Novel four dimensional magnetic resonance imaging to monitor pancreatic tumor infiltrating blood vessels and tumor response to chemoradiation therapy

新型四维磁共振成像监测胰腺肿瘤浸润血管和肿瘤对放化疗的反应

• 批准号: 9979801
• 负责人: Zhaoyang Fan
• 金额: $ 21.63万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-17 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9979801
• 关键词: 3-Dimensional; 4D MRI; Abdomen; Address; Aftercare; Blood Vessels; CA-19-9 Antigen; Cancerous; Clinical; Collaborations; Data; Development; Diagnosis; Disease; Evaluation; Excision; Four-dimensional; Geometry; Goals; Image; Imaging Techniques; Invaded; Magnetic Resonance Imaging; Malignant Neoplasms; Malignant neoplasm of pancreas; Methods; Monitor; Morphologic artifacts; Morphology; Motion; Neoadjuvant Therapy; Neoplasms in Vascular Tissue; Noise; Operative Surgical Procedures; Organ; Outcome; Pancreas; Pancreatic Ductal Adenocarcinoma; Patient-Focused Outcomes; Patients; Phase; Prediction of Response to Therapy; Primary Neoplasm; Quantitative Evaluations; Radial; Radiation; Radiation Dose Unit; Radiation therapy; Reproducibility; Research Personnel; Resectable; Resolution; Resort; Scanning; Solid Neoplasm; Specificity; Surgeon; Survival Rate; Techniques; Testing; Therapeutic Intervention; Three-Dimensional Image; Time; Tissues; Treatment outcome; Unresectable; Visualization; base; chemoradiation; contrast enhanced; contrast imaging; effective therapy; healthy volunteer; imaging biomarker; imaging modality; imaging study; improved; non-invasive imaging; novel; outcome forecast; pancreatic cancer patients; pancreatic neoplasm; recruit; respiratory; response; response biomarker; soft tissue; success; surgery outcome; targeted treatment; treatment planning; treatment response; treatment strategy; tumor

Background: Pancreas cancer patients have a dismal prognosis, with the cumulative 5-year survival of 7%. Most patients present with locally advanced (LAPC) or borderline resectable (BRPC) pancreatic cancer. The overall survival rates in the patients undergoing margin-negative resection after chemoradiation therapies are 2-3 times of the unresected group. The superior outcome of surgery calls for novel local treatment strategies aiming at downstaging patients and improving resection rate. Targeted therapy such as stereotactic body radiation therapy (SBRT) with simultaneous integrated boost (SIB) to tumor infiltrating blood vessels has the potential to sterilize cancerous tissue around the vessels that limit surgery. However, the SIB treatment is not commonly applied due to challenges in managing internal organ motion, visualization and segmentation of boost volumes, and tracking the tumor response to the therapy with current CT based planning and response assessment. Magnetic resonance imaging (MRI) is intrinsically superior to CT in soft tissue contrast, but until recently, few sequences were available to address the specific needs in pancreas radiotherapy including the need to resolve motion and differentiate tumor infiltrated vessels. We pioneered a 3D k-space resorting based four-dimensional MRI (4D- MRI) technique for the abdomen. Despite its high resolution, the current 4D-MRI images have insufficient vessel contrast for segmenting and targeting. Goals: The first goal of this study is to optimize the 4D-MRI technique so it generates a sufficiently high blood vessel contrast for SBRT-SIB target localization. The second goal is to use this novel 4D-MRI with vessel highlight to identify imaging makers that predict tumor resectability after chemoradiation therapy intervention. Methods: We will optimize the novel sequence by incorporating a new slab-selective function which highlights tumor encasing blood vessels and quantify the enhancement of contrast-to-noise (CNR) ratio as well as morphological changes for the vessels within the pancreatic tumor. A flow phantom and healthy volunteers will be used to optimize 4D-MRI parameters such as the number of radial lines, resolution and slab-selective volume. The CNR will be correlated to flow rates in the phantom. To validate the method, we will also recruit 30 patients diagnosed with LAPC or BRPC and perform pre- and post- chemoradiation 4D-MRI studies. The changes of the vessel CNR, geometry and morphology will be correlated to standard clinical outcomes. Impact: Success of this study will provide a non-invasive imaging method capable of localizing tumor involving blood vessels while overcoming respiratory motion blur. The information will be available to guide targeted radiation dose escalation to the boost volume defined by the involved vessels, which initially preclude resection. Therefore, the project answers an unmet need in current pancreatic cancer management since more than 85% of the patients have non-resectable cancer due to vessel involvement.

背景：胰腺癌患者的预后较弱，累计5年 生存率为7％。大多数患者出现在本地高级（LAPC）或可切除的边界 （BRPC）胰腺癌。接受保证金阴性的患者的总生存率 化学放疗治疗后的切除量是未分析组的2-3倍。上级 手术的结果要求采取新型的当地治疗策略，旨在使患者下台和 提高切除率。有针对性的疗法，例如立体定向的身体放射治疗（SBRT） 与肿瘤浸润血管的同时综合增强（SIB）具有潜力 在限制手术的血管周围对癌组织进行消毒。但是，SIB治疗不是 由于管理内部器官运动，可视化和 升压体积的分割，并跟踪肿瘤对治疗的反应，目前CT 基于计划和响应评估。磁共振成像（MRI）本质上是 在软组织对比中，优于CT，但直到最近，很少有序列可用于解决 胰腺放疗的特定需求，包括解决运动和区分的需求 肿瘤浸润的血管。我们开创了基于3D K空间求职的四维MRI（4D- MRI）腹部技术。尽管分辨率很高，但当前的4D-MRI图像具有 用于分割和靶向的容器对比度不足。 目标：这项研究的第一个目标是优化4D-MRI技术，以生成一个 SBRT-SIB目标定位的足够高血管对比度。第二个目标是使用 这款带有血管的新型4D-MRI可以识别预测肿瘤的成像制造商 化学放疗治疗干预后的可切除性。 方法：我们将通过合并新的平板选择函数来优化新序列 这突出了包围血管的肿瘤并量化对比度的增强 胰腺肿瘤内血管的（CNR）比以及形态变化。流动 幻影和健康志愿者将用于优化4D-MRI参数，例如数字 径向线，分辨率和平板选择体积。 CNR将与流速相关 幻影。为了验证该方法，我们还将招募30名诊断为LAPC或 BRPC并进行化学前后4D-MRI研究。船只的变化 CNR，几何学和形态将与标准临床结果相关。 影响：这项研究的成功将提供能够本地化的非侵入性成像方法 涉及血管的肿瘤，同时克服呼吸运动模糊。信息将是 可用于指导针对的辐射剂量升级到所涉及的增强体积 船只，最初排除了切除术。因此，该项目回答了未满足的需求 当前的胰腺癌管理，因为超过85％的患者具有不可切除的患者 由于血管受累而引起的癌症。

项目成果

Quantifying vascular invasion in pancreatic cancer-a contrast CT based method for surgical resectability evaluation.

量化胰腺癌的血管侵犯——一种基于对比 CT 的手术可切除性评估方法。

• DOI: 10.1088/1361-6560/ab8106
• 发表时间: 2020
• 期刊: Physics in medicine and biology
• 影响因子: 3.5
• 作者: Lao,Yi;David,John;Fan,Zhaoyang;Bian,Shelly;Shiu,Almon;Chang,EricL;Sheng,Ke;Yang,Wensha;Tuli,Richard
• 通讯作者: Tuli,Richard

Combined morphologic and metabolic pipeline for Positron emission tomography/computed tomography based radiotherapy response evaluation in locally advanced pancreatic adenocarcinoma.

基于正电子发射断层扫描/计算机断层扫描的局部晚期胰腺腺癌放疗反应评估的形态学和代谢组合管道。

• DOI: 10.1016/j.phro.2018.12.003
• 发表时间: 2019
• 期刊: Physics and imaging in radiation oncology
• 作者: Lao,Yi;David,John;Torosian,Arman;Placencio,Veronica;Wang,Yalin;Hendifar,Andrew;Yang,Wensha;Tuli,Richard
• 通讯作者: Tuli,Richard

Automatic segmentation of high-risk clinical target volume for tandem-and-ovoids brachytherapy patients using an asymmetric dual-path convolutional neural network.

• DOI: 10.1002/mp.15490
• 发表时间: 2022-03
• 期刊: Medical physics
• 影响因子: 3.8