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（由申请人提供）：头颈部癌症流行病学的变化导致越来越多的年轻和健康患者接受明确的外照射放疗（EBRT）。在具有良好临床结局和延长预期寿命的患者人群中，辐射的长期后遗症在治疗相关发病率和死亡率的管理中变得越来越重要。下颌骨放射性骨坏死（ORN）是一种毁灭性的放射并发症，估计发生率高达16%的头部和颈部组织学。改变的骨血管分布和口腔内的机会性感染有助于ORN的发展，导致骨破坏的不可阻挡的过程，其缺乏正常的愈合过程。早期ORN通常使用抗生素，局部伤口护理和高压氧（HBO）进行管理。晚期ORN需要手术切除和用健康的非辐射组织重建。这种疾病过程的成功管理需要提高识别ORN风险患者的能力，监测保守治疗的有效性，并改善术前计划，以确保切除时边缘清晰。动态对比增强磁共振成像（DCE-MRI）是一种临床可用的定量成像方法，在头颈部实体瘤的研究中越来越多地用于评估微血管功能。在我们的机构，DCE-MRI被集成到多模态临床算法中，旨在改善头颈部肿瘤的诊断、分期和肿瘤学监测。DCE-MRI可以检测与骨愈合、坏死和转移灶相关的骨血管改变，具有良好的空间分辨率。我们假设DCE-MRI可用于检测放射后骨血管分布的变化，以监测ORN的临床进展和对治疗的反应。为了验证这一假设，我们将评估DCE-MRI识别下颌骨ORN风险患者的潜力，监测对保守治疗的反应，并确定晚期下颌骨ORN的程度，以帮助制定手术计划。成功完成这一建议有可能彻底改变下颌骨ORN的诊断和管理。临床医生将首次能够识别有ORN风险的患者，并适当管理辐照后护理。目前采用的保守措施的有效性可以使用客观指标进行测试，改进的术前计划可以降低由于残余骨受损导致的手术失败率。