Imaging Chemotherapy-Induced Brain Damage in Pediatric Cancer Survivors

儿科癌症幸存者中化疗诱导的脑损伤的成像 许多儿童癌症幸存者由于化疗而面临慢性和改变生活的副作用。 接受大剂量甲氨蝶呤（MTX）化疗的儿童可能会出现神经认知功能减退 包括记忆力注意力和集中力的损伤总体累积发生率 神经认知疾病的发病率为25 - 45%。在接受治疗和接受治疗之间 以及未来的发病率不幸的是，一旦癌症幸存者出现临床发病率，往往为时已晚 用于健康维护干预。为了防止治疗后药物引起的临床问题，重要的是 开发诊断工具，以检测仍然可逆的早期组织损伤。但 相关生物标志物的开发在本领域中获得的关注令人惊讶地少。为了缩小差距，我们的目标是 开发新的诊断生物标志物，用于在临床问题出现之前检测早期组织损伤， 很明显然后，所获得的信息可用于在长期故障发生之前启动纠正措施。 疾病的发生并最终保护我们患者的健康。我们项目的总体目标是 检测化疗引起的脑损伤的早期成像迹象，可以预测慢性 几个月或几年后的神经认知问题。我们处于追求这一目标的独特地位，因为我们 可以利用图像注册表，其中包含连续正电子发射断层扫描（PET）和磁 在化疗之前、期间和之后对儿科癌症患者进行核磁共振成像（MRI）扫描。我们 初步数据显示，新的PET/MRI技术，可以同时评估大脑 形态学和代谢，可以检测和量化大脑的生理紊乱， 灵敏度使用这种新的成像技术，我们将测量大脑体积，皮质厚度（T1 SPGR）， 白质脑病（T2）、脑灌注（动脉自旋标记）和局部脑代谢率 葡萄糖代谢（rCMRglc）。我们假设背外侧前额叶的成像生物标志物 用PET/MRI测量的大脑和扣带回，将与执行功能评分相关， 通过神经认知功能测试进行评估。甲氨蝶呤神经毒性的预测和早期检测 将使我们能够确定哪些患者将受益于早期干预，处方个人治疗方案， 并最终预防长期发病。

Imaging Chemotherapy-Induced Brain Damage in Pediatric Cancer Survivors Many pediatric cancer survivors face chronic and life-altering side effects as a result of their chemotherapy. Children treated with high dose methotrexate (MTX) chemotherapy can experience neurocognitive decrements that include impairments in memory, attention, and concentration. The overall cumulative incidence of neurocognitive morbidities ranges from 25 to 45%. There is a window of time between the exposure to therapy and future morbidity. Unfortunately, once cancer survivors present with clinical morbidities, it is often too late for health-preserving interventions. To prevent drug-induced clinical problems after therapy, it is important to develop diagnostic tools to detect the early stages of tissue damage that are still reversible. However, the development of related biomarkers has gained surprisingly little attention in the field. To close this gap, we aim to develop novel diagnostic biomarkers for detection of early tissue damage before clinical problems become apparent. The obtained information could then be used to initiate corrective actions before long-term morbidities occur and ultimately preserve the health of our patients. The overall goal of our project is to detect early imaging signs of chemotherapy-induced brain damage that can predict chronic neurocognitive problems months or years later. We are uniquely positioned to pursue this goal because we can leverage an image registry, which contains serial positron emission tomography (PET) and magnetic resonance imaging (MRI) scans of pediatric cancer patients before, during and after chemotherapy. Our preliminary data showed that novel PET/MRI techniques, which enable simultaneous assessment of brain morphology and metabolism, can detect and quantify physiological disturbances of the brain with high sensitivity. Using this new imaging technology, we will measure brain volume, cortical thickness (T1 SPGR), leukoencephalopathy (T2), brain perfusion (arterial spin labeling), and regional cerebral metabolic rate of glucose metabolism (rCMRglc). We hypothesize that imaging biomarkers in the dorsolateral prefrontal brain and cingulate gyrus, as measured with PET/MRI, will correlate with executive function scores, assessed with neurocognitive function tests. Prediction and early detection of MTX-induced neurotoxicity will allow us to identify patients who will benefit from early interventions, prescribe individual treatment regimes, and ultimately prevent long-term morbidities.