Establishing the validity of brain tumor perfusion imaging

建立脑肿瘤灌注成像的有效性

• 批准号: 9754786
• 负责人: Christopher Chad Quarles
• 金额: $ 26.49万
• 依托单位: ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9754786
• 关键词: Address; Adoption; Aftercare; Biopsy; Blood Vessels; Blood Volume; Blood flow; Bolus Infusion; Brain Neoplasms; Cell Density; Cell Shape; Cell Size; Clinic; Clinical; Clinical Trials; Communities; Community Clinical Oncology Program; Complex; Computer Simulation; Consensus; Contrast Media; Data; Dependence; Dose; Evaluation; Extravasation; Future; Gadolinium; Geometry; Glioma; Goals; Healthcare; Image; Imaging Techniques; Injections; Institutes; Kinetics; Lead; Local Therapy; Magnetic Resonance Imaging; Maps; Measurement; Measures; Methodology; Methods; Multi-Institutional Clinical Trial; Operative Surgical Procedures; Oxidants; Patients; Perfusion; Permeability; Physicians; Physiologic pulse; Prediction of Response to Therapy; Predisposition; Prospective Studies; Protocols documentation; Publishing; Radiation necrosis; Recommendation; Recurrence; Reference Standards; Relaxation; Research; Resources; Scheme; Series; Signal Transduction; Site; Standardization; Techniques; Time; Tissues; Validation; Vendor; base; cancer imaging; cerebral blood volume; clinical care; clinically relevant; cost effective; density; digital; ferumoxytol; image archival system; imaging modality; improved; in vivo; iron oxide; maltreatment; neuro-oncology; novel; open source; perfusion imaging; physical property; prevent; response; targeted treatment; tool; treatment effect; tumor

ABSTRACT The central goal of this proposal is to establish the accuracy of brain tumor perfusion imaging. Dynamic susceptibility contrast (DSC) MRI is one of the most widely used advanced imaging techniques in neuro- oncology. Multiple studies have shown how DSC-MRI measures of relative cerebral blood volume (rCBV) can differentiate glioma grades, tumor types and identify tumor components in non-enhancing glioma distinguish tumor recurrence from post-treatment effects, and predict tumoral response and patient survival after targeted therapy. Despite DSC-MRI's potential impact on clinical care, its broad scale integration has been slow, in large part from a lack of consensus about methodology and how to prevent potential rCBV inaccuracies. Although DSC relies on the assumption that gadolinium-based contrast agents (GBCA) remain within the vascular lumen, this condition is often violated in vivo. If not corrected for, contrast agent leakage effects lead to rCBV inaccuracy, misdiagnosis, and potentially mistreatment. While numerous leakage correction strategies exist, a fundamental limitation has prevented the standardization and wide-spread adoption of DSC-MRI methodology: To date, no study has validated the accuracy of leakage corrected rCBV measures in patients. The lack of validation impacts DSC-MRI standardization efforts, the establishment of rCBV thresholds for clinic use, multi-site comparisons and clinical trials. Given the importance of rCBV accuracy we propose to address this through two highly focused studies. First, we aim to validate rCBV accuracy by comparison to an intravascular reference standard in high-grade glioma patients. Multiple acquisition and analysis techniques will be investigated. Second, using a novel in silico digital phantom we aim to systematically define the range of DSC-MRI protocols that maintain consistent rCBV measurements. Impact on Healthcare: Our primary deliverable is to provide the neuro-oncology community with validated image acquisition and analysis methods for accurate rCBV mapping in brain tumor patients. Validated DSC-MRI techniques will improve its clinical reliability and justify its use across a range of clinical scenarios, including tumor localization, therapy response assessment, surgical and biopsy guidance, and multi-site clinical trials of conventional and targeted brain tumor therapies. !

抽象的 该建议的核心目标是确定脑肿瘤灌注成像的准确性。动态的 敏感性对比（DSC）MRI是神经 - 最广泛使用的晚期成像技术之一 肿瘤学。多项研究表明，DSC-MRI相对脑血体积（RCBV）的测量如何 区分神经胶质瘤等级，肿瘤类型并确定非增强神经胶质瘤中的肿瘤成分区分 治疗后的肿瘤复发，并预测靶向后的肿瘤反应和患者生存 治疗。尽管DSC-MRI对临床护理的潜在影响，但其广泛整合却很慢， 很大程度上是由于缺乏关于方法论的共识以及如何预防潜在的RCBV不准确性。 尽管DSC依赖于以下假设，即基于Gadolinium的对比剂（GBCA）仍在 血管腔，这种情况通常在体内受到侵犯。如果未纠正，对比剂泄漏效应铅 为了RCBV的不准确，误诊和潜在的虐待。而众多泄漏校正策略 存在，基本限制阻止了DSC-MRI的标准化和广泛采用 方法论：迄今为止，尚无研究验证泄漏校正患者的RCBV测量的准确性。 缺乏验证会影响DSC-MRI标准化工作，建立诊所的RCBV阈值 使用，多站点比较和临床试验。鉴于RCBV准确性的重要性，我们建议解决 这是通过两项高度集中的研究。首先，我们旨在通过与 高级神经胶质瘤患者的血管内参考标准。多次获取和分析技术将 被调查。其次，使用硅数字幻影中的小说，我们旨在系统地定义 DSC-MRI协议保持一致的RCBV测量。对医疗保健的影响：我们的主要 可交付的是为神经肿瘤学社区提供经过验证的图像获取和分析方法 在脑肿瘤患者中精确的RCBV映射。经过验证的DSC-MRI技术将改善其临床 可靠性并证明其在各种临床情况下的使用，包括肿瘤定位，治疗反应 评估，手术和活检指导以及常规大脑和靶向大脑的多站点临床试验 肿瘤疗法。 呢