Radiation and brain structure: minimising deficits in paediatric brain tumour survivors

1.由于手术和放射治疗等各种治疗策略的可用性，患有脑肿瘤的儿童的总体存活率急剧增加。然而，这些生存率的提高伴随着严重的脑损伤。例如，注意力、记忆力、任务切换能力、处理速度和识字能力方面的缺陷在幸存者中很常见。为了更好地了解这些损伤是如何产生的，成像技术已被用于研究辐射对大脑结构的损伤。磁共振成像（MRI）使我们能够拍摄大脑的照片。使用一种称为扩散MRI的特殊技术，可以测量大脑结构的损伤程度并在空间上绘制此图。2.该项目旨在绘制癌症幸存者的脑微结构损伤，并确定这种损伤与各种治疗后脑缺陷的关系。有一个具体的机会，以匹配放射治疗领域的成像数据，以更好地了解辐射剂量，微结构脑损伤和认知和行为缺陷之间的关系。随着质子治疗的出现，更好地理解这些关系也是及时的，因为早期证据表明质子与光子放射治疗的认知结果有所改善。更好地理解这些关系打开了机会，以修改放射治疗领域，以节省重要的大脑区域，并减少频率和严重程度与治疗后的大脑问题发生在未来。扩散MRI的配准能够测量脑结构的损伤程度并在空间上将其与来自放射治疗计划系统中的剂量分布立方体的逐点剂量进行映射，这将允许首次针对要导出的剂量分布来评估从多壳扩散MRI导出的各种微结构参数。这项工作与EPSRC的战略密切相关，通过开发创新的分析技术和新型成像技术来优化诊断和治疗，以改变健康预测和监测，并与EPSRC的各种研究领域，包括医学成像和医疗保健技术5。该项目汇集了一个多学科团队，包括神经肿瘤学专家，放射肿瘤学家，成像物理学家和神经心理学家，他们在伦敦大学学院医院，大奥蒙德街儿童医院和UCL医学物理和生物医学工程系以及UCL大奥蒙德街儿童健康研究所之间工作。

1. The overall survival rate of children with brain tumours has increased dramatically due to the availability of various treatment strategies such as surgery and radiotherapy. However, these improvements in survival are accompanied by serious brain impairments. For example, deficits in attention, memory, ability to switch between tasks, speed of processing and literacy are commonly seen in survivors. To better understand how these impairments arise, imaging techniques have been used to investigate damage to structure of the brain as a result of irradiation. Magnetic resonance imaging (MRI) allows us to take pictures of the brain. Using a special technique called diffusion MRI it is possible to measure the degree of damage to the brain structure and to map this spatially.2. This project seeks to map brain microstructural damage in cancer survivors and to determine how this damage relates to various post-treatment brain deficits. There is a specific opportunity to match radiotherapy treatment fields to imaging data to better understand the relationship between radiation dose, microstructural brain damage and cognitive and behavioural deficits. With the emergence of proton therapy it is also timely to better understand these relationships given that early evidence suggests improved cognitive outcomes in proton versus photon radiotherapy. Better understanding of these relationships opens the opportunity to modify the radiotherapy treatment fields to spare vital brain regions and reduce the frequency and severity with which post-treatment brain problems occur in the future.3. The co-registration of diffusion MRI, which is able to measure the degree of damage to the brain structure and to map this spatially, with point by point dose from the dose distribution cube in a radiotherapy treatment planning system will allow assessment of various microstructural parameters derived from multi-shell diffusion MRI against the dose distribution to be derived for the first time.4. This work closely aligns with EPSRC strategies to optimise diagnosis and treatment by the development of innovative analytical techniques and novel imaging technologies to transform prediction and monitoring for health and with various EPSRC research areas including medical imaging and healthcare technologies5. This project brings together a multi-disciplinary team with experts in neuro-oncology, radiation oncologists, imaging physicists and neuro-psychologists working between University College London Hospital, Great Ormond Street Hospital for Children and the UCL Department of Medical Physics and Biomedical Engineering and UCL Great Ormond Street Institute of Child Health.