Advanced diffusion MRI for evaluating early response to radiation treatment in cervical cancer

先进的扩散 MRI 用于评估宫颈癌放射治疗的早期反应

• 批准号: 10596155
• 负责人: Rebecca Ann Rakow-Penner
• 金额: $ 63.35万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10596155
• 关键词: Access to Information; Affect; Aftercare; Age; Agreement; Algorithms; Benign; Biological Markers; Bladder; Brain; Cancer Etiology; Cancer Patient; Cervical; Cervical Cancer Screening; Cervix Uteri; Cessation of life; Chemotherapy and/or radiation; Classification; Clinical; Contrast Media; Data; Detection; Development; Diagnosis; Diffusion; Diffusion Magnetic Resonance Imaging; Disease; Disease Progression; Early treatment; Edema; Evaluation; Free Will; Functional disorder; Gold; Hemorrhage; Hysterectomy; Image; Imaging Techniques; Indolent; Infertility; Inflammation; Intestines; Lesion; Machine Learning; Magnetic Resonance Imaging; Malignant - descriptor; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Manuals; Measures; Methods; Mission; Modeling; Morbidity - disease rate; Morphologic artifacts; Organ; Outcome; Patient Care; Patients; Pelvic Pain; Performance; Pilot Projects; Positron-Emission Tomography; Property; Prostate; Public Health; Radiation; Radiation therapy; Reader; Research; Restriction Spectrum Imaging; Sampling; Sensitivity and Specificity; Signal Transduction; Source; Staging; Standardization; Structure; Techniques; Testing; Therapeutic; Time; Tissues; Translating; Treatment Efficacy; Tumor Burden; Tumor Tissue; United States National Institutes of Health; Visualization software; Water; Woman; Work; X-Ray Computed Tomography; biomedical imaging; biophysical model; biophysical properties; cancer imaging; chemoradiation; classification algorithm; clinically significant; cohort; contrast enhanced; imaging modality; improved; innovation; magnetic field; mortality; nerve injury; novel strategies; prevent; prospective; radiation response; radical hysterectomy; response; screening program; standard of care; theories; tool; treatment planning; treatment response; tumor; uptake; water diffusion

Project Summary Despite the advent of aggressive cervical cancer screening programs, cervical cancer remains one of the most common cancers affecting women under age 35, and the fourth most common cause of cancer death worldwide. The standard of care for early stage (≥IB) cervical cancer is hysterectomy or radiation. Unfortunately, the consequences of radical treatment include fertility loss, nerve injury causing bladder and bowel dysfunction, and pelvic pain. There is a critical need to reduce cervical cancer mortality, while minimizing the potential morbidities of treatment. To achieve this end requires refined approaches for diagnosis and evaluation of response to treatment using noninvasive biomarkers to differentiate indolent from clinically significant disease at the earliest possible time-point. PET/CT is currently the mainstay in evaluating response to treatment and is highly confounded by post-treatment changes such as edema. Magnetic resonance imaging (MRI) with advanced diffusion-weighted imaging may offer an alternative approach to evaluate treatment response, with additional advantages of being a radiation-free and contrast media-free exam. The overall objective in this application is to develop and evaluate a robust advanced diffusion-weighted imaging technique that provides a highly sensitive and specific reflection of cervical cancer tumor burden and treatment response at the earliest possible time point. Our hypothesis is that restriction spectrum imaging (RSI), an advanced diffusion imaging technique, is as sensitive and specific as standard of care post-treatment PET/CT for evaluation of treatment efficacy of cervical cancer and can be performed 3 months earlier than standard of care PET/CT. The aims of this proposal are 1) Determine the RSI model for cervical cancer evaluation, 2) Develop and validate a cervical cancer classification algorithm from multi-parametric MRI based on the Aim 1 biophysical model using established machine learning techniques, 3) Prospectively validate RSI-MRI compared to PET/CT in evaluating response to radiation treatment in cervical cancer patients (≥ stage IB) in a pilot study0. The main significance of this study is the development of a radiation-free and non-contrast imaging technique for evaluating response to treatment three months earlier than the current standard of care PET/CT. This will allow appropriate treatment earlier preventing unnecessary progression of disease. The innovation proposed involves developing a diffusion model specific for cervix imaging within the RSI framework based on the biophysical characteristics of healthy and malignant cervical tissue. We will then apply this quantitative technique prospectively on a preliminary cohort of patients before and after treatment and compare to the standard of care PET/CT imaging. At the completion of the study, a new tool for evaluating response to treatment in cervical cancer that is contrast and radiation free will be available. This is directly translatable to the clinical setting to benefit cervical cancer patients. Cervical cancer patients will be better served, particularly patients not responding to treatment, as they can be directed to appropriate treatment at an earlier time point.

项目概要 尽管出现了积极的宫颈癌筛查计划，但宫颈癌仍然是最常见的癌症之一。 影响 35 岁以下女性的常见癌症，也是全球第四大癌症死亡原因。 早期（≥IB）宫颈癌的标准治疗是子宫切除术或放射治疗。不幸的是， 根治性治疗的后果包括生育能力丧失、神经损伤导致膀胱和肠道功能障碍，以及 骨盆疼痛。迫切需要降低宫颈癌死亡率，同时尽量减少潜在的发病率 的治疗。为了实现这一目标，需要改进诊断和评估反应的方法 使用非侵入性生物标志物进行治疗，尽早区分惰性疾病和临床显着疾病 可能的时间点。 PET/CT 是目前评估治疗反应的主要手段，具有很高的应用价值。 因治疗后的变化（例如水肿）而混淆。具有先进技术的磁共振成像 (MRI) 弥散加权成像可能提供另一种评估治疗反应的方法， 无辐射和无造影剂检查的优点。该应用程序的总体目标是 开发和评估强大的先进扩散加权成像技术，该技术提供高灵敏度 以及尽早具体反映宫颈癌肿瘤负荷和治疗反应。 我们的假设是限制谱成像 (RSI)，一种先进的扩散成像技术，与 敏感性和特异性作为治疗后 PET/CT 的护理标准，用于评估宫颈癌的治疗效果 癌症，可以比标准护理 PET/CT 提前 3 个月进行。该提案的目标是 1) 确定用于宫颈癌评估的 RSI 模型，2) 开发并验证宫颈癌分类 基于 Aim 1 生物物理模型的多参数 MRI 算法，使用已建立的机器学习 技术，3) 前瞻性验证 RSI-MRI 与 PET/CT 相比在评估放射反应方面的效果 一项试点研究中对宫颈癌患者（≥ IB 期）的治疗0。本研究的主要意义在于 开发无辐射和非对比成像技术来评估治疗三的反应 比当前标准护理 PET/CT 早了几个月。这将有助于及早进行适当的治疗，以预防 不必要的疾病进展。所提出的创新涉及开发一个特定于 基于健康和恶性生物物理特征的 RSI 框架内的子宫颈成像 宫颈组织。然后，我们将前瞻性地将这种定量技术应用于初步的患者队列 治疗前后并与护理标准 PET/CT 成像进行比较。研究完成后， 一种用于评估宫颈癌治疗反应的新工具将是对比剂和无辐射的 可用的。这可以直接转化为临床环境，使宫颈癌患者受益。宫颈癌 患者将得到更好的服务，特别是对治疗没有反应的患者，因为他们可以被引导到 在较早的时间点进行适当的治疗。