Advanced MRI methods for detecting pseudo-progression of glioblastomas

用于检测胶质母细胞瘤假性进展的先进 MRI 方法

• 批准号: 8581766
• 负责人: Harish Poptani
• 金额: $ 34.51万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-06 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8581766
• 关键词: Accounting; Achievement; Adjuvant Chemotherapy; Anisotropy; Appearance; Area; Bayesian Analysis; Biopsy; Blood flow; Brain; Brain Neoplasms; Cephalic; Chemical Shift Imaging; Choline; Clinical; Clinical Management; Clinical Trials; Data; Decision Support Systems; Detection; Development; Diagnosis; Diffusion; Diffusion Magnetic Resonance Imaging; Early Intervention; Enhancing Lesion; Excision; Exhibits; Functional Magnetic Resonance Imaging; Glioblastoma; Glioma; Goals; Image; Immunotherapy; Intervention; Lesion; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Measures; Metabolism; Methods; Modality; Monitor; Morbidity - disease rate; Necrosis; Network-based; Newly Diagnosed; Operative Surgical Procedures; Patients; Perfusion; Phase; Postoperative Period; Predisposition; Primary Brain Neoplasms; Progression-Free Survivals; Radiation; Radiation therapy; Regimen; Repeat Surgery; Reporting; Resolution; Risk; Role; Scanning; Second Look Surgery; Sensitivity and Specificity; Shapes; Support System; Systemic Therapy; Testing; Tissues; Treatment outcome; Triage; Update; Water; Weight; alternative treatment; base; bevacizumab; chemotherapy; computer based statistical methods; follow-up; image guided intervention; imaging modality; improved; neuro-oncology; novel; public health relevance; response; spectroscopic imaging; standard of care; temozolomide; tool; treatment effect; tumor; tumor progression

DESCRIPTION (provided by applicant): Neo-adjuvant chemotherapy with temozolomide, along with radiation therapy has become the standard of care for the treatment of gliomas as this regimen improves survival of newly diagnosed glioblastoma patients. However, in about a third of the patients, progressive and enhancing lesions on MRI occur within six months after end of chemo-radiation therapy, which resolve without further interventions. These lesions are termed as pseudo-progression (PsP) as they mimic the appearance of a tumor on standard clinical MRI. Patients with PsP have a longer survival indicating that the progressive lesions were due to treatment effect rather than due to true tumor progression (TP). Accurate identification of PsP is critical for patient management as PsP patients can avoid unnecessary repeat surgery and continue effective chemotherapy, while alternative treatments, including resection or immunotherapy can be offered for TP. Functional MRI tools, such as, diffusion tensor imaging (DTI), perfusion imaging and magnetic resonance spectroscopy (MRS), probe changes in water mobility, blood flow and tissue metabolism, which are more sensitive in detecting changes than anatomical changes observed by standard MRI. Furthermore, in a clinical setting, it is unlikely that a single imaging parameter or modality will suffice in accurae detection of PsP. We thus hypothesize that the combination of whole brain MRS, perfusion imaging and DTI can provide a more accurate detection of PsP. In order to test this hypothesis, we will develop a novel decision support system that uses important features from all the imaging modalities in a completely non-biased way. Specifically, we will achieve the following aims: SA1: To assess the utility of 3D EPSI in differentiation of PsP patients from TP. SA2: To determine the role of dynamic susceptibility weighted contrast imaging in differentiation of PsP from TP. SA3: To evaluate the accuracy of DTI parameters, such as mean diffusivity (MD), fractional anisotropy (FA) and tensor shape measures including linear anisotropy coefficient (CL), planar anisotropy coefficient (CP) and spherical anisotropy coefficient (CS) in the identification of PsP. SA4: To determine the best combination of imaging parameters for accurate diagnosis of PsP. The utility of these parameters will be tested both at first clinical presentation (baseline) as well as change in these parameters on one-month follow up scan. A Bayesian network based decision support system will be used to detect PsP which will include advanced imaging parameters, as well as change in these parameters from baseline. The novelty of this approach is that it will provide a multi-dimensional analysis of brain tumors, whic will facilitate an accurate diagnosis of PsP and avoid unnecessary second-look surgery in these patients.

描述（由申请方提供）：使用替莫唑胺的新辅助化疗，沿着放射治疗已成为胶质瘤治疗的标准治疗方案，因为该方案可提高新诊断胶质母细胞瘤患者的生存率。然而，在大约三分之一的患者中，MRI上的进行性和增强性病变发生在放化疗结束后的六个月内，无需进一步干预即可消退。这些病变被称为假进展（PsP），因为它们在标准临床MRI上模拟肿瘤的外观。PsP患者的生存期更长，表明进展性病变是由于治疗效果而不是由于真正的肿瘤进展（TP）。准确识别PsP对于患者管理至关重要，因为PsP患者可以避免不必要的重复手术并继续有效的化疗，同时可以为TP提供替代治疗，包括切除或免疫治疗。功能性MRI工具，如扩散张量成像（DTI）、灌注成像和磁共振波谱（MRS），探测水流动性、血流和组织代谢的变化，其在检测变化方面比标准MRI观察到的解剖学变化更敏感。此外，在临床环境中，单个成像参数或模态不太可能足以准确检测PsP。因此，我们假设全脑MRS，灌注成像和DTI的组合可以提供一个更准确的检测PsP。为了验证这一假设，我们将开发一种新的决策支持系统，该系统以完全无偏见的方式使用所有成像方式的重要特征。具体而言，我们将实现以下目标：SA 1：评估3D EPSI在区分PsP患者和TP中的效用。SA2：确定动态磁敏感加权对比成像在鉴别PsP和TP中的作用。SA3：评价DTI参数，如平均扩散系数（MD）、各向异性分数（FA）和张量形状指标（包括线性各向异性系数（CL）、平面各向异性系数（CP）和球面各向异性系数（CS））在鉴别PsP中的准确性。SA4：确定准确诊断PsP的最佳成像参数组合。将在首次临床表现（基线）以及1个月随访扫描时这些参数的变化时检验这些参数的效用。将使用基于贝叶斯网络的决策支持系统检测PsP，其中将包括高级成像参数以及这些参数相对于基线的变化。这种方法的新奇在于，它将提供对脑肿瘤的多维分析，这将有助于准确诊断PsP，并避免这些患者不必要的二次手术。