MR Spectroscropy and Imaging in Head and Neck Tumors

描述(由申请人提供)： 今年将有超过55,000名美国人罹患头颈癌，占美国所有癌症的近3%。这些癌症在男性和50岁以上的人中更常见。其中85%以上的癌症与烟酒消费有关。尽管积极的手术和放射治疗(RT)可能导致严重的功能丧失，但在过去的30年里，头颈部癌症患者的存活率相对保持不变。基于肿瘤形态或临床特征的预测指标在定义疗效时通常不太准确。因此，迫切需要一种可靠的预测这些肿瘤早期反应的指标。磁共振波谱(MRS)和成像(MRI)可以非侵入性地识别特定的代谢模式和组织生理学，可以作为预测和监测早期治疗反应的标志。对41例非霍奇金淋巴瘤和12例HN肿瘤的初步研究表明，31P MRS可以在治疗开始前预测疗效。与31P MRS相比，1H MRS和MRI具有更高的灵敏度和空间分辨率，因此有助于研究较小的肿瘤和研究肿瘤的异质性反应。这项建议的总体目标是测试核磁共振波谱和成像可以预测和监测头颈部肿瘤治疗的早期反应的假设。目标1：评价PME/13NTP比值在预测和检测31P MRS治疗反应中的作用；目标2：确定总胆碱(CHO)和乳酸(Lac)水平是否可以预测和监测治疗反应；目标3：使用生理MRI参数(T2、ADC和DCE)作为局部肿瘤对化疗和放疗反应的预测/监测指标。 将使用质子去耦合和NOE增强的3D CSI序列进行31P MRS研究。1H MRS研究将通过实施选择性多量子相干转移脉冲序列(SEL-MQC)来执行，用于在临床扫描仪上检测乳酸(Lac)和总胆碱(Tcho)。用于实施动态对比增强(DCE)、扩散加权成像(DWI)和T2加权成像(T2WI)成像的标准MRI脉冲序列将被简化，以便在一小时内对人类HN患者实施由31P MRS或1H MRS结合动态对比增强(DCE)、扩散加权成像(DWI)和T2WI的完整检查。

DESCRIPTION (provided by applicant): More than 55,000 Americans will develop cancer of the head and neck (HN) this year accounting for nearly 3% of all cancers in the United States. These cancers are more common in men and in people over age 50. More than 85% of these cancers are related to tobacco and alcohol consumption. Despite aggressive surgery and radiotherapy (RT), which may result in significant functional loss, the survival rate of patients with head and neck cancer has remained relatively unchanged over the past three decades. The predictive indices based on tumor morphology or clinical characteristics are generally less accurate in defining outcome of response. Hence, there is an urgent need for a reliable predictor of early response in these tumors. Magnetic resonance spectroscopy (MRS) and imaging (MRI) can non-invasively identify specific metabolic patterns and tissue physiology that may be used as markers for predicting and monitoring early treatment response. Preliminary studies on 41 cases of non-Hodgkins Lymphomas and 12 cases of HN tumors indicate that 31p MRS can predict response prior to initiation of therapy. 1H MRS and MRI provides higher sensitivity and spatial resolution than 31p MRS and would thus facilitate studying smaller tumors and investigating heterogeneous tumor response. The overall goal for this proposal is to test the hypothesis that NMR spectroscopy and imaging can predict and monitor early response to treatment of head and neck tumors. This hypothesis will be tested with the following specific aims: Aim 1: To evaluate the utility of the PME/13 NTP ratio in predicting and detecting treatment response by 31p MRS, Aim 2: To determine if total choline (Cho) and lactate (Lac) levels can predict and monitor treatment response and Aim 3: To use physiological MRI parameters (T2, ADC and DCE) as predictors/monitors of local tumor response to chemotherapy and radiation therapy of HN tumors. 31p MRS studies will be performed using proton decoupled and NOE enhanced 3D CSI sequence. 1H MRS studies will be performed by implementing a selective multi-quantum coherence transfer pulse sequence (Sel-MQC), for detection of lactate (Lac) and total choline (TCho) on the clinical scanner. Standard MRI pulse sequences for implementing dynamic contrast enhanced (DCE), diffusion weighted imaging (DWI) and T2 weighted imaging (T2WI) imaging will be streamlined so that a complete examination consisting of 31p MRS or 1H MRS combined with DCE, DWI and T2WI can be implemented on human HN patients within one hour.