Imaging as a Biomarker for Diffuse Intrinsic Brainstem Gliomas

成像作为弥漫性内源性脑干胶质瘤的生物标志物

• 批准号: 7965439
• 负责人: Katherine e Warren
• 金额: $ 19.87万
• 依托单位: DIVISION OF BASIC SCIENCES - NCI
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7965439
• 关键词: Aftercare; Area; Biologic Characteristic; Biological; Biological Markers; Biopsy; Blinded; Brain Stem; Brain Stem Glioma; Brain Stem Neoplasms; Central Nervous System Neoplasms; Cerebrum; Characteristics; Childhood; Childhood Brain Neoplasm; Childhood Central Nervous System Neoplasm; Clinical; Clinical Trials; Country; Diagnosis; Diagnostic radiologic examination; Diffuse; Diffusion Magnetic Resonance Imaging; Diffusion weighted imaging; Enrollment; Glioma; Image; Imaging Techniques; Laboratories; Lesion; Location; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Magnetism; Measurement; Measures; Metabolic; Methods; Modality; Necrosis; Nuclear; Oncologist; Operative Surgical Procedures; Outcome; Patients; Pediatric Oncologist; Perfusion; Play; Pontine structure; Positron-Emission Tomography; Predisposition; Protons; Publishing; Radiation; Radiation therapy; Reader; Reporting; Research; Risk; Role; Scanning; Side; Spectrum Analysis; Surveys; Tissues; Tumor Tissue; base; falls; fluorodeoxyglucose positron emission tomography; imaging modality; non-invasive monitor; outcome forecast; response; spectroscopic imaging; tumor; tumor progression; two-dimensional

The ideal method for non-invasive monitoring of biological or metabolic activity in the brainstem has not yet been established. Existing methods for evaluating cerebral tissue (e.g. PET) have limitations when applied to the brainstem. New noninvasive imaging methods are currently being studied. We are using dynamic susceptibility contrast MR perfusion, dynamic enhanced MRI, proton nuclear magnetic spectroscopic imaging, and FDG PET to further investigate the imaging characteristics of pontine gliomas. There are four clinical trials which currently fall under this project. Nearly all pediatric patients with CNS tumors undergo extensive imaging on at least one of these studies. Over the past year, we have demonstrated the difficulty in using standard MRI for definition of response in clinical trials and have proposed a new definition of clinical benefit for these patients based on these results. Response to treatment and therefore efficacy of new gents is typically measured using two-dimensional tumor measurements following WHO criteria, or more recently, using RECIST criteria. RECIST criteria have not been validated for the measurement of pediatric CNS tumors and two-dimensional measurements continue to be the standard in consortium trials. We compared the 1D, 2D and 3D measurements of diffuse intrinsic pontine gliomas by four separate blinded readers. The results show that there is significant variability (0-197%) in all measurements and change in tumor size is therefore a poor indicator of response for clinical trials. We have also electronically surveyed pediatric oncologists and neuro-oncologists across the country to determine the standard practice of tumor measurement. Our results show that there is no standard measurement method being used in the measurement of these lesions. We have published a report recommending the use of FLAIR images to measure DIPG and comparing these with the best response scans on study. Images should be compared side by side. Central review was also recommended for clinical trials involving DIPG. We are continuing to evaluate the utility of additional MR sequences, including perfusion and spectroscopic imaging in an attempt to define the role of specific imaging techniques (e.g. spectroscopy, PET) in these patients.

尚未建立非侵入性监测生物或代谢活性的理想方法。当应用于脑干时，现有的评估脑组织（例如PET）的方法有局限性。目前正在研究新的无创成像方法。我们使用动态敏感性对比度MR灌注，动态增强MRI，质子核磁光谱成像和FDG PET来进一步研究蓬蒂因胶质瘤的成像特性。目前有四项临床试验属于该项目。几乎所有患有中枢神经系统肿瘤的儿科患者都对其中的至少一项研究进行了广泛的成像。在过去的一年中，我们证明了在临床试验中使用标准MRI来定义反应的困难，并根据这些结果提出了对这些患者的临床益处的新定义。 通常使用RECIST标准在WHO标准之后或更新的标准之后，使用二维肿瘤测量值对治疗的反应以及新的绅士的功效进行测量。恢复标准尚未验证用于测量小儿中枢神经系统肿瘤，二维测量仍然是财团试验的标准。我们通过四个单独的盲目读者比较了弥漫性庞蒂•神经胶质瘤的1D，2D和3D测量。结果表明，所有测量值都有很大的可变性（0-197％），因此肿瘤大小的变化是临床试验反应的不良指标。我们还对全国各地的小儿肿瘤学家和神经肿瘤学家进行了电子调查，以确定肿瘤测量的标准实践。我们的结果表明，在测量这些病变中没有使用标准测量方法。我们发表了一份报告，建议使用Flair图像来测量DIPG并将其与研究中的最佳响应扫描进行比较。图像应并排比较。还建议对涉及DIPG的临床试验进行中央审查。我们正在继续评估其他MR序列的实用性，包括灌注和光谱成像，以定义这些患者在这些患者中的特定成像技术（例如光谱，PET）的作用。