Assessment of therapeutic response and treatment planning for brain tumors using metabolic and physiological MRI.
Assessment of therapeutic response and treatment planning for brain tumors using metabolic and physiological MRI.
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DOI：
10.1002/nbm.1669
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发表时间：
2011-07
影响因子：
2.9
通讯作者：
Nelson, Sarah J.
中科院分区：
文献类型：
--
作者：
Nelson, Sarah J.
MRI常规用于胶质瘤患者的诊断、治疗计划和治疗反应评估。神经胶质瘤是空间异质性和浸润性病变，其对治疗的反应相当多变。归类为低级别组织学的患者的中位总生存期为7年或更长，但需要仔细监测，以确保其肿瘤不会升级为恶性表型。具有最具侵袭性的IV级组织学的患者的中位总生存期为12-15个月，并且通常经历多次手术和辅助治疗以试图控制其疾病。尽管在空间分辨率和灵敏度的解剖图像的改进，仍然有相当大的模糊性在解释的钆增强病变的大小在T1加权图像作为治疗反应的措施，并在区分治疗效果和浸润性肿瘤在较大的T2病变的变化。将代谢和生理成像技术整合到常规临床MR检查中，将大大有助于规划局部治疗，如手术、放射和靶向药物输送，以及更可靠的治疗反应评估。已被证明能为胶质瘤患者提供有价值数据的先进方法是扩散、灌注和光谱成像。除了增强和非增强解剖学病变体积变化的标准测量外，包括采集此类数据的多参数检查能够评估肿瘤细胞结构、缺氧、正常组织结构的破坏、血管密度和血管通透性的变化。这对于解释新疗法的I期和II期临床试验的结果尤其重要，这些临床试验越来越多地包括被设计为具有抗血管生成和抗增殖特性的药物，而不是对肿瘤细胞活力具有直接影响的药物。
MRI is routinely used for diagnosis, treatment planning and assessment of response to therapy for patients with glioma. Gliomas are spatially heterogeneous and infiltrative lesions that are quite variable in terms of their response to therapy. Patients classified as having low-grade histology have a median overall survival of 7 years or more, but need to be monitored carefully to make sure that their tumor does not upgrade to a more malignant phenotype. Patients with the most aggressive grade IV histology have a median overall survival of 12–15 months and often undergo multiple surgeries and adjuvant therapies in an attempt to control their disease. Despite improvements in the spatial resolution and sensitivity of anatomic images, there remain considerable ambiguities in the interpretation of changes in the size of the gadolinium-enhancing lesion on T1-weighted images as a measure of treatment response, and in differentiating between treatment effects and infiltrating tumor within the larger T2 lesion. The planning of focal therapies, such as surgery, radiation and targeted drug delivery, as well as a more reliable assessment of the response to therapy, would benefit considerably from the integration of metabolic and physiological imaging techniques into routine clinical MR examinations. Advanced methods that have been shown to provide valuable data for patients with glioma are diffusion, perfusion and spectroscopic imaging. Multiparametric examinations that include the acquisition of such data are able to assess tumor cellularity, hypoxia, disruption of normal tissue architecture, changes in vascular density and vessel permeability, in addition to the standard measures of changes in the volume of enhancing and nonenhancing anatomic lesions. This is particularly critical for the interpretation of the results of Phase I and Phase II clinical trials of novel therapies, which are increasingly including agents that are designed to have anti-angiogenic and anti-proliferative properties as opposed to having a direct effect on tumor cell viability.
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影响因子：
3.9
作者：
Chang, Susan M.;Nelson, Sarah;Vandenberg, Scott;Cha, Soonmee;Prados, Michael;Butowski, Nicholas;McDermott, Michael;Parsa, Andrew T.;Aghi, Manish;Clarke, Jennifer;Berger, Mitchel
通讯作者：
Berger, Mitchel
影响因子：
4.4
作者：
Barboriak, Daniel P.;MacFall, James R.;Dewhirst, Mark W.
通讯作者：
Dewhirst, Mark W.
DOI：
10.1073/pnas.91.6.2076
发表时间：
1994-03-15
影响因子：
11.1
作者：
BOBO, RH;LASKE, DW;OLDFIELD, EH
通讯作者：
OLDFIELD, EH
影响因子：
50.5
作者：
Brada, M;Viviers, L;Westbury, C
通讯作者：
Westbury, C
影响因子：
5
作者：
Bian, Wei;Khayal, Inas S.;Nelson, Sarah J.
通讯作者：
Nelson, Sarah J.