Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) to Establish Objective Clinical Outcome Measures for Mandibular Osteoradionecrosis

使用动态对比增强磁共振成像 (DCE-MRI) 建立下颌放射性骨坏死的客观临床结果测量

• 批准号: 9135823
• 负责人: STEPHEN Y LAI
• 金额: $ 46.96万
• 依托单位: UNIVERSITY OF TX MD ANDERSON CAN CTR
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-23 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9135823
• 关键词: 3-Dimensional; Acute; Algorithms; Antibiotics; Blood Vessels; Cancer Patient; Caring; Chronic; Clinical; Clinical Research; Complication; Contrast Media; Coupled; Data; Debridement; Development; Diagnosis; Diagnostic Imaging; Disease Management; Disease Progression; Dose; Drug Kinetics; Effectiveness; Epidemic; Epidemiology; Event; Excision; External Beam Radiation Therapy; Failure; Goals; Head and Neck Cancer; Head and Neck Neoplasms; Head and neck structure; Healed; Health; Histology; Human; Human Papillomavirus; Hyperbaric Oxygen; Image; Impaired wound healing; Infection; Injection of therapeutic agent; Institution; Knowledge; Lead; Life Expectancy; Magnetic Resonance Imaging; Mandible; Maps; Measurement; Measures; Methods; Mission; Modality; Monitor; Morbidity - disease rate; Natural History; Necrosis; Operative Surgical Procedures; Opportunistic Infections; Oral cavity; Oropharyngeal Neoplasms; Osteoradionecrosis; Outcome; Outcome Measure; Pathologic; Patient Outcomes Assessments; Patients; Perfusion; Physiology; Populations at Risk; Postoperative Period; Process; Public Health; Radiation; Radiation therapy; Residual state; Resolution; Resources; Risk; SEER Program; Signal Transduction; Solid Neoplasm; Staging; Staging System; Surgical Flaps; Surgical Management; Techniques; Testing; Time; Tissues; University of Texas M D Anderson Cancer Center; Work; base; bone; bone healing; bone health; cancer therapy; cohort; contrast enhanced; density; healing; imaging modality; impression; improved; irradiation; lifetime risk; mortality; patient population; quantitative imaging; reconstruction; response; treatment response; tumor growth; wound

 DESCRIPTION (provided by applicant): Changes in the epidemiology of head and neck cancers have resulted in an increased number of younger and healthier patients being treated with definitive external beam radiotherapy (EBRT). The long term sequelae of irradiation in a patient population with good clinical outcomes and extended life expectancy are becoming increasingly relevant in the management of treatment-associated morbidity and mortality. Osteoradionecrosis (ORN) of the mandible is a devastating complication of irradiation with an estimated rate of up to 16% across head and neck histologies. Altered bone vascularity and opportunistic infections within the oral cavity contribute to the development of ORN leading to an inexorable process of bone destruction which lacks the normal sequence of healing events. Early-stage ORN is often managed using antibiotics, local wound care and hyperbaric oxygen (HBO). Advanced ORN requires surgical resection and reconstruction with healthy non-irradiated tissue. Successful management of this disease process requires an improved ability to identify patients at risk for ORN, monitor the effectiveness of conservative management and improve pre-operative planning to insure clear margins at time of resection. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a clinically available quantitative imaging method that is increasingly employed to assess microvascular function in the study of solid tumors of the head and neck. At our institution, DCE-MRI is integrated into a multi-modality clinical algorithm aimed at improving the diagnosis, staging and oncologic surveillance of head and neck tumors. DCE-MRI can detect altered bone vascularity associated with bone healing, necrosis and metastatic involvement, with excellent spatial resolution. We hypothesize that DCE-MRI can be used to detect alterations in bone vascularity following irradiation to monitor ORN clinical progression and response to treatment. To test this hypothesis, we will evaluate the potential of DCE-MRI to identify patients at risk for mandibular ORN, monitor response to conservative management, and identify the extent of advanced mandibular ORN to assist in surgical planning. Successful completion of this proposal has the potential to revolutionize the diagnosis and management of mandibular ORN. For the first time, clinicians will be able to identify patients at risk for ORN and manage post-irradiation care appropriately. The effectiveness of currently employed conservative measures could be tested using an objective measure and improved pre-operative planning could reduce the rate of surgical failure due to residual compromised bone.

 描述（由适用提供）：头颈癌的流行病学变化导致使用确定的外束放射治疗（EBRT）治疗的年轻，更健康的患者数量增加。具有良好临床结局和延长寿命延长的患者人群中辐射的长期后遗症越来越多地与治疗相关的发病率和死亡率的管理相关。下颌骨的骨质体（Osteoradionochromesis）是辐射的毁灭性并发症，估计在头颈部组织学上的估计速率高达16％。口腔内的骨血管性和机会性感染的改变有助于ORN的发展，导致骨破坏过程不可阻碍，缺乏正常的愈合事件序列。通常使用抗生素，局部伤口护理和高压氧（HBO）对早期ORN进行管理。先进的ORN需要使用健康的非辐照组织进行手术重构和重建。成功管理此疾病过程需要提高识别有ORN风险的患者，监测保守管理的有效性并改善术前计划以确保和解时确保明确的边际利润的能力。动态对比增强的磁共振成像（DCE-MRI）是一种临床上可用的定量成像方法，越来越多地用于评估头颈实体瘤的微血管功能。在我们的机构中​​，DCE-MRI被整合到旨在改善头部和颈部肿瘤的诊断，分期和肿瘤监测的多模式临床算法中。 DCE-MRI可以检测到与骨骼愈合，坏死和转移性受累相关的骨血管的改变，并具有出色的空间分辨率。我们假设DCE-MRI可用于检测照射后骨血管的改变，以监测ORN临床进展和对治疗的反应。为了检验这一假设，我们将评估DCE-MRI的潜力，以鉴定有下颌ORN风险的患者，监控对保守管理的反应，并确定高级下颌ORN的程度，以协助手术计划。该提案的成功完成有可能彻底改变下颌ORN的诊断和管理。临床医生将第一次能够识别出有ORN风险的患者，并适当地管理辐射后护理。可以使用客观的测量和改进的术前计划来测试当前使用的保守措施的有效性，这可以降低由于残留损害骨骼而导致的手术衰竭率。