intraclass correlation coefficient. We did encounter a MRI protocol dependence of the VIF fitting parameters. The correction algorithm significantly improved the reproducibility of the fitting parameters. These results support the idea that the use of a patient specific measured AIF, not necessarily averaged over a large volume, offers a significant benefit with respect to an external AIF or a measured cohort average AIF.
  Magnetic Resonance Imaging 12/2010; 28(10):1420-30. · 1.99 Impact Factor
• Article: MR spectroscopy findings in early stages of motor neuron disease.

  M M van der Graaff, C Lavini, E M Akkerman, Ch B Majoie, A J Nederveen, A H Zwinderman, F Brugman, L H van den Berg, J M B V de Jong, M de Visser
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  ABSTRACT: Upper motor neuron degeneration varies in different phenotypes of MND. We used single-voxel MR spectroscopy of the primary motor cortex to detect corticomotoneuron degeneration and glial hyperactivity in different phenotypes of MND with a relatively short disease duration, contributing to further delineation of the phenotypes. We prospectively included patients with ALS-B, ALS-L, and PMA and compared their data with those of patients with PLS and healthy controls. Each cohort consisted of 12 individuals. Disease duration was <1 year in ALS and PMA, but longer in PLS by definition. Follow-up examination was at 6 months. We measured ALSFRS-R, finger- and foot-tapping speed, and levels of the following: 1) NAAx, 2) mIns, and 3) Glx in the primary motor cortex. At baseline, we found significantly decreased NAAx levels and increased mIns levels in PLS. Levels of NAAx and mIns in patients with ALS-L and ALS-B were not significantly different from those in controls, but NAAx levels were significantly lower compared with those in PMA. At follow-up, only in PMA was a decrease of NAAx demonstrated. Glx levels varied widely in all groups. Levels of NAAx and mIns correlated well with clinical variables. Metabolite changes suggest neuronal dysfunction and active glial involvement in PLS. The corticomotoneuron is affected in early ALS-B and ALS-L, but at a later stage also in PMA. MR spectroscopy data are useful to obtain insight into the disease process at the level of the upper motor neuron in various phenotypes of MND.
  American Journal of Neuroradiology 11/2010; 31(10):1799-806. · 2.93 Impact Factor
• Source

  Available from: brainlife.org

  Article: Bevacizumab and dose-intense temozolomide in recurrent high-grade glioma.

  J J C Verhoeff, C Lavini, M E van Linde, L J A Stalpers, C B L M Majoie, J C Reijneveld, W R van Furth, D J Richel
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  ABSTRACT: Angiogenesis inhibition is a rational treatment strategy for high-grade glioma (HGG). Combined antiangiogenic therapy and chemotherapy could be beneficial, taking advantage of different mechanisms of antitumour activity of both therapies. We carried out a phase I-II clinical trial with the combination of bevacizumab and continuous dose-intense temozolomide (TMZ) for patients with a recurrent HGG after first- or second-line treatment. Twenty-three HGG patients were treated with bevacizumab (10 mg/kg i.v. every 3 weeks) and TMZ (daily 50 mg/m(2)), until clinical or radiological progression. Conventional and dynamic magnetic resonance imaging (MRI) were carried out on days -4, 3 and 21 and until clinical or radiological progression. Overall response rate (20%), 6-month progression-free survival (PFS6) (17.4%), median progression-free survival (13.9 weeks) and median overall survival (OS) (17.1 weeks) were considerably lower compared with most other studies with bevacizumab-containing regimens. The dynamic MRI parameters contrast transfer coefficient and relative cerebral blood volume decreased rapidly during the early phases of treatment, reflecting changes in vascularisation and vessel permeability but not in tumour activity. In addition, >50% of patients showed oedema reduction and a reduced shift on T1 images. Treatment with bevacizumab and TMZ is feasible and well tolerated but did not improve PFS6 and median OS.
  Annals of Oncology 08/2010; 21(8):1723-7. · 6.43 Impact Factor