Longitudinal Overlap and Metabolite Analysis in Spectroscopic MRI-Guided Proton Beam Therapy in Pediatric High-Grade Glioma.

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Tomography Pub Date : 2025-06-19 DOI:10.3390/tomography11060071

Abinand C Rejimon, Anuradha G Trivedi, Vicki Huang, Karthik K Ramesh, Natia Esiashvilli, Eduard Schreibmann, Hyunsuk Shim, Kartik Reddy, Bree R Eaton

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Abstract

Background: Pediatric high-grade glioma (pHGG) is a highly aggressive cancer with unique biology distinct from adult high-grade glioma, limiting the effectiveness of standard treatment protocols derived from adult research.

Objective: The purpose of this report is to present preliminary results from an ongoing pilot study integrating spectroscopic magnetic resonance imaging (sMRI) to guide proton beam therapy and longitudinal imaging analysis in pediatric patients with high-grade glioma (pHGG).

Methods: Thirteen pediatric patients under 21 years old with supratentorial WHO grade III-IV glioma underwent baseline and serial whole-brain spectroscopic MRI alongside standard structural MRIs. Radiation targets were defined using T1-weighted contrast enhanced, T2-FLAIR, and Cho/NAA ≥ 2X maps. Longitudinal analyses included voxel-level metabolic change maps and spatial overlap metrics comparing pre-proton therapy and post-.

Results: Six patients had sufficient longitudinal data; five received sMRI-guided PBT. Significant positive correlation (R² = 0.89, p < 0.0001) was observed between T2-FLAIR and Cho/NAA ≥ 2X volumes. Voxel-level difference maps of Cho/NAA and Choline revealed dynamic metabolic changes across follow-up scans. Analyzing Cho/NAA and Cho changes over time allowed differentiation between true progression and pseudoprogression, which conventional MRI alone struggles to achieve.

Conclusions: Longitudinal sMRI enhanced metabolic tracking in pHGG, detects early tumor changes, and refines RT targeting beyond structural imaging. This first in-kind study highlights the potential of sMRI biomarkers in tracking treatment effects and emphasizes the complementary roles of metabolic and radiographic metrics in evaluating therapy response in pHGG.

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mri引导下质子束治疗小儿高级别胶质瘤的纵向重叠和代谢物分析。

背景：儿童高级别胶质瘤（pHGG）是一种高度侵袭性的癌症，具有与成人高级别胶质瘤不同的独特生物学特性，限制了成人研究中衍生的标准治疗方案的有效性。目的：本报告的目的是介绍一项正在进行的试点研究的初步结果，该研究将光谱磁共振成像（sMRI）用于指导小儿高级别胶质瘤（pHGG）患者的质子束治疗和纵向成像分析。方法：13例21岁以下患有幕上WHO III-IV级胶质瘤的儿童患者在标准结构MRI的基础上进行了基线和系列全脑磁共振成像。使用t1加权对比度增强图、T2-FLAIR图和Cho/NAA≥2X图确定辐射目标。纵向分析包括体素水平的代谢变化图和比较质子治疗前和治疗后的空间重叠度量。结果：6例患者有足够的纵向资料；5例接受smri引导的PBT。T2-FLAIR与Cho/NAA≥2X体积呈正相关（R2 = 0.89, p < 0.0001）。Cho/NAA和胆碱的体素水平差异图揭示了随访扫描期间的动态代谢变化。分析Cho/NAA和Cho随时间的变化可以区分真进展和假进展，这是常规MRI难以实现的。结论：纵向sMRI增强了pHGG的代谢跟踪，发现早期肿瘤变化，并改进了结构成像之外的RT靶向。这一首次同类研究强调了sMRI生物标志物在跟踪治疗效果方面的潜力，并强调了代谢和放射学指标在评估pHGG治疗反应中的互补作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Tomography Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

2.70

自引率

10.50%

发文量

222

期刊介绍： TomographyTM publishes basic (technical and pre-clinical) and clinical scientific articles which involve the advancement of imaging technologies. Tomography encompasses studies that use single or multiple imaging modalities including for example CT, US, PET, SPECT, MR and hyperpolarization technologies, as well as optical modalities (i.e. bioluminescence, photoacoustic, endomicroscopy, fiber optic imaging and optical computed tomography) in basic sciences, engineering, preclinical and clinical medicine. Tomography also welcomes studies involving exploration and refinement of contrast mechanisms and image-derived metrics within and across modalities toward the development of novel imaging probes for image-based feedback and intervention. The use of imaging in biology and medicine provides unparalleled opportunities to noninvasively interrogate tissues to obtain real-time dynamic and quantitative information required for diagnosis and response to interventions and to follow evolving pathological conditions. As multi-modal studies and the complexities of imaging technologies themselves are ever increasing to provide advanced information to scientists and clinicians. Tomography provides a unique publication venue allowing investigators the opportunity to more precisely communicate integrated findings related to the diverse and heterogeneous features associated with underlying anatomical, physiological, functional, metabolic and molecular genetic activities of normal and diseased tissue. Thus Tomography publishes peer-reviewed articles which involve the broad use of imaging of any tissue and disease type including both preclinical and clinical investigations. In addition, hardware/software along with chemical and molecular probe advances are welcome as they are deemed to significantly contribute towards the long-term goal of improving the overall impact of imaging on scientific and clinical discovery.