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.

尚未建立无创监测脑干生物或代谢活动的理想方法。评估脑组织的现有方法（例如 PET）在应用于脑干时存在局限性。目前正在研究新的非侵入性成像方法。我们正在利用动态磁敏感对比MR灌注、动态增强MRI、质子核磁波谱成像和FDG PET进一步研究脑桥胶质瘤的影像学特征。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至少在其中一项研究中接受了广泛的影像学检查。在过去的一年里，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。 通常使用遵循 WHO 标准的二维肿瘤测量来测量对治疗的反应以及新药物的疗效，或者最近使用 RECIST 标准来测量。 RECIST 标准尚未针对儿科中枢神经系统肿瘤的测量进行验证，二维测量仍然是联合试验中的标准。我们比较了四位独立的盲读员对弥漫性内在脑桥神经胶质瘤的 1D、2D 和 3D 测量结果。结果表明，所有测量值均存在显着差异（0-197%），因此肿瘤大小的变化对于临床试验的反应来说是一个较差的指标。我们还对全国各地的儿科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做法。我们的结果表明，没有标准的测量方法用于测量这些病变。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 的临床试验进行集中审查。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，试图确定特定成像技术（例如光谱、PET）在这些患者中的作用。