Improved whole-brain spectroscopic MRI for radiation therapy planning

确定放射治疗计划的脑肿瘤边缘的范围仍然是一项具有挑战性的任务， 这些肿瘤的浸润性质和当前标准成像方法的局限性。多项研究 包括我们自己的已经证明，用于检测组织中代谢物的MR技术，MR光谱， 成像或光谱MRI（sMRI）可以以高度灵敏度检测浸润性肿瘤的区域， 特异性，能够更好地对导致早期复发和延长生命的区域进行放射治疗。sMRI 能够识别以胆碱/N-乙酰天冬氨酸比率增加为标志的肿瘤程度，包括 诊断MRI无法检测到的区域，通常不进行治疗。通过允许这些 对于以前未检测到的待治疗区域，sMRI有可能提高放射治疗的疗效 并显著延迟复发。在我们的3个部位sMRI引导的放射剂量递增初步研究中， 于2019年完成，我们能够证明其可行性和安全性。所有30例GBM患者的生存分析 显示了23个月的中位总生存期（OS），而GBM患者的OS为16个月 接受标准治疗我们的试验已被批准为国家临床试验网络（ECOG-ACRIN） 试验（EAF 211）。这是一个很好的机会，在ACRIN的工作人员支持下传播这种技术， 美国放射学会（ACR）。我们将在本年度的更新资助期内实现目标。 该项目利用三个研究中心的各种专业知识，并与西门子医疗公司合作， 设计和验证改善sMRI采集、分析和临床所需的技术改进 一体化这些改进包括：（1）更新了快速和运动鲁棒的sMRI，以提高图像质量; (2)新的加速数据处理管道将Cho/NAA比率图返回到PACS，以便临床及时 放射学报告;（3）新的处理，显示和分析方法，将呈现代谢物图谱， 高效的方式，具有临床医生友好的界面，可与放射治疗计划集成 软件系统;以及（4）开发新工具，以预测最佳基线RT计划策略， sMRI。本研究的完成将提供强大的sMRI采集方法和软件工具， 准备在临床使用中部署，这将有助于指导重要的治疗决策。

Identifying the extent of brain tumor margins for radiation treatment planning remains a challenging task due to the infiltrative nature of these tumors and limitations in current standard imaging methods. Multiple studies including our own have demonstrated that an MR technique for detecting metabolites in tissue, MR spectroscopic imaging or spectroscopic MRI (sMRI), can detect areas of infiltrating tumor with a high degree of sensitivity and specificity, enabling better radiation treatment of areas that lead to early recurrence and extending life. sMRI enables the identification of tumor extent that is marked by increased Choline/N-Acetylaspartate ratios, including regions that are not detectable by diagnostic MRI and that are normally left untreated. By allowing these previously undetected regions to be treated, sMRI has the potential to improve the efficacy of radiation treatment and significantly delay recurrence. In our 3-site sMRI-guided radiation dose escalation pilot study which was completed in 2019, we were able to demonstrate feasibility and safety. Survival analysis of all 30 GBM patients shows a promising median overall survival (OS) of 23 months compared to 16 months OS for GBM patients receiving standard-of-care. Our trial has been approved as a National Clinical Trial Network (ECOG-ACRIN) trial (EAF211). This is a great opportunity to disseminate this technique with staff support from ACRIN and American College of Radiology (ACR). We will achieve the goal in the renewal funding period of our current project by leveraging diverse expertise at three research sites and collaboration with Siemens Healthineers to engineer and validate technological improvements needed to improve sMRI acquisition, analysis, and clinical integration. These improvements include: (1) updated rapid and motion-robust sMRI for improved image quality; (2) new accelerated data processing pipelines to return Cho/NAA ratio maps to PACS for clinically timely radiology reporting; (3) new processing, display, and analysis methods that will present metabolite maps in an efficient manner with a clinician-friendly interface that enables integration with radiation treatment planning software systems; and (4) development of new tools to predict the optimal baseline RT planning strategies using sMRI. The completion of this study will provide robust sMRI acquisition methods and software tools that are ready to be deployed in clinical use and which will help guide important treatment decisions.