PET/MR study of Metastatic Lymph Nodes in Head and Neck Cancer

描述（由申请人提供）：头颈癌占美国每年诊断的浸润性癌症（约55，000例患者）的约3%。大约三分之二的患者患有局部晚期疾病。头颈部癌症治愈的最佳机会通常是在最初表现时进行积极治疗，包括完全淋巴结清扫。准确识别淋巴结转移是制定治疗计划和评估治疗反应的关键步骤。术前了解淋巴结转移的程度有助于避免不必要的淋巴结切除。然而，目前的成像方法不足以在诊断成像和治疗后评价中对转移性淋巴结进行可靠的评估。本研究的总体目标是开发PET/MR技术，用于准确、无创地检测淋巴结转移，以制定治疗计划并评估治疗后转移性淋巴结中的残留肿瘤，从而最大限度地减少不必要的淋巴结切除。将使用最先进的PET/MR扫描仪在一个会话中同时采集PET和MRI数据。我们的中心假设是FDG-PET和DCE-MRI测量的组合模型可以比单独的FDG-PET或DCE-MRI更准确地检测转移性淋巴结。当PET和MRI扫描同时在一个环境中进行时，可以最好地测试这一假设，因为它可以最大限度地减少单独PET和MRI扫描之间肿瘤微环境的任何生理差异，此外还可以减少参与患者的就诊次数。我们建议对计划进行全淋巴结清扫手术的头颈癌患者（n=50）进行动态PET/MR扫描，以便对清扫淋巴结的病理评估可用作评价PET/MR测量准确性的参考标准。在手术过程中，将记录淋巴结的水平，以便在PET/MR和病理学评价之间进行水平比较。本研究的第一阶段（目的1）是评估FDG-PET和DCE-MRI联合测量比单独使用FDG-PET或DCE-MRI更准确地识别转移性淋巴结的程度。目的二是确定FDG-PET和DCE-MRI动力学参数之间的相关性，并探讨FDG-PET和DCE-MRI参数的互补作用。使用免疫组织化学染色，将拟定联合分析的转运速率常数与肿瘤细胞膜上葡萄糖转运蛋白的表达水平进行比较。如果成功的话，这项研究将建立一种更可靠和准确的方法来非侵入性地检测头颈部癌症的转移淋巴结。这种方法也可以扩展到评估淋巴结转移，用于其他类型癌症的诊断和治疗后评估。

DESCRIPTION (provided by applicant): Head and neck cancers represent approximately 3% of invasive cancers (about 55,000 patients) diagnosed annually in the United States. Approximately two thirds of all patients present with locally advanced disease. The best chance for cure of head and neck cancer is typically aggressive treatment at initial presentation including complete lymph node dissection. Accurate identification of nodal metastases is a crucial step for treatment planning and evaluation of therapy response. Knowledge of the extent of nodal metastases prior to surgery can help avoid unnecessary removal of lymph nodes. However, current imaging methods are not adequate for reliable assessment of metastatic nodes in both diagnostic imaging and post-treatment evaluation. The overarching goal of this study is to develop PET/MR techniques for accurate, non-invasive detection of nodal metastases for treatment planning and assessment of residual tumor in metastatic nodes after treatment, such that unnecessary removal of nodes can be minimized. A state-of-the-art PET/MR scanner will be utilized to acquire PET and MRI data simultaneously within one session. Our central hypothesis is that a combined model of FDG-PET and DCE-MRI measures can detect metastatic nodes more accurately than FDG-PET or DCE-MRI alone. This hypothesis can be best tested when both PET and MRI scans are simultaneously conducted in one setting, as it can minimize any physiological difference in tumor microenvironment between separate PET and MRI scans, in addition to the benefit of fewer visits for the participating patients. We propose to conduct dynamic PET/MR scans with head and neck cancer patients (n=50) scheduled for full node dissection surgery so that pathological evaluation of dissected nodes can be used as the reference standard to evaluate the accuracy of PET/MR measures. During the surgery, the level of nodes will be recorded for level- to-level comparison between PET/MR and pathology evaluation. The first phase of the study (Aim 1) is to assess the extent of which a combination of FDG-PET and DCE- MRI measures can identify metastatic nodes more accurately than FDG-PET or DCE-MRI alone. Aim 2 is to determine the association between the kinetic parameters of FDG-PET and DCE-MRI and investigate the complimentary roles of FDG-PET and DCE-MRI parameters. Transport rate constant from the proposed joint analysis will be compared with the expression level of glucose transporters on the tumor cell membrane using immunohistochemistry staining. If successful, the research in this proposal will establish a more reliable and accurate method to non-invasively detect metastatic lymph nodes in head and neck cancer. This method can then also be extended to evaluating nodal metastasis for diagnosis and post-treatment evaluation in other types of cancer.