Improved whole-brain spectroscopic MRI for radiation therapy planning

为放射治疗计划确定脑瘤边缘的范围仍然是一项具有挑战性的任务，因为 这些肿瘤的浸润性和目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了一种检测组织中代谢物的磁共振技术，磁共振波谱 成像或光谱磁共振成像(SMRI)，可以高度敏感地检测浸润性肿瘤区域，并 特异性，使导致早期复发和延长寿命的区域能够得到更好的放射治疗。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范围，包括 诊断核磁共振无法检测到的区域，通常不进行治疗。通过允许这些 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 并显著延缓复发。在我们的三点sMRI引导的辐射剂量递增试点研究中， 2019年完工，我们能够证明可行性和安全性。30例肾小球基底膜瘤患者的生存分析 GBM患者的中位总生存期(OS)为23个月，而中位生存期为16个月 接受标准护理。我们的试验已被批准为国家临床试验网络(ECOG-ACRIN) 试验(EAF211)。这是一个很好的机会来传播这项技术，并得到ACRIN和 美国放射学会(ACR)。我们将在我们目前的续订资金期内实现这一目标 该项目通过利用三个研究地点的不同专业知识并与西门子医疗保健公司合作来实现 设计并验证改进sMRI采集、分析和临床所需的技术改进 整合。这些改进包括：(1)更新快速和运动稳健的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，以供临床及时使用 放射学报告；(3)新的处理、显示和分析方法，将在 高效的方式，具有临床医生友好的界面，支持与放射治疗计划集成 软件系统；以及(4)开发新工具来预测最优基线RT计划策略 核磁共振检查。这项研究的完成将提供强大的sMRI采集方法和软件工具，这些工具 准备好投入临床使用，这将有助于指导重要的治疗决定。

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.