Multi-Modality Quantitative Imaging for Evaluation of Response to Cancer Therapy

骨转移在晚期癌症中很常见，包括前列腺癌，那里有 超过70%的晚期疾病患者有骨转移的证据。尽管它们普遍存在 和重要的临床意义，目前还没有被广泛接受的定量成像 对治疗反应的评估。对反应或进展的评估通常基于 结合CT和血清标记物的骨显像目测解释。这个项目的目标是 因此，开发、验证并向临床实践推进用于评估的多模式定量度量 骨转移瘤对治疗的反应。SPECT-CT联合系统及其健壮性的实现 补偿方法使定量SPECT成像方法得以发展，这种方法具有 最近开始在临床上使用。在这里，我们建议利用这些发展之间的联系，通过 遵循三个目标。(1)利用模拟和模型研究，我们将首先优化和评估以下方法 99mTcMDP的SPECT/CT(QSPECT)定量显像我们建议将体模研究扩展到 一个QIN合作项目，以评估跨不同扫描仪和中心的方法。(2) 基于这些QSPECT方法，我们将开发、优化和表征定量骨SPECT 评估治疗反应的指标。计算这些指数将涉及半自动 骨和骨病变的分割，在一个集成的软件工具中实现。计算出的指数 将包括病变的数量、骨病变的负担，以及随着治疗而病变摄取的变化。我们会 在治疗前的测试-再测试研究中，使用真实的模拟来表征指数的可变性。(3) 最后，我们将应用这些方法，并在目前的新治疗方案的临床试验中验证它们。 骨转移耐去势前列腺癌。在这些研究中，我们将从以下几个方面评估这些方法 并将在体内将这些方法与从 Na18F PET/CT。我们还将调查全身核磁共振提供的额外信息量 和PSMA PET/CT。我们将把这些方法和图像提供给秦国，并建议组织 细分和响应指标的挑战，以利用全秦对这些业务的兴趣 区域。总之，这些定量成像工具和研究将提供一种有效的方法 临床易患的骨转移瘤疗效的定量成像评估 与临床标准骨显像相比，成本仅有轻微增加即可实施。

Bone metastases are common in advanced cancers including prostate adenocarcinoma, where there is evidence of bone metastases in more than 70% of patients with advanced disease. Despite their prevalence and the important clinical implications, there is currently no widely accepted quantitative imaging assessment for response to therapy. Assessment of response or progression is typically made based on visual interpretation of bone scintigraphy in conjunction with CT and serum markers. The goal of this project is thus to develop, validate, and advance to clinical practice multi-modality quantitative metrics for assessing response of bone metastases to therapy. Combined SPECT-CT systems and the implementation of robust compensation methods has enabled the development of quantitative SPECT imaging methods, which have recently become clinically available. Here we propose to exploit the nexus of these developments via the following 3 aims. (1) Using simulation and phantom studies, we will first optimize and evaluate methods for quantitative SPECT/CT (QSPECT) imaging of Tc-99m MDP. We propose to expand the phantom studies to a QIN cooperative project in order to evaluate the methods across different scanners and centers. (2) Based on these QSPECT methods, we will develop, optimize, and characterize quantitative bone SPECT indices for assessing response to therapy. Computing these indices will involve semi-automatic segmentation of bone and bone lesions, implemented in an integrated software tool. The indices calculated will include the number of lesions, bone lesion burden, and change in lesion uptake with therapy. We will characterize the variability of the indices using realistic simulations and in pre-therapy test-retest studies. (3) Finally, we will apply the methods and validate them in current clinical trials of new therapeutic regimens for bone metastatic castrate-resistant prostate cancer. In these studies, we will evaluate the methods in terms of time to progression and will compare the methods in vivo to similar quantitative metrics estimated from Na18F PET/CT. We will also investigate the amount of additional information provided by whole-body MRI and PSMA PET/CT. We will make the methods and images available to the QIN and propose to organize challenges of segmentation and response metrics to take advantage of the QIN-wide interest in these areas. Together, these quantitative imaging tools and studies will provide a validated approach for quantitative imaging-based evaluation of response in bone metastases that is readily clinically implementable with only a minor increase in cost relative to clinical standard bone scintigraphy.