Treatment Planning using Physiologic MRI Data

此应用程序请求支持将生理学磁共振成像(MRI)方法集成到 更好地描述和描绘多形性胶质母细胞瘤(GBM)脑肿瘤为放射治疗做准备 治疗。我们假设这些成像方法的使用将导致更精确的 放射治疗计划。拟议的研究基于大量的初步数据。 指示化学位移成像(CSI)、灌注和扩散成像和基于MR的低氧标测ADD 有关肿瘤生理学的更多信息，可纳入治疗计划，目标是 降低肿瘤复发率。尽管T2磁共振成像上的异常区域已知与 随着肿瘤的显微镜扩散，其中一些异常表现为无恶性细胞的水肿，而 其他区域可能包含高度集中的恶性细胞，这些细胞应该被合并到 治疗提高了音量。虽然大多数恶性脑瘤在放射治疗领域内复发，但20- 25%的复发发生在这些领域之外。出于这个原因，我们预计至少25%的患者 将会有10%的提升量差异。我们预计，至少有一部分这样的场外 通过使用成像技术，可以预测复发。因此，成像技术将是 用于识别每个肿瘤内可能有高复发风险的“高风险亚体积”。之后 放射治疗结束后，患者将接受一系列生理学MRI扫描；研究终点是 第一次循环。具体目标是： 1)使用血氧水平依赖(BOLD)MRI创建单个肿瘤内的低氧地图 结合了Carbogen的呼吸。 2)利用化学位移成像(CSI)技术探讨肿瘤的增殖潜能。 3)用增强灌注MRI评价肿瘤的血管生成特征。 4)磁共振弥散加权成像评价肿瘤细胞密度。 5)比较AIMS 1-4中创建的地图的位置和区域。 6)根据AIM 5定义的区域生成临床靶区(CTV)。

This application requests support to integrate physiologic magnetic resonance imaging (MRI) methods to better describe and delineate glioblastoma multiforme (GBM) brain tumors in preparation for radiation therapy treatment.We hypothesize that the use of these imaging methods will result in more precise radiotherapy treatment planning. The proposed research is based upon extensive preliminary data indicating chemical shift imaging (CSI), perfusion and diffusion imaging and MR-based hypoxia mapping add additional information about tumor physiology that can be incorporated into a treatment plan with the goal of decreasing the rate of tumor recurrence. Although regions of abnormality on T2 MRI are known to correlate with microscopic spread of tumor, some of this abnormality represents edema without malignant cells while other areas may contain a high concentration of malignant cells that should be incorporated into the treatment boost volume. While most malignant brain tumors recur within the radiation treatment fields, 20- 25% of recurrencesoccur outside of these fields. For this reason, we expect that in at least 25% of patients there will be a boost volume discrepancy > 10%. We anticipate that at least some of these out-of-field recurrences could be predicted by the use of the imaging techniques. Thus, the imaging techniques will be used to identify "high-risk subvolumes" within each tumor, which may be at high risk of recurrence. After completing radiotherapy, patients will be followed with serial physiologic MRI scans; the study endpoint being the first recurrence.The SPECIFIC AIMS are: 1) Create maps of hypoxia within individual tumors using blood oxygen level dependent (BOLD) MRI combined with carbogen breathing. 2) Probe the proliferative potential of tumors using chemical-shift imaging (CSI). 3) Assess the angiogenic features of a tumor using contrast enhanced perfusion MRI. 4) Assess the cellularity of a tumor using diffusion-weighted MRI. 5) Compare the locations and areas of maps created in AIMS 1-4. 6) Generate clinical target volumes (CTV's) from the regions defined by AIM 5.