Multimodal Neuroimaging for Evaluating Lower-Grade Astrocytoma
Abstract
Lay Abstract Gliomas are the most common malignant primary brain tumors in adults. As the development of diagnosis and treatment, patients with lower grade astrocytoma have long survival. Current treatment for these patients is typically surgery followed by radiation therapy, which relies on the definition of the extent of cancer on structural images. However, these images mainly reflect blood vessel damage. Thus, surgeons have difficulty determining when a maximum safe resection of the tumor has been achieved, and radiation oncologists have a hard time avoiding over-treating normal brain tissues. Despite these aggressive treatments, most patients recur, and damage caused by tumor growth and treatment often leads to significantly impaired cognitive function. New ways to improve the characterization of tumor cells and predict cognitive impairment are critical for improving the management of these patients. Metabolic changes often precede anatomic and microstructural changes, and their detection would enable the early assessment and drive intervention. We have developed methods of acquiring MR metabolic imaging to provide the concentrations of in vivo (steady-state) brain metabolites non-invasively and demonstrated its importance for evaluating patients with glioma by measuring neuronal function, differentiating tumor cells from normal brain, and assessing response to therapy. Hyperpolarized carbon-13 pyruvate MR metabolite imaging is another promising new technology that provides dynamic metabolic processes in a rapid time. Recently we have developed methods to detect the conversions from pyruvate to lactate and glutamate simultaneously in the human brain after injection of a carbon-13 probe, which makes it possible to evaluate the glucose consumption within the normal brain related to cognitive impairment and assess response to therapy within the lesion in astrocytoma. The proposed study will investigate patients with lower grade astrocytoma using a multimodality MR protocol that combines steady state and dynamic metabolic imaging methods with advanced MR techniques to assess brain metabolism, white matter integrity, blood vessel abnormality, and brain functional networks. The first aim will evaluate the normal and abnormal brain changes during radiation therapy and then correlate these changes to impairments in cognitive functioning and quality of life. Aim 2 will examine signatures associated with recurrent tumors and evaluate the impact of tumor burden on cognition and quality of life. The results of the proposed study will be critical for improving the clinical management of patients, will aid neuro-oncologists in making timely decisions on managing their patients, will help surgeons improve the extent of their resections, will assist radiation oncologists to plan the delivery of radiation therapy, and will improve quality of life for patients with lower grade astrocytoma. Thus, these results will direct appropriate patients to enroll in precision medicine-based clinical trials and develop novel strategies to treat cognitive impairment. Successful completion of the study will also have a major impact on Service Members who have lower grade astrocytoma for avoiding aggressive treatment when they are not necessary, reduce treatment induced side effects, minimizing the time in the hospital, maximizing the time on duty, or return to duty, and reduce the impact of cancer in their lives.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210884
Entities
People
- Yan Li
Organizations
- United States Army
- University of California, San Francisco