MR Spectroscropy and Imaging in Head and Neck Tumors

描述（由申请人提供）： 今年将有超过55，000名美国人患上头颈癌（HN），占美国所有癌症的近3%。这些癌症在男性和50岁以上的人群中更常见。超过85%的癌症与吸烟和饮酒有关。尽管积极的手术和放射治疗（RT）可能导致显著的功能丧失，但头颈癌患者的生存率在过去三十年中保持相对不变。基于肿瘤形态学或临床特征的预测指标在定义缓解结局方面通常不太准确。因此，迫切需要一个可靠的预测这些肿瘤的早期反应。磁共振波谱（MRS）和成像（MRI）可以非侵入性地识别特定的代谢模式和组织生理学，可用作预测和监测早期治疗反应的标志物。对41例非霍奇金淋巴瘤和12例HN肿瘤的初步研究表明，31 p MRS可以在开始治疗前预测反应。1H MRS和MRI提供了比31 p MRS更高的灵敏度和空间分辨率，因此有助于研究较小的肿瘤和研究异质性肿瘤反应。该提案的总体目标是测试核磁共振波谱和成像可以预测和监测头颈部肿瘤治疗的早期反应的假设。该假设将通过以下具体目的进行检验：目的1：评价PME/13 NTP比率在通过31 p MRS预测和检测治疗反应中的效用，目的2：确定总胆碱（Cho）和乳酸盐（Lac）水平是否可以预测和监测治疗反应，目的3：使用生理MRI参数（T2、ADC和DCE）作为HN肿瘤化疗和放疗局部肿瘤反应的预测/监测指标。 将使用质子去耦和NOE增强的3D CSI序列进行31 p MRS研究。将通过实施选择性多量子相干转移脉冲序列（Sel-MQC）进行1H MRS研究，用于在临床扫描仪上检测乳酸盐（Lac）和总胆碱（TCho）。将简化用于实施动态对比增强（DCE）、弥散加权成像（DWI）和T2加权成像（T2 WI）成像的标准MRI脉冲序列，以便在1小时内对人类HN患者实施由31 p MRS或1H MRS结合DCE、DWI和T2 WI组成的完整检查。

DESCRIPTION (provided by applicant): More than 55,000 Americans will develop cancer of the head and neck (HN) this year accounting for nearly 3% of all cancers in the United States. These cancers are more common in men and in people over age 50. More than 85% of these cancers are related to tobacco and alcohol consumption. Despite aggressive surgery and radiotherapy (RT), which may result in significant functional loss, the survival rate of patients with head and neck cancer has remained relatively unchanged over the past three decades. The predictive indices based on tumor morphology or clinical characteristics are generally less accurate in defining outcome of response. Hence, there is an urgent need for a reliable predictor of early response in these tumors. Magnetic resonance spectroscopy (MRS) and imaging (MRI) can non-invasively identify specific metabolic patterns and tissue physiology that may be used as markers for predicting and monitoring early treatment response. Preliminary studies on 41 cases of non-Hodgkins Lymphomas and 12 cases of HN tumors indicate that 31p MRS can predict response prior to initiation of therapy. 1H MRS and MRI provides higher sensitivity and spatial resolution than 31p MRS and would thus facilitate studying smaller tumors and investigating heterogeneous tumor response. The overall goal for this proposal is to test the hypothesis that NMR spectroscopy and imaging can predict and monitor early response to treatment of head and neck tumors. This hypothesis will be tested with the following specific aims: Aim 1: To evaluate the utility of the PME/13 NTP ratio in predicting and detecting treatment response by 31p MRS, Aim 2: To determine if total choline (Cho) and lactate (Lac) levels can predict and monitor treatment response and Aim 3: To use physiological MRI parameters (T2, ADC and DCE) as predictors/monitors of local tumor response to chemotherapy and radiation therapy of HN tumors. 31p MRS studies will be performed using proton decoupled and NOE enhanced 3D CSI sequence. 1H MRS studies will be performed by implementing a selective multi-quantum coherence transfer pulse sequence (Sel-MQC), for detection of lactate (Lac) and total choline (TCho) on the clinical scanner. Standard MRI pulse sequences for implementing dynamic contrast enhanced (DCE), diffusion weighted imaging (DWI) and T2 weighted imaging (T2WI) imaging will be streamlined so that a complete examination consisting of 31p MRS or 1H MRS combined with DCE, DWI and T2WI can be implemented on human HN patients within one hour.