Cardiac Magnetic Resonance Imaging in Early Detection and Therapy Monitoring of Myocardial Cardiotoxicity under Chemotherapy

心脏磁共振成像在化疗下心肌毒性早期检测和治疗监测中的应用

• 批准号: 419344766
• 负责人: Dr. Christian Houbois
• 金额: --
• 依托单位: Department of Medical Imaging
• 依托单位国家: 德国
• 项目类别: Research Fellowships
• 财政年份: 2019
• 资助国家: 德国
• 起止时间: 2018-12-31 至 2020-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/419344766?language=en
• 关键词: Cardiac; Magnetic; Resonance; Imaging; Early

Breast cancer is the leading cancer in women with a 5-year survival of 90%. However, survival is significantly reduced in patients (15-20%) with an additional overexpression of HER2 /neu receptors (5-year survival rate 80%). Treatment in these patients relies on a combination of Anthracyclines and Trastuzumab (monoclonal antibody) with an increased risk of cardiotoxicity related to the combination therapy.Monitoring of the left ventricular (LV) function during/after therapy is of outmost impartance in these patients in order to identify dysfunction early on and to allow for therapy modification avoiding possible longtime cardiac damage (e.g. heart failure). Currently, monitoring is performed by radionuclide ventriculography (MUGA) and echocardiography (Echo); however, both methods focus on global functional parameters and do not investigate direct changes of the myocardium.Cardiac MRI not only allows for accurate assessment of ventricular function but also non-invasive tissue diagnosis to detect early changes such as edema or fibrosis. Beside current techniques, new quantitative methods such as cardiac relaxometry (T1 / T2 mapping) are at the forefront of investigations. Furthermore, MRI is superior to Echo in assessment of regional myocardial function/deformation (Strain) due to its high reproducibility.The value of these quantitative approaches in the early detection of cardiotoxicity under Anthracyclines / Trastuzumab therapy to avoid possible long-term effects is the focus of projects outlines in this application.For this reason the applicant plans a one year stay at the Department of Medical Imaging of the University Health Network / Peter Munk Cardiac Center at the University of Toronto (Canada). One of the largest and comprehensive studies on the subject of cardiotoxicity and MRI, the EMBRACE-MRI (clincialtrial.gov: NCT02306538) study is currently conducted as this center. The study population included 150 patients with an HER2 / neu+ tumor under Anthracyclines / Trastuzumab therapy; beside many different laboratory parameters close interval Echo and MRI examinations are performed (-1,3,6,9,15,24 months after the start of therapy).The work plan contains the evaluation/analysis of these MRI examinations with regard to late gadolinium enhancement (LGE), Strain, T1 / T2 mapping and ECV (Extracellular Volume Fraction) in the prediction of cardiotoxicity.This study provides a comprehensive insight into the problem of cardiotoxicity; and based on the results, it is anticipated to establish quantitative imaging biomarkers for early detection of cardiotoxicity.The resulting expertise in the planning / conduction of various cardio-oncology projects would also further strengthen the interdisciplinary expertise of the cancer center at University of Cologne and the Institute for Diagnostic and Interventional Radiology.

乳腺癌是女性的主要癌症，5年生存率为90%。然而，HER 2/neu受体额外过表达的患者（15-20%）的生存率显著降低（5年生存率80%）。这些患者的治疗依赖于蒽环类药物和曲妥珠单抗（单克隆抗体）的联合治疗，与联合治疗相关的心脏毒性风险增加。在治疗期间/治疗后监测左心室（LV）功能对这些患者至关重要，以便早期识别功能障碍，并允许治疗调整，避免可能的长期心脏损伤（例如心力衰竭）。目前，监测方法主要是放射性核素心室造影（MUGA）和超声心动图（Echo）;然而，这两种方法都侧重于整体功能参数，而不是研究心肌的直接变化。心脏MRI不仅可以准确评估心室功能，还可以进行非侵入性组织诊断，以发现水肿或纤维化等早期变化。除了目前的技术，新的定量方法，如心脏舒张（T1 / T2映射）是在调查的最前沿。此外，委员会认为，MRI在评价局部心肌功能/变形（应变）方面具有上级的可重复性。这些定量方法在早期检测蒽环类药物/曲妥珠单抗治疗下的心脏毒性以避免可能的长期毒性的价值。本申请表中的项目重点是长期效果，因此，申请人计划在本校医学影像学系学习一年健康网络/加拿大多伦多大学Peter Munk心脏中心。作为心脏毒性和MRI主题的最大和全面研究之一，EMBRACE-MRI（clincialtrial.gov：NCT 02306538）研究目前作为该中心进行。研究人群包括150例接受蒽环类/曲妥珠单抗治疗的HER 2/ neu+肿瘤患者;除了许多不同的实验室参数外，还进行近间隔回波和MRI检查（治疗开始后-1，3，6，9，15，24个月）。工作计划包含关于晚期钆增强（LGE），应变，T1 / T2标测和ECV（细胞外体积分数）在预测心脏毒性中的作用。这项研究提供了对心脏毒性问题的全面了解;根据结果，预计将建立定量成像生物标志物，用于早期检测心脏毒性。肿瘤学项目还将进一步加强科隆大学癌症中心和诊断和介入放射学研究所的跨学科专业知识。

项目成果

Chronic lung allograft dysfunction phenotype and prognosis by machine learning CT analysis

• DOI: 10.1183/13993003.01652-2021
• 发表时间: 2022-07-01
• 期刊: EUROPEAN RESPIRATORY JOURNAL
• 影响因子: 24.3
• 作者: McInnis, Micheal C.;Ma, Jin;Martinu, Tereza
• 通讯作者: Martinu, Tereza