EVALUATION OF POSITRON EMISSION TOMOGRAPHY-MAGNETIC RESONANCE IMAGING (PET-MRI)

项目摘要/摘要 胰腺癌是一种侵袭性的恶性肿瘤，通常表现为晚期疾病。即使是在 那些通过常规成像(CT扫描或MRI)被认为是可切除疾病的患者，许多被发现 在手术探查时有更晚期的癌症。在这些患者中，手术是无益的。 因此，患者在很大程度上暴露于不必要的手术的发病率和由此造成的延误 适当的治疗；即全身化疗。第二，确定对新佐剂的反应 对于交界性可切除或局部晚期胰腺癌患者的治疗是不够的，因为 用常规成像很难区分治疗反应/炎症和肿瘤进展。 通常，这些患者被带到手术中，被发现患有不能切除的疾病，而且，以类似于 在上述情况下，都暴露在手术的所有风险中，而没有可能的好处。总而言之，改进了 需要胰腺癌分期的方法来改进治疗患者的选择(手术， 化疗和/或放射治疗)。这将减少与无效相关的发病率和治疗延误。 还将降低成本，更好地分配稀缺和昂贵的治疗相关资源(即 手术室时间)。一种新型的正电子发射断层成像和磁学联合成像方式 磁共振成像(PET-MRI)有可能解决目前的这些缺点。PET-MRI联合 MRI的精确解剖细节与PET的功能成像。这有可能会更好地 勾画肿瘤的范围，区分存活的癌症和治疗/坏死性肿瘤。我们假设 在治疗前的评估中，PET-MRI将提高检测隐匿性转移疾病的能力 评估胰腺癌患者对新辅助治疗的反应。 常规影像(CT和MRI)。在这方面，本研究的目的是(1)确定是否存在 PET-MRI在胰腺癌患者术前分期中的价值及应用 PET-MRI对接受新辅助治疗的胰腺癌患者治疗反应的判断 在我们机构进行临床试验。如果成功并在大型研究中得到验证，PET-MRI有可能更好地 选择患者进行适当的治疗，从而避免患者不必要的发病率，并最终改善 胰腺癌患者的长期预后。

PROJECT SUMMARY/ABSTRACT Pancreatic adenocarcinoma is an aggressive malignancy that often presents with advanced disease. Even in those patients deemed to have resectable disease by conventional imaging (CT scan or MRI), many are found to have more advanced cancer at the time of surgical exploration. In these patients, surgery is not beneficial. Thus, patients are exposed to the morbidity of unnecessary surgery and the resultant delays in the most appropriate therapy; namely, systemic chemotherapy. Second, determining the response to neoadjuvant treatment in patients with borderline resectable or locally advanced pancreatic cancer is inadequate, as differentiating treatment response/inflammation from tumor progression is difficult with conventional imaging. Often, these patients are taken to surgery, found to have unresectable disease and, in a similar fashion to the aforementioned situation, are exposed to all of the risks of surgery with no possible benefit. In sum, improved methods of pancreatic cancer staging are needed to improve patient selection for treatment (surgery, chemotherapy, and/or radiation). This will reduce the morbidity and treatment delays associated with futile surgery and will also reduce costs and better allocate scarce and expensive treatment-related resources (i.e. operating room time). The novel combined imaging modality of positron emission tomography and magnetic resonance imaging (PET-MRI) has the potential to address these current shortcomings. PET-MRI combines the precise anatomic detail of MRI with the functional imaging of PET. This has the potential to better delineate the extent of a tumor and differentiate viable cancer from treated/necrotic tumor. We hypothesize that PET-MRI will have improved ability to both detect occult metastatic disease in the pre-treatment evaluation of patients with pancreatic cancer and determine response to neoadjuvant treatment when compared to conventional imaging (CT and MRI). In this regard, the aims of this study are to (1) determine if there is a benefit of PET-MRI in the pre-operative staging of patients with pancreatic adenocarcinoma and (2) to utilize PET-MRI in determining response to treatment in patients with pancreatic cancer enrolled on a neoadjuvant clinical trial at our institution. If successful and validated in large studies, PET-MRI has the potential to better select patients for appropriate therapy, thus sparing patients unnecessary morbidity and, ultimately, improve long-term outcomes in patients with pancreatic cancer.