Advanced Imaging Tools to Assess Cancer Therapeutics in Pediatric

评估儿科患者癌症治疗的先进影像工具 成像测试对于儿童癌症的诊断是必不可少的。然而，计算机断层扫描(CT)和 正电子发射断层扫描(PET)/CT与大量的辐射暴露有关。几个大的 人群研究表明，CT扫描的累积辐射剂量显著增加了 儿童在晚年罹患白血病、甲状腺癌和脑癌的风险。因此，有一个紧急的 需要减少由医学成像程序引起的儿童辐射暴露。为此，我们 开发了一种用于儿童肿瘤分期的无辐射成像测试，基于先进的全身 扩散加权磁共振成像(WB-DW MRI)技术。我们的团队是第一个整合 使用MRI技术进行解剖定位的肿瘤生理信息(质子扩散)(纳米颗粒- 增强的T1加权MRI)，基于集成的PET/CT扫描的概念(柳叶刀肿瘤学)。而数据仓库 MRI对肿瘤的检测具有很高的敏感性和特异性，DW-MRI对肿瘤的诊断价值 对儿童的治疗监测尚未得到广泛研究。目前评估肿瘤的方法 儿童的治疗反应经常使用正电子发射计算机断层扫描测量注射后肿瘤代谢的变化 放射性葡萄糖(18F-FDG)。WB-DW磁共振与18F-FDG PET在肿瘤治疗中的对比研究 监测一直没有定论，可能是因为扫描不是同时获得的。因此， 明显的差异可能是由于扫描时间的不同。我们处于一个独特的位置来 通过同时测量治疗诱导的肿瘤代谢变化和 在儿童中的传播。这些测量直到最近才成为可能，因为新的集成 PET/MRI技术，可在我们儿科医院获得。我们项目的总体目标是 DW MRI与18F-FDG PET显像对肿瘤诊断价值的比较 儿童癌症患者的治疗反应评估。在我们追求更好的和立即的 临床上适用的方法对于微创成像测试，我们将首先应用人工智能 开发超低剂量18F-FDG PET/MR扫描的算法。接下来，我们将确定超低的价值- 剂量18F-FDGPET和DW-MRI用于监测肿瘤对经典化疗的反应：我们将 确定应仅使用18F-FDG PET、仅使用DW-MRI还是使用 相结合的方法。最后，我们将确定超低剂量18F-FDG PET和先进的DW- 核磁共振技术用于监测肿瘤对免疫疗法的反应。无辐射WB-DW核磁共振和超高频 与传统的18F-FDG PET/CT扫描相比，低剂量18F-FDG PET/MRI需要的辐射暴露显著减少。 该项目的结果将为儿童提供个性化的癌症治疗反应评估 与目前的临床成像测试相比，辐射暴露大大减少，因此 消除生命后期继发癌症的相关风险。

Advanced Imaging Tools to Assess Cancer Therapeutics in Pediatric Patients Imaging tests are essential for cancer diagnoses in children. However, computed tomography (CT) and positron emission tomography (PET)/CT are associated with considerable radiation exposure. Several large population studies have demonstrated that cumulative radiation doses from CT scans significantly increase the risk of children developing leukemia, thyroid cancer, and brain cancer later in life. Thus, there is an urgent need to reduce the radiation exposure of children caused by medical imaging procedures. To this end, we have developed a radiation-free imaging test for pediatric tumor staging, based on advanced whole body diffusion-weighted magnetic resonance imaging (WB-DW MRI) technology. Our team was the first to integrate tumor physiology information (proton diffusion) with an MRI technique for anatomical orientation (nanoparticle- enhanced T1-weighted MRI), based on the concept of integrated PET/CT scans (Lancet Oncology). While DW MRI has demonstrated high sensitivity and specificity for cancer detection, the value of DW MRI for cancer therapy monitoring in children has not yet been extensively studied. Current approaches for assessing tumor therapy responses in children often measure changes in tumor metabolism using PET after the injection of radioactive glucose (18F-FDG). Previous comparisons of WB-DW MRI and 18F-FDG PET for cancer therapy monitoring have been inconclusive, possibly because the scans were not obtained at the same time. Thus, apparent differences may be due to differences in the timing of the scan. We are in a unique position to address this problem by simultaneously measuring therapy-induced changes in tumor metabolism and diffusion in children. These measurements have only recently become possible due to novel integrated PET/MRI technology, which is available at our pediatric hospital. The overall goal of our project is to compare the diagnostic value of DW MRI with that of 18F-FDG PET-based imaging tests for tumor therapy response assessment in children with cancer. In our pursuit of an improved and immediately clinically applicable approach for a minimally invasive imaging test, we will first apply artificial intelligence algorithms to develop ultra-low-dose 18F-FDG PET/MR scans. Next, we will determine the value of ultra-low- dose 18F-FDG PET and DW-MRI scans for monitoring tumor response to classical chemotherapy: We will determine which pediatric tumor type should be monitored with 18F-FDG PET only, DW-MRI only or a combined approach. Finally, we will determine the value of ultra-low-dose 18F-FDG PET and advanced DW- MRI techniques for monitoring tumor response to immunotherapies. Both radiation-free WB-DW MRI and ultra- low-dose 18F-FDG PET/MRI entail significantly less radiation exposure than traditional 18F-FDG PET/CT scans. The results of this project will yield customized cancer therapy response assessments for children with substantially reduced radiation exposure compared with current clinical imaging tests, thus eliminating associated risks of secondary cancer development later in life.