PREDICTING HUMAN TUMOR RESPONSE BY 31P MRS

描述：在活体31-P磁共振波谱提供了一种非 侵入性地监测组织新陈代谢，提供关于 肿瘤生物化学，并提供了监测变化的机会 在治疗过程中发生在病人身上。一些初步研究 人类肿瘤的研究现在已经完成。这些结果表明，31-P磁共振 体内人类癌症的谱系通常有代谢 不同于正常组织的特征。这些 包括磷单酯(PME)、磷酸二酯(PDE)水平升高 和细胞pH值，并降低磷酸肌酸(PCr)。在最近的研究中， 这些特征提供了预后信息，或早期 化疗或放射治疗反应的指标。在一些研究中 代谢信息与T2定量测量的结合 从1H磁共振图像中提取，提高了预测的准确性。 虽然这些初步研究提供了一致的信息，但他们 都是规模相对较小的单一机构研究， 研究规模受机器使用时间和患者有限的限制 人口。最近，在以下方面取得了重大进展 技术，允许化学变换的广泛应用 成像、去耦合和优化线圈设计。基于这些 发展和初步研究，现在是时候进行 ~(31)P-MRS在癌症治疗中价值的决定性试验 病人。为了达到这个目的，一项合作的前瞻性研究 具有合适肿瘤的实质性患者组进行31-P MRS 提出了调查建议。此建议书是8个互动R01之一 来自8个机构合作研究1500多名患者的建议 伴有非霍奇金淋巴瘤、原发性乳腺癌、软组织肉瘤 还有头颈癌。这一机构将为 前三个肿瘤组，并将提供一个仪器质量控制 中央资源。最先进的技术将在 所有机构，包括设计的双调谐面线圈 特别是为了访问这些区域中的解剖位置 疾病.区分个体的31-P质子去偶联 磷脂代谢物.图像引导的三维化学位移 用于精确定位肿瘤的~(31)P磁共振波谱的成像；定量 代谢物水平；以及模式识别在 光谱分析和表征。这项研究将测试 体内基线~(31)P磁共振波谱可预测肿瘤的假设 治疗反应以及基线频谱之间比较 在治疗过程的早期进行进一步的光谱检查可以提供 治疗反应的早期指标。该研究将确定 其他癌症和治疗的MRS合作试验标准， 并将为使用该技术加速 评价新的治疗方法并将该技术应用于 对个别病人的管理。

DESCRIPTION: In vivo 31-P MR spectroscopy provides a means of non- invasively monitoring tissue metabolism, providing new information about tumor biochemistry, and providing the opportunity to monitor changes occurring in patients during treatment. A number of preliminary studies of human tumors have now been completed. These show that 31-P MR spectra of human cancers in vivo typically have metabolic characteristics which differ from those of normal tissues. These include raised levels of phosphomonoesters (PME), phosphodiesters (PDE) and cellular pH, and reduced phosphocreatine (PCr). In recent studies, these characteristics have provided prognostic information, or early indicators of response to chemotherapy or radiotherapy. In some studies combination of metabolic information with quantitative T2 measurements derived from 1H MR images has increased the accuracy of prediction. Whilst these preliminary studies provide consistent information, they have been relatively small scale single institution studies, with the study size limited by access to machine time and limited patient populations. Recently, there have been significant advances in technology, permitting the wide spread application of chemical shift imaging, decoupling and optimized coil design. Based on these developments and preliminary studies, it is now timely to undertake a definitive trial of the value of 31 P MRS in the management of cancer patients. To achieve this end, a cooperative prospective study in substantial patient groups with appropriate tumors for 31-P MRS investigation is proposed. This proposal is one of 8 Interactive R01 proposals from 8 institutions collaborating to study over 1500 patients with non-Hodgkin's lymphoma, primary breast cancer, soft tissue sarcoma and head and neck carcinoma. This institution will contribute to the first three tumor groups, and will provide an instrument quality control central resource. State of the art techniques will be established at all institutions, including double tuned surface coils designed specifically to access the range of anatomical locations in these diseases; proton decoupling of 31-P to distinguish individual phospholipid metabolites; image guided 3 dimensional chemical shift imaging to accurately localize 31-P MR spectra to tumor; quantification of metabolite levels; and the application of pattern recognition to spectral analysis and characterization. The study will test the hypotheses that a baseline in vivo 31-P MR spectra can predict tumor response to treatment, and that comparison between the baseline spectrum and further spectra taken early in the course of treatment can provide an early indicator of response to treatment. The study will establish standards for cooperative MRS trials in other cancers and treatments, and will provide a basis for use of the technique in accelerating the evaluation of new treatments and in applying the technique in the management of individual patients.