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Epel B, Viswakarma N, Sundramoorthy SV, Pawar NJ, Kotecha M. Oxygen Imaging of a Rabbit Tumor Using a Human-Sized Pulse Electron Paramagnetic Resonance Imager. Mol Imaging Biol 2024; 26:403-410. [PMID: 37715089 DOI: 10.1007/s11307-023-01852-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE Spatial heterogeneity in tumor hypoxia is one of the most important factors regulating tumor growth, development, aggressiveness, metastasis, and affecting treatment outcome. Most solid tumors are known to have hypoxia or low oxygen levels (pO2 ≤10 torr). Electron paramagnetic resonance oxygen imaging (EPROI) is an emerging oxygen mapping technology. EPROI utilizes the linear relationship between the relaxation rates of the injectable OX071 trityl spin probe and the partial oxygen pressure (pO2). However, most of the EPROI studies have been limited to mouse models of solid tumors because of the instrument-size limitations. The purpose of this work was to develop a human-sized 9-mT (250 MHz resonance frequency, 60 cm bore size) pulse EPROI instrument and evaluate its performance with rabbit VX-2 tumor oxygen imaging. METHODS A New Zealand white rabbit with a 3.2-cm VX-2 tumor in the calf muscle was imaged using the human-sized EPROI instrument and a 2.25-in. ID volume coil. The animal received a ~8-min intravenous injection of OX071 (5.2 mL total volume at 72 mM concentration) and, after 75 min, an intratumoral injection (120 μL total at 5 mM OX071 concentration) and underwent EPROI. At the end of the experiments, MRI was performed using a preclinical 9.4-T MRI system to outline the tumor boundaries. RESULTS For the first time, a human-sized pulse EPROI instrument with a 60-cm bore size/250-MHz frequency was built and evaluated using rabbit tumor oxygen imaging. For the first time, the systemic IV injection of the oxygen-sensitive trityl OX071 spin probe was used for an animal of this size. The resulting EPROI image from the IV injection showed complete tumor coverage. The image obtained after intratumoral injection showed localized coverage in the upper lobe of the tumor, demonstrating the need for improved intratumoral injection protocol. CONCLUSIONS This study demonstrates the performance of the world's first human-sized pulse EPROI instrument. It also demonstrates that the EPROI of larger animals can be performed using the systemic injection of a manageable amount of the spin probe. This brings EPROI one step closer to clinical applications in cancer therapies. Oxygen imaging is a platform technology, and the instrument and techniques developed here will also be useful for other clinical applications.
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Affiliation(s)
- Boris Epel
- O2M Technologies, LLC, Chicago, IL, 60612, USA.
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL, 60637, USA.
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McCabe A, Martin S, Rowe S, Shah J, Morgan PS, Borys D, Panek R. Oxygen-enhanced MRI assessment of tumour hypoxia in head and neck cancer is feasible and well tolerated in the clinical setting. Eur Radiol Exp 2024; 8:27. [PMID: 38443722 PMCID: PMC10914657 DOI: 10.1186/s41747-024-00429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/08/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Tumour hypoxia is a recognised cause of radiotherapy treatment resistance in head and neck squamous cell carcinoma (HNSCC). Current positron emission tomography-based hypoxia imaging techniques are not routinely available in many centres. We investigated if an alternative technique called oxygen-enhanced magnetic resonance imaging (OE-MRI) could be performed in HNSCC. METHODS A volumetric OE-MRI protocol for dynamic T1 relaxation time mapping was implemented on 1.5-T clinical scanners. Participants were scanned breathing room air and during high-flow oxygen administration. Oxygen-induced changes in T1 times (ΔT1) and R2* rates (ΔR2*) were measured in malignant tissue and healthy organs. Unequal variance t-test was used. Patients were surveyed on their experience of the OE-MRI protocol. RESULTS Fifteen patients with HNSCC (median age 59 years, range 38 to 76) and 10 non-HNSCC subjects (median age 46.5 years, range 32 to 62) were scanned; the OE-MRI acquisition took less than 10 min and was well tolerated. Fifteen histologically confirmed primary tumours and 41 malignant nodal masses were identified. Median (range) of ΔT1 times and hypoxic fraction estimates for primary tumours were -3.5% (-7.0 to -0.3%) and 30.7% (6.5 to 78.6%) respectively. Radiotherapy-responsive and radiotherapy-resistant primary tumours had mean estimated hypoxic fractions of 36.8% (95% confidence interval [CI] 17.4 to 56.2%) and 59.0% (95% CI 44.6 to 73.3%), respectively (p = 0.111). CONCLUSIONS We present a well-tolerated implementation of dynamic, volumetric OE-MRI of the head and neck region allowing discernment of differing oxygen responses within biopsy-confirmed HNSCC. TRIAL REGISTRATION ClinicalTrials.gov, NCT04724096 . Registered on 26 January 2021. RELEVANCE STATEMENT MRI of tumour hypoxia in head and neck cancer using routine clinical equipment is feasible and well tolerated and allows estimates of tumour hypoxic fractions in less than ten minutes. KEY POINTS • Oxygen-enhanced MRI (OE-MRI) can estimate tumour hypoxic fractions in ten-minute scanning. • OE-MRI may be incorporable into routine clinical tumour imaging. • OE-MRI has the potential to predict outcomes after radiotherapy treatment.
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Affiliation(s)
- Alastair McCabe
- Academic Unit of Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - Stewart Martin
- Academic Unit of Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Selene Rowe
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jagrit Shah
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Paul S Morgan
- Mental Health & Clinical Neurosciences Unit, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Medical Physics & Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Damian Borys
- Department of Systems Biology and Engineering, Silesian University of Technology, Gliwice, Poland
| | - Rafal Panek
- Mental Health & Clinical Neurosciences Unit, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Medical Physics & Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Brighi C, Waddington DEJ, Keall PJ, Booth J, O’Brien K, Silvester S, Parkinson J, Mueller M, Yim J, Bailey DL, Back M, Drummond J. The MANGO study: a prospective investigation of oxygen enhanced and blood-oxygen level dependent MRI as imaging biomarkers of hypoxia in glioblastoma. Front Oncol 2023; 13:1306164. [PMID: 38192626 PMCID: PMC10773871 DOI: 10.3389/fonc.2023.1306164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Background Glioblastoma (GBM) is the most aggressive type of brain cancer, with a 5-year survival rate of ~5% and most tumours recurring locally within months of first-line treatment. Hypoxia is associated with worse clinical outcomes in GBM, as it leads to localized resistance to radiotherapy and subsequent tumour recurrence. Current standard of care treatment does not account for tumour hypoxia, due to the challenges of mapping tumour hypoxia in routine clinical practice. In this clinical study, we aim to investigate the role of oxygen enhanced (OE) and blood-oxygen level dependent (BOLD) MRI as non-invasive imaging biomarkers of hypoxia in GBM, and to evaluate their potential role in dose-painting radiotherapy planning and treatment response assessment. Methods The primary endpoint is to evaluate the quantitative and spatial correlation between OE and BOLD MRI measurements and [18F]MISO values of uptake in the tumour. The secondary endpoints are to evaluate the repeatability of MRI biomarkers of hypoxia in a test-retest study, to estimate the potential clinical benefits of using MRI biomarkers of hypoxia to guide dose-painting radiotherapy, and to evaluate the ability of MRI biomarkers of hypoxia to assess treatment response. Twenty newly diagnosed GBM patients will be enrolled in this study. Patients will undergo standard of care treatment while receiving additional OE/BOLD MRI and [18F]MISO PET scans at several timepoints during treatment. The ability of OE/BOLD MRI to map hypoxic tumour regions will be evaluated by assessing spatial and quantitative correlations with areas of hypoxic tumour identified via [18F]MISO PET imaging. Discussion MANGO (Magnetic resonance imaging of hypoxia for radiation treatment guidance in glioblastoma multiforme) is a diagnostic/prognostic study investigating the role of imaging biomarkers of hypoxia in GBM management. The study will generate a large amount of longitudinal multimodal MRI and PET imaging data that could be used to unveil dynamic changes in tumour physiology that currently limit treatment efficacy, thereby providing a means to develop more effective and personalised treatments.
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Affiliation(s)
- Caterina Brighi
- Image X Institute, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - David E. J. Waddington
- Image X Institute, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Paul J. Keall
- Image X Institute, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Jeremy Booth
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
- Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, NSW, Australia
| | | | - Shona Silvester
- Image X Institute, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Jonathon Parkinson
- Department of Neurosurgery, Royal North Shore Hospital, Sydney, NSW, Australia
- The Brain Cancer Group Sydney, St Leonards, NSW, Australia
| | - Marco Mueller
- Siemens Healthcare Pty Ltd, Brisbane, QLD, Australia
| | - Jackie Yim
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
- The Brain Cancer Group Sydney, St Leonards, NSW, Australia
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Dale L. Bailey
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Michael Back
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
- The Brain Cancer Group Sydney, St Leonards, NSW, Australia
| | - James Drummond
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
- The Brain Cancer Group Sydney, St Leonards, NSW, Australia
- Department of Neuroradiology, Royal North Shore Hospital, Sydney, NSW, Australia
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Baker JHE, Moosvi F, Kyle AH, Püspöky Banáth J, Saatchi K, Häfeli UO, Reinsberg SA, Minchinton AI. Radiosensitizing oxygenation changes in murine tumors treated with VEGF-ablation therapy are measurable using oxygen enhanced-MRI (OE-MRI). Radiother Oncol 2023; 187:109795. [PMID: 37414252 DOI: 10.1016/j.radonc.2023.109795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE There is a significant need for a widely available, translatable, sensitive and non-invasive imaging biomarker for tumor hypoxia in radiation oncology. Treatment-induced changes in tumor tissue oxygenation can alter the sensitivity of cancer tissues to radiation, but the relative difficulty in monitoring the tumor microenvironment results in scarce clinical and research data. Oxygen-Enhanced MRI (OE-MRI) uses inhaled oxygen as a contrast agent to measure tissue oxygenation. Here we investigate the utility of dOE-MRI, a previously validated imaging approach employing a cycling gas challenge and independent component analysis (ICA), to detect VEGF-ablation treatment-induced changes in tumor oxygenation that result in radiosensitization. METHODS Murine squamous cell carcinoma (SCCVII) tumor-bearing mice were treated with 5 mg/kg anti-VEGF murine antibody B20 (B20-4.1.1, Genentech) 2-7 days prior to radiation treatment, tissue collection or MR imaging using a 7 T scanner. dOE-MRI scans were acquired for a total of three repeated cycles of air (2 min) and 100% oxygen (2 min) with responding voxels indicating tissue oxygenation. DCE-MRI scans were acquired using a high molecular weight (MW) contrast agent (Gd-DOTA based hyperbranched polygylcerol; HPG-GdF, 500 kDa) to obtain fractional plasma volume (fPV) and apparent permeability-surface area product (aPS) parameters derived from the MR concentration-time curves. Changes to the tumor microenvironment were evaluated histologically, with cryosections stained and imaged for hypoxia, DNA damage, vasculature and perfusion. Radiosensitizing effects of B20-mediated increases in oxygenation were evaluated by clonogenic survival assays and by staining for DNA damage marker γH2AX. RESULTS Tumors from mice treated with B20 exhibit changes to their vasculature that are consistent with a vascular normalization response, and result in a temporary period of reduced hypoxia. DCE-MRI using injectable contrast agent HPG-GDF measured decreased vessel permeability in treated tumors, while dOE-MRI using inhaled oxygen as a contrast agent showed greater tissue oxygenation. These treatment-induced changes to the tumor microenvironment result in significantly increased radiation sensitivity, illustrating the utility of dOE-MRI as a non-invasive biomarker of treatment response and tumor sensitivity during cancer interventions. CONCLUSIONS VEGF-ablation therapy-mediated changes to tumor vascular function measurable using DCE-MRI techniques may be monitored using the less invasive approach of dOE-MRI, an effective biomarker of tissue oxygenation that can monitor treatment response and predict radiation sensitivity.
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Affiliation(s)
| | - Firas Moosvi
- University of British Columbia, Department of Physics & Astronomy, Vancouver, BC, V6T 1Z1, Canada
| | - Alastair Hugh Kyle
- Integrative Oncology - Radiation Biology Unit, BC Cancer Research Institute, Vancouver, BC, V5Z 1L3, Canada
| | - Judit Püspöky Banáth
- Integrative Oncology - Radiation Biology Unit, BC Cancer Research Institute, Vancouver, BC, V5Z 1L3, Canada
| | - Katayoun Saatchi
- University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, V6T 1Z3, Canada
| | - Urs Otto Häfeli
- University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, V6T 1Z3, Canada
| | | | - Andrew Ivor Minchinton
- Integrative Oncology - Radiation Biology Unit, BC Cancer Research Institute, Vancouver, BC, V5Z 1L3, Canada
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Perez RC, Kim D, Maxwell AWP, Camacho JC. Functional Imaging of Hypoxia: PET and MRI. Cancers (Basel) 2023; 15:3336. [PMID: 37444446 DOI: 10.3390/cancers15133336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Molecular and functional imaging have critical roles in cancer care. Existing evidence suggests that noninvasive detection of hypoxia within a particular type of cancer can provide new information regarding the relationship between hypoxia, cancer aggressiveness and altered therapeutic responses. Following the identification of hypoxia inducible factor (HIF), significant progress in understanding the regulation of hypoxia-induced genes has been made. These advances have provided the ability to therapeutically target HIF and tumor-associated hypoxia. Therefore, by utilizing the molecular basis of hypoxia, hypoxia-based theranostic strategies are in the process of being developed which will further personalize care for cancer patients. The aim of this review is to provide an overview of the significance of tumor hypoxia and its relevance in cancer management as well as to lay out the role of imaging in detecting hypoxia within the context of cancer.
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Affiliation(s)
- Ryan C Perez
- Florida State University College of Medicine, Tallahassee, FL 32306, USA
| | - DaeHee Kim
- Department of Diagnostic Imaging, The Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Aaron W P Maxwell
- Department of Diagnostic Imaging, The Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Juan C Camacho
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, FL 32306, USA
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Dubec MJ, Buckley DL, Berks M, Clough A, Gaffney J, Datta A, McHugh DJ, Porta N, Little RA, Cheung S, Hague C, Eccles CL, Hoskin PJ, Bristow RG, Matthews JC, van Herk M, Choudhury A, Parker GJM, McPartlin A, O'Connor JPB. First-in-human technique translation of oxygen-enhanced MRI to an MR Linac system in patients with head and neck cancer. Radiother Oncol 2023; 183:109592. [PMID: 36870608 DOI: 10.1016/j.radonc.2023.109592] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND AND PURPOSE Tumour hypoxia is prognostic in head and neck cancer (HNC), associated with poor loco-regional control, poor survival and treatment resistance. The advent of hybrid MRI - radiotherapy linear accelerator or 'MR Linac' systems - could permit imaging for treatment adaptation based on hypoxic status. We sought to develop oxygen-enhanced MRI (OE-MRI) in HNC and translate the technique onto an MR Linac system. MATERIALS AND METHODS MRI sequences were developed in phantoms and 15 healthy participants. Next, 14 HNC patients (with 21 primary or local nodal tumours) were evaluated. Baseline tissue longitudinal relaxation time (T1) was measured alongside the change in 1/T1 (termed ΔR1) between air and oxygen gas breathing phases. We compared results from 1.5 T diagnostic MR and MR Linac systems. RESULTS Baseline T1 had excellent repeatability in phantoms, healthy participants and patients on both systems. Cohort nasal concha oxygen-induced ΔR1 significantly increased (p < 0.0001) in healthy participants demonstrating OE-MRI feasibility. ΔR1 repeatability coefficients (RC) were 0.023-0.040 s-1 across both MR systems. The tumour ΔR1 RC was 0.013 s-1 and the within-subject coefficient of variation (wCV) was 25% on the diagnostic MR. Tumour ΔR1 RC was 0.020 s-1 and wCV was 33% on the MR Linac. ΔR1 magnitude and time-course trends were similar on both systems. CONCLUSION We demonstrate first-in-human translation of volumetric, dynamic OE-MRI onto an MR Linac system, yielding repeatable hypoxia biomarkers. Data were equivalent on the diagnostic MR and MR Linac systems. OE-MRI has potential to guide future clinical trials of biology guided adaptive radiotherapy.
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Affiliation(s)
- Michael J Dubec
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK.
| | - David L Buckley
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK; Biomedical Imaging, University of Leeds, Leeds, UK
| | - Michael Berks
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Abigael Clough
- Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - John Gaffney
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Anubhav Datta
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Damien J McHugh
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Nuria Porta
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Ross A Little
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Susan Cheung
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Christina Hague
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Cynthia L Eccles
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - Peter J Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Robert G Bristow
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Julian C Matthews
- Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Marcel van Herk
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Ananya Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Geoff J M Parker
- Bioxydyn Ltd, Manchester, UK; Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Andrew McPartlin
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Radiation Oncology, Princess Margaret Cancer Center, Toronto, Canada
| | - James P B O'Connor
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Radiology, The Christie NHS Foundation Trust, Manchester, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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Gouel P, Decazes P, Vera P, Gardin I, Thureau S, Bohn P. Advances in PET and MRI imaging of tumor hypoxia. Front Med (Lausanne) 2023; 10:1055062. [PMID: 36844199 PMCID: PMC9947663 DOI: 10.3389/fmed.2023.1055062] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Tumor hypoxia is a complex and evolving phenomenon both in time and space. Molecular imaging allows to approach these variations, but the tracers used have their own limitations. PET imaging has the disadvantage of low resolution and must take into account molecular biodistribution, but has the advantage of high targeting accuracy. The relationship between the signal in MRI imaging and oxygen is complex but hopefully it would lead to the detection of truly oxygen-depleted tissue. Different ways of imaging hypoxia are discussed in this review, with nuclear medicine tracers such as [18F]-FMISO, [18F]-FAZA, or [64Cu]-ATSM but also with MRI techniques such as perfusion imaging, diffusion MRI or oxygen-enhanced MRI. Hypoxia is a pejorative factor regarding aggressiveness, tumor dissemination and resistance to treatments. Therefore, having accurate tools is particularly important.
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Affiliation(s)
- Pierrick Gouel
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Pierre Decazes
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Pierre Vera
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Isabelle Gardin
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Sébastien Thureau
- QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France,Département de Radiothérapie, Centre Henri Becquerel, Rouen, France
| | - Pierre Bohn
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France,*Correspondence: Pierre Bohn,
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Bluemke E, Bertrand A, Chu KY, Syed N, Murchison AG, Cooke R, Greenhalgh T, Burns B, Craig M, Taylor N, Shah K, Gleeson F, Bulte D. Oxygen-enhanced MRI and radiotherapy in patients with oropharyngeal squamous cell carcinoma. Clin Transl Radiat Oncol 2022; 39:100563. [PMID: 36655119 PMCID: PMC9841018 DOI: 10.1016/j.ctro.2022.100563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Background and purpose This study aimed to assess the role of T1 mapping and oxygen-enhanced MRI in patients undergoing radical dose radiotherapy for HPV positive oropharyngeal cancer, which has not yet been examined in an OE-MRI study. Materials and methods Variable Flip Angle T1 maps were acquired on a 3T MRI scanner while patients (n = 12) breathed air and/or 100 % oxygen, before and after fraction 10 of the planned 30 fractions of chemoradiotherapy ('visit 1' and 'visit 2', respectively). The analysis aimed to assess to what extent (1) native R1 relates to patient outcome; (2) OE-MRI response relates to patient outcome; (3) changes in mean R1 before and after radiotherapy related to clinical outcome in patients with oropharyngeal squamous cell carcinoma. Results Due to the radiotherapy being largely successful, the sample sizes of non-responder groups were small, and therefore it was not possible to properly assess the predictive nature of OE-MRI. The tumour R1 increased in some patients while decreasing in others, in a pattern that was overall consistent with the underlying OE-MRI theory and previously reported tumour OE-MRI responses. In addition, we discuss some practical challenges faced when integrating this technique into a clinical trial, with the aim that sharing this is helpful to researchers planning to use OE-MRI in future clinical studies. Conclusion Altogether, these results suggest that further clinical OE-MRI studies to assess hypoxia and radiotherapy response are worth pursuing, and that there is important work to be done to improve the robustness of the OE-MRI technique in human applications in order for it to be useful as a widespread clinical technique.
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Affiliation(s)
- Emma Bluemke
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, UK,Corresponding author at: Old Road Campus Research Building, University of Oxford, Headington, Oxford OX3 7DQ, UK.
| | - Ambre Bertrand
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, UK
| | - Kwun-Ye Chu
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, UK,Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, UK
| | - Nigar Syed
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, UK
| | - Andrew G. Murchison
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, UK
| | - Rosie Cooke
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, UK,Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, UK
| | - Tessa Greenhalgh
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, UK,University Hospital Southampton NHS Foundation Trust, UK
| | | | | | - Nia Taylor
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, UK
| | - Ketan Shah
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, UK,Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, UK
| | - Fergus Gleeson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, UK
| | - Daniel Bulte
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, UK
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9
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deSouza NM, Choudhury A, Greaves M, O’Connor JPB, Hoskin PJ. Imaging hypoxia in endometrial cancer: How and why should it be done? Front Oncol 2022; 12:1020907. [PMID: 36439503 PMCID: PMC9682004 DOI: 10.3389/fonc.2022.1020907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2023] Open
Affiliation(s)
- Nandita M. deSouza
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Imaging, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Ananya Choudhury
- Radiation Oncology, The Christie National Health Service (NHS) Foundation Trust Manchester, Manchester, United Kingdom
- The Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Mel Greaves
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
| | - James P. B. O’Connor
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Imaging, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- The Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Peter J. Hoskin
- The Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Radiation Oncology, Mount Vernon Cancer Centre, Northwood, United Kingdom
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10
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Gallez B. The Role of Imaging Biomarkers to Guide Pharmacological Interventions Targeting Tumor Hypoxia. Front Pharmacol 2022; 13:853568. [PMID: 35910347 PMCID: PMC9335493 DOI: 10.3389/fphar.2022.853568] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/23/2022] [Indexed: 12/12/2022] Open
Abstract
Hypoxia is a common feature of solid tumors that contributes to angiogenesis, invasiveness, metastasis, altered metabolism and genomic instability. As hypoxia is a major actor in tumor progression and resistance to radiotherapy, chemotherapy and immunotherapy, multiple approaches have emerged to target tumor hypoxia. It includes among others pharmacological interventions designed to alleviate tumor hypoxia at the time of radiation therapy, prodrugs that are selectively activated in hypoxic cells or inhibitors of molecular targets involved in hypoxic cell survival (i.e., hypoxia inducible factors HIFs, PI3K/AKT/mTOR pathway, unfolded protein response). While numerous strategies were successful in pre-clinical models, their translation in the clinical practice has been disappointing so far. This therapeutic failure often results from the absence of appropriate stratification of patients that could benefit from targeted interventions. Companion diagnostics may help at different levels of the research and development, and in matching a patient to a specific intervention targeting hypoxia. In this review, we discuss the relative merits of the existing hypoxia biomarkers, their current status and the challenges for their future validation as companion diagnostics adapted to the nature of the intervention.
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Affiliation(s)
- Bernard Gallez
- Biomedical Magnetic Resonance Research Group, Louvain Drug Research Institute, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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11
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Wong KL, Cheng KH, Lam SK, Liu C, Cai J. Review of functional magnetic resonance imaging in the assessment of nasopharyngeal carcinoma treatment response. PRECISION RADIATION ONCOLOGY 2022. [DOI: 10.1002/pro6.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Kwun Lam Wong
- Department of Health Technology and Informatics The Hong Kong Polytechnic University Hong Kong SAR People's Republic of China
- Department of Radiotherapy Hong Kong Sanatorium & Hospital HKSH Medical Group Hong Kong SAR People's Republic of China
| | - Ka Hei Cheng
- Department of Health Technology and Informatics The Hong Kong Polytechnic University Hong Kong SAR People's Republic of China
| | - Sai Kit Lam
- Department of Health Technology and Informatics The Hong Kong Polytechnic University Hong Kong SAR People's Republic of China
| | - Chenyang Liu
- Department of Health Technology and Informatics The Hong Kong Polytechnic University Hong Kong SAR People's Republic of China
| | - Jing Cai
- Department of Health Technology and Informatics The Hong Kong Polytechnic University Hong Kong SAR People's Republic of China
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12
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Bluemke E, Stride E, Bulte DP. A General Model to Calculate the Spin-Lattice Relaxation Rate (R1) of Blood, Accounting for Hematocrit, Oxygen Saturation, Oxygen Partial Pressure, and Magnetic Field Strength Under Hyperoxic Conditions. J Magn Reson Imaging 2022; 55:1428-1439. [PMID: 34596290 DOI: 10.1002/jmri.27938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Under normal physiological conditions, the spin-lattice relaxation rate (R1) in blood is influenced by many factors, including hematocrit, field strength, and the paramagnetic effects of deoxyhemoglobin and dissolved oxygen. In addition, techniques such as oxygen-enhanced magnetic resonance imaging (MRI) require high fractions of inspired oxygen to induce hyperoxia, which complicates the R1 signal further. A quantitative model relating total blood oxygen content to R1 could help explain these effects. PURPOSE To propose and assess a general model to estimate the R1 of blood, accounting for hematocrit, SO2 , PO2 , and B0 under both normal physiological and hyperoxic conditions. STUDY TYPE Mathematical modeling. POPULATION One hundred and twenty-six published values of R1 from phantoms and animal models. FIELD STRENGTH/SEQUENCE 5-8.45 T. ASSESSMENT We propose a two-compartment nonlinear model to calculate R1 as a function of hematocrit, PO2 , and B0. The Akaike Information Criterion (AIC) was used to select the best-performing model with the fewest parameters. A previous model of R1 as a function of hematocrit, SO2 , and B0 has been proposed by Hales et al, and our work builds upon this work to make the model applicable under hyperoxic conditions (SO2 > 0.99). Models were assessed using the AIC, mean squared error (MSE), coefficient of determination (R2 ), and Bland-Altman analysis. The effect of volume fraction constants W RBC and W plasma was assessed by the SD of resulting R1. The range of the model was determined by the maximum and minimum B0, hematocrit, SO2 , and PO2 of the literature data points. STATISTICAL TESTS Bland-Altman, AIC, MSE, coefficient of determination (R2 ), SD. RESULTS The model estimates agreed well with the literature values of R1 of blood (R2 = 0.93, MSE = 0.0013 s-2 ), and its performance was consistent across the range of parameters: B0 = 1.5-8.45 T, SO2 = 0.40-1, PO2 = 30-700 mmHg. DATA CONCLUSION Using the results from this model, we have quantified and explained the contradictory decrease in R1 reported in oxygen-enhanced MRI and oxygen-delivery experiments. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Emma Bluemke
- Department of Engineering Sciences, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Eleanor Stride
- Department of Engineering Sciences, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Daniel P Bulte
- Department of Engineering Sciences, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
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13
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Using Variable Flip Angle (VFA) and Modified Look-Locker Inversion Recovery (MOLLI) T1 mapping in clinical OE-MRI. Magn Reson Imaging 2022; 89:92-99. [PMID: 35341905 DOI: 10.1016/j.mri.2022.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE The imaging technique known as Oxygen-Enhanced MRI is under development as a noninvasive technique for imaging hypoxia in tumours and pulmonary diseases. While promising results have been shown in preclinical experiments, clinical studies have mentioned experiencing difficulties with patient motion, image registration, and the limitations of single-slice images compared to 3D volumes. As clinical studies begin to assess feasibility of using OE-MRI in patients, it is important for researchers to communicate about the practical challenges experienced when using OE-MRI on patients to help the technique advance. MATERIALS AND METHODS We report on our experience with using two types of T1 mapping (MOLLI and VFA) for a recently completed OE-MRI clinical study on oropharyngeal squamous cell carcinoma. RESULTS We report: (1) the artefacts and practical difficulties encountered in this study; (2) the difference in estimated T1 from each method used - the VFA T1 estimation was higher than the MOLLI estimation by 27% on average; (3) the standard deviation within the tumour ROIs - there was no significant difference in the standard deviation seen within the tumour ROIs from the VFA versus MOLLI; and (4) the OE-MRI response collected from either method. Lastly, we collated the MRI acquisition details from over 45 relevant manuscripts as a convenient reference for researchers planning future studies. CONCLUSION We have reported our practical experience from an OE-MRI clinical study, with the aim that sharing this is helpful to researchers planning future studies. In this study, VFA was a more useful technique for using OE-MRI in tumours than MOLLI T1 mapping.
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D'Alonzo RA, Gill S, Rowshanfarzad P, Keam S, MacKinnon KM, Cook AM, Ebert MA. In vivo noninvasive preclinical tumor hypoxia imaging methods: a review. Int J Radiat Biol 2021; 97:593-631. [PMID: 33703994 DOI: 10.1080/09553002.2021.1900943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/28/2021] [Accepted: 03/01/2021] [Indexed: 12/15/2022]
Abstract
Tumors exhibit areas of decreased oxygenation due to malformed blood vessels. This low oxygen concentration decreases the effectiveness of radiation therapy, and the resulting poor perfusion can prevent drugs from reaching areas of the tumor. Tumor hypoxia is associated with poorer prognosis and disease progression, and is therefore of interest to preclinical researchers. Although there are multiple different ways to measure tumor hypoxia and related factors, there is no standard for quantifying spatial and temporal tumor hypoxia distributions in preclinical research or in the clinic. This review compares imaging methods utilized for the purpose of assessing spatio-temporal patterns of hypoxia in the preclinical setting. Imaging methods provide varying levels of spatial and temporal resolution regarding different aspects of hypoxia, and with varying advantages and disadvantages. The choice of modality requires consideration of the specific experimental model, the nature of the required characterization and the availability of complementary modalities as well as immunohistochemistry.
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Affiliation(s)
- Rebecca A D'Alonzo
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, Australia
| | - Suki Gill
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, Australia
| | - Synat Keam
- School of Medicine, The University of Western Australia, Crawley, Australia
| | - Kelly M MacKinnon
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, Australia
| | - Alistair M Cook
- School of Medicine, The University of Western Australia, Crawley, Australia
| | - Martin A Ebert
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia
- 5D Clinics, Claremont, Australia
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Mishkovsky M, Gusyatiner O, Lanz B, Cudalbu C, Vassallo I, Hamou MF, Bloch J, Comment A, Gruetter R, Hegi ME. Hyperpolarized 13C-glucose magnetic resonance highlights reduced aerobic glycolysis in vivo in infiltrative glioblastoma. Sci Rep 2021; 11:5771. [PMID: 33707647 PMCID: PMC7952603 DOI: 10.1038/s41598-021-85339-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 02/28/2021] [Indexed: 12/15/2022] Open
Abstract
Glioblastoma (GBM) is the most aggressive brain tumor type in adults. GBM is heterogeneous, with a compact core lesion surrounded by an invasive tumor front. This front is highly relevant for tumor recurrence but is generally non-detectable using standard imaging techniques. Recent studies demonstrated distinct metabolic profiles of the invasive phenotype in GBM. Magnetic resonance (MR) of hyperpolarized 13C-labeled probes is a rapidly advancing field that provides real-time metabolic information. Here, we applied hyperpolarized 13C-glucose MR to mouse GBM models. Compared to controls, the amount of lactate produced from hyperpolarized glucose was higher in the compact GBM model, consistent with the accepted "Warburg effect". However, the opposite response was observed in models reflecting the invasive zone, with less lactate produced than in controls, implying a reduction in aerobic glycolysis. These striking differences could be used to map the metabolic heterogeneity in GBM and to visualize the infiltrative front of GBM.
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Affiliation(s)
- Mor Mishkovsky
- Laboratory of Functional and Metabolic Imaging, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Olga Gusyatiner
- Neuroscience Research Center, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Service of Neurosurgery Lausanne, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Bernard Lanz
- Laboratory of Functional and Metabolic Imaging, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Cristina Cudalbu
- Center for Biomedical Imaging (CIBM), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Irene Vassallo
- Neuroscience Research Center, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Service of Neurosurgery Lausanne, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Marie-France Hamou
- Neuroscience Research Center, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Service of Neurosurgery Lausanne, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Jocelyne Bloch
- Neuroscience Research Center, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Service of Neurosurgery Lausanne, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Arnaud Comment
- General Electric Healthcare, Chalfont St Giles, Buckinghamshire, HP8 4SP, UK
| | - Rolf Gruetter
- Laboratory of Functional and Metabolic Imaging, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Department of Radiology, University of Geneva (UNIGE), Geneva, Switzerland
- Department of Radiology, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Monika E Hegi
- Neuroscience Research Center, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
- Service of Neurosurgery Lausanne, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
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Scarpelli ML, Healey DR, Fuentes A, Kodibagkar VD, Quarles CC. Correlation of Tumor Hypoxia Metrics Derived from 18F-Fluoromisonidazole Positron Emission Tomography and Pimonidazole Fluorescence Images of Optically Cleared Brain Tissue. Tomography 2020; 6:379-388. [PMID: 33364428 PMCID: PMC7744194 DOI: 10.18383/j.tom.2020.00046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
18F-fluoromisonidazole (FMISO) positron emission tomography (PET) is a widely used noninvasive imaging modality for assessing hypoxia. We describe the first spatial comparison of FMISO PET with an ex vivo reference standard for hypoxia across whole tumor volumes. Eighteen rats were orthotopically implanted with C6 or 9L brain tumors and made to undergo FMISO PET scanning. Whole brains were excised, sliced into 1-mm-thick sections, optically cleared, and fluorescently imaged for pimonidazole using an in vivo imaging system. FMISO maximum tumor uptake, maximum tumor-to-cerebellar uptake (TCmax), and hypoxic fraction (extracted 110 minutes after FMISO injection) were correlated with analogous metrics derived from pimonidazole fluorescence images. FMISO SUVmax was not significantly different between C6 and 9L brain tumors (P = .70), whereas FMISO TCmax and hypoxic fraction were significantly greater for C6 tumors (P < .01). FMISO TCmax was significantly correlated with the maximum tumor pimonidazole intensity (ρ = 0.76, P < .01), whereas FMISO SUVmax was not. FMISO tumor hypoxic fraction was significantly correlated with the pimonidazole-derived hypoxic fraction (ρ = 0.78, P < .01). Given that FMISO TCmax and tumor hypoxic fraction had strong correlations with the pimonidazole reference standard, these metrics may offer more reliable measures of tumor hypoxia than conventional PET uptake metrics (SUVmax). The voxel-wise correlation between FMISO uptake and pimonidazole intensity for a given tumor was strongly dependent on the tumor's TCmax (ρ = 0.81, P < .01) and hypoxic fraction (ρ = 0.85, P < .01), indicating PET measurements within individual voxels showed greater correlation with pimonidazole reference standard in tumors with greater hypoxia.
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Affiliation(s)
- Matthew L. Scarpelli
- Barrow Neuroimaging Innovation Center, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ; and
| | - Debbie R. Healey
- Barrow Neuroimaging Innovation Center, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ; and
| | - Alberto Fuentes
- Barrow Neuroimaging Innovation Center, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ; and
| | - Vikram D. Kodibagkar
- Barrow Neuroimaging Innovation Center, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ; and
| | - C. Chad Quarles
- Barrow Neuroimaging Innovation Center, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ; and
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Qian J, Yu X, Li B, Fei Z, Huang X, Luo P, Zhang L, Zhang Z, Lou J, Wang H. In vivo Monitoring of Oxygen Levels in Human Brain Tumor Between Fractionated Radiotherapy Using Oxygen-enhanced MR Imaging. Curr Med Imaging 2020; 16:427-432. [PMID: 32410542 DOI: 10.2174/1573405614666180925144814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/19/2018] [Accepted: 09/11/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND It was known that the response of tumor cells to radiation is closely related to tissue oxygen level and fractionated radiotherapy allows reoxygenation of hypoxic tumor cells. Non-invasive mapping of tissue oxygen level may hold great importance in clinic. OBJECTIVE The aim of this study is to evaluate the role of oxygen-enhanced MR imaging in the detection of tissue oxygen levels between fractionated radiotherapy. METHODS A cohort of 10 patients with brain metastasis was recruited. Quantitative oxygen enhanced MR imaging was performed prior to, 30 minutes and 22 hours after first fractionated radiotherapy. RESULTS The ΔR1 (the difference of longitudinal relaxivity between 100% oxygen breathing and air breathing) increased in the ipsilateral tumor site and normal tissue by 242% and 152%, respectively, 30 minutes after first fractionated radiation compared to pre-radiation levels. Significant recovery of ΔR1 in the contralateral normal tissue (p < 0.05) was observed 22 hours compared to 30 minutes after radiation levels. CONCLUSION R1-based oxygen-enhanced MR imaging may provide a sensitive endogenous marker for oxygen changes in the brain tissue between fractionated radiotherapy.
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Affiliation(s)
- Junchao Qian
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei Cancer Hospital, Hefei 230031, China.,Anhui Province Key Laboratory of Medical Physics and Technology, Center of Medical Physics and Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei 230031, China
| | - Xiang Yu
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei Cancer Hospital, Hefei 230031, China
| | - Bingbing Li
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei Cancer Hospital, Hefei 230031, China
| | - Zhenle Fei
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei Cancer Hospital, Hefei 230031, China
| | - Xiang Huang
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei Cancer Hospital, Hefei 230031, China
| | - Peng Luo
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei Cancer Hospital, Hefei 230031, China
| | - Liwei Zhang
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei Cancer Hospital, Hefei 230031, China
| | - Zhiming Zhang
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei Cancer Hospital, Hefei 230031, China
| | - Jianjun Lou
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei Cancer Hospital, Hefei 230031, China
| | - Hongzhi Wang
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei Cancer Hospital, Hefei 230031, China.,Anhui Province Key Laboratory of Medical Physics and Technology, Center of Medical Physics and Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei 230031, China
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18
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Xue W, Ton H, Zhang J, Xie T, Chen X, Zhou B, Guo Y, Fang J, Wang S, Zhang W. Patient‑derived orthotopic xenograft glioma models fail to replicate the magnetic resonance imaging features of the original patient tumor. Oncol Rep 2020; 43:1619-1629. [PMID: 32323818 PMCID: PMC7107810 DOI: 10.3892/or.2020.7538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/12/2020] [Indexed: 12/14/2022] Open
Abstract
Patient-derived orthotopic glioma xenograft models are important platforms used for pre-clinical research of glioma. In the present study, the diagnostic ability of magnetic resonance imaging (MRI) was examined with regard to the identification of biomarkers obtained from patient-derived glioma xenografts and human tumors. Conventional MRI, diffusion weighted imaging and dynamic contrast-enhanced (DCE)-MRI were used to analyze seven pairs of high grade gliomas with their corresponding xenografts obtained from non-obese diabetic-severe-combined immunodeficiency nude mice. Tumor samples were collected for transcriptome sequencing and histopathological staining, and differentially expressed genes were screened between the original tumors and the corresponding xenografts. Gene Ontology (GO) analysis was performed to predict the functions of these genes. In 6 cases of xenografts with diffuse growth, the degree of enhancement was significantly lower compared with the original tumors. Histopathological staining indicated that the microvascular area and microvascular diameter of the xenografts were significantly lower compared with the original tumors (P=0.009 and P=0.007, respectively). In one case, there was evidence of nodular tumor growth in the mouse. Both MRI and histopathological staining showed a clear demarcation between the transplanted tumors and the normal brain tissues. The relative apparent diffusion coefficient values of the 7 cases examined were significantly higher compared with the corresponding original tumors (P=0.001) and transfer coefficient values derived from DCE-MRI of the tumor area was significantly lower compared with the original tumors (P=0.016). GO analysis indicated that the expression levels of extracellular matrix-associated genes, angiogenesis-associated genes and immune function-associated genes in the original tumors were higher compared with the corresponding xenografts. In conclusion, the data demonstrated that the MRI features of patient-derived xenograft glioma models in mice were different compared with those of the original patient tumors. Differential gene expression may underlie the differences noted in the MRI features between original tumors and corresponding xenografts. The results of the present study highlight the precautions that should be taken when extrapolating data from patient-derived xenograft studies, and their applicability to humans.
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Affiliation(s)
- Wei Xue
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
| | - Haipeng Ton
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
| | - Junfeng Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
| | - Tian Xie
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
| | - Xiao Chen
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
| | - Bo Zhou
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
| | - Yu Guo
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
| | - Jingqin Fang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
| | - Shunan Wang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
| | - Weiguo Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
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Thompson E, Smart S, Kinchesh P, Bulte D, Stride E. Magnetic resonance imaging of oxygen microbubbles. Healthc Technol Lett 2019; 6:138-142. [PMID: 31832209 PMCID: PMC6849496 DOI: 10.1049/htl.2018.5058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 04/12/2019] [Accepted: 05/23/2019] [Indexed: 12/26/2022] Open
Abstract
Oxygen loaded microbubbles are being investigated as a means of reducing tumour hypoxia in order to improve response to cancer therapy. To optimise this approach, it is desirable to be able to measure changes in tissue oxygenation in real-time during treatment. In this study, the feasibility of using magnetic resonance imaging (MRI) for this purpose was investigated. Longitudinal relaxation time (T1) measurements were made in simple hydrogel phantoms containing two different concentrations of oxygen microbubbles. T1 was found to be unaffected by the presence of oxygen microbubbles at either concentration. Upon application of ultrasound to destroy the microbubbles, however, a statistically significant reduction in T1 was seen for the higher microbubble concentration. Further work is needed to assess the influence of physiological conditions upon the measurements, but these preliminary results suggest that MRI could provide a method for quantifying the changes in tissue oxygenation produced by microbubbles during therapy.
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Affiliation(s)
- Elinor Thompson
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, OX3 7DQ, UK
| | - Sean Smart
- Radiobiology Research Institute, Department of Oncology, University of Oxford, OX3 7DQ, UK
| | - Paul Kinchesh
- Radiobiology Research Institute, Department of Oncology, University of Oxford, OX3 7DQ, UK
| | - Daniel Bulte
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, OX3 7DQ, UK
| | - Eleanor Stride
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, OX3 7DQ, UK
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Fiordelisi MF, Cavaliere C, Auletta L, Basso L, Salvatore M. Magnetic Resonance Imaging for Translational Research in Oncology. J Clin Med 2019; 8:jcm8111883. [PMID: 31698697 PMCID: PMC6912299 DOI: 10.3390/jcm8111883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/19/2022] Open
Abstract
The translation of results from the preclinical to the clinical setting is often anything other than straightforward. Indeed, ideas and even very intriguing results obtained at all levels of preclinical research, i.e., in vitro, on animal models, or even in clinical trials, often require much effort to validate, and sometimes, even useful data are lost or are demonstrated to be inapplicable in the clinic. In vivo, small-animal, preclinical imaging uses almost the same technologies in terms of hardware and software settings as for human patients, and hence, might result in a more rapid translation. In this perspective, magnetic resonance imaging might be the most translatable technique, since only in rare cases does it require the use of contrast agents, and when not, sequences developed in the lab can be readily applied to patients, thanks to their non-invasiveness. The wide range of sequences can give much useful information on the anatomy and pathophysiology of oncologic lesions in different body districts. This review aims to underline the versatility of this imaging technique and its various approaches, reporting the latest preclinical studies on thyroid, breast, and prostate cancers, both on small laboratory animals and on human patients, according to our previous and ongoing research lines.
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21
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Jiang K, Tang H, Mishra PK, Macura SI, Lerman LO. Measurement of murine kidney functional biomarkers using DCE-MRI: A multi-slice TRICKS technique and semi-automated image processing algorithm. Magn Reson Imaging 2019; 63:226-234. [PMID: 31442558 DOI: 10.1016/j.mri.2019.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/16/2019] [Accepted: 08/18/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To propose a rapid multi-slice T1 measurement method using time-resolved imaging of contrast kinetics (TRICKS) and a semi-automated image processing algorithm for comprehensive assessment murine kidney function using dynamic contrast-enhanced MRI (DCE-MRI). METHODS A multi-slice TRICKS sampling scheme was implemented in an established rapid T1 measurement method. A semi-automated image-processing scheme employing basic image processing techniques and machine learning was developed to facilitate image analysis. Reliability of the multi-slice technique in measuring renal perfusion and glomerular filtration rate (GFR) was tested in normal mice (n = 7 for both techniques) by comparing to the validated single-slice technique. Utility of this method was demonstrated on mice after either sham surgery (n = 7) or induction of unilateral renal artery stenosis (RAS, n = 8). Renal functional parameters were extracted using a validated bi-compartment model. RESULTS The TRICKS sampling scheme achieved an acceleration factor of 2.7, allowing imaging of eight axial slices at 1.23 s/scan. With the aid of the semi-automated scheme, image analysis required under 15-min for both kidneys per mouse. The multi-slice technique yielded renal perfusion and GFR values comparable to the single-slice technique. Model-fitted renal parameters successfully differentiated control and stenotic mouse kidneys, including renal perfusion (706.5 ± 164.0 vs. 375.9 ± 277.9 mL/100 g/min, P = 0.002), blood flow (1.6 ± 0.4 vs. 0.7 ± 0.7 mL/min, P < 0.001), and GFR (142.9 ± 17.9 vs. 58.0 ± 42.8 μL/min, P < 0.001). CONCLUSION The multi-slice TRICKS-based DCE-MRI technique, with a semi-automated image processing scheme, allows rapid and comprehensive measurement of murine kidney function.
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Affiliation(s)
- Kai Jiang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Hui Tang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Prasanna K Mishra
- Division of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Slobodan I Macura
- Division of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
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22
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Salem A, Little RA, Latif A, Featherstone AK, Babur M, Peset I, Cheung S, Watson Y, Tessyman V, Mistry H, Ashton G, Behan C, Matthews JC, Asselin MC, Bristow RG, Jackson A, Parker GJM, Faivre-Finn C, Williams KJ, O'Connor JPB. Oxygen-enhanced MRI Is Feasible, Repeatable, and Detects Radiotherapy-induced Change in Hypoxia in Xenograft Models and in Patients with Non-small Cell Lung Cancer. Clin Cancer Res 2019; 25:3818-3829. [PMID: 31053599 DOI: 10.1158/1078-0432.ccr-18-3932] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/04/2019] [Accepted: 03/14/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Hypoxia is associated with poor prognosis and is predictive of poor response to cancer treatments, including radiotherapy. Developing noninvasive biomarkers that both detect hypoxia prior to treatment and track change in tumor hypoxia following treatment is required urgently. EXPERIMENTAL DESIGN We evaluated the ability of oxygen-enhanced MRI (OE-MRI) to map and quantify therapy-induced changes in tumor hypoxia by measuring oxygen-refractory signals in perfused tissue (perfused Oxy-R). Clinical first-in-human study in patients with non-small cell lung cancer (NSCLC) was performed alongside preclinical experiments in two xenograft tumors (Calu6 NSCLC model and U87 glioma model). RESULTS MRI perfused Oxy-R tumor fraction measurement of hypoxia was validated with ex vivo tissue pathology in both xenograft models. Calu6 and U87 experiments showed that MRI perfused Oxy-R tumor volume was reduced relative to control following single fraction 10-Gy radiation and fractionated chemoradiotherapy (P < 0.001) due to both improved perfusion and reduced oxygen consumption rate. Next, evaluation of 23 patients with NSCLC showed that OE-MRI was clinically feasible and that tumor perfused Oxy-R volume is repeatable [interclass correlation coefficient: 0.961 (95% CI, 0.858-0.990); coefficient of variation: 25.880%]. Group-wise perfused Oxy-R volume was reduced at 14 days following start of radiotherapy (P = 0.015). OE-MRI detected between-subject variation in hypoxia modification in both xenograft and patient tumors. CONCLUSIONS These findings support applying OE-MRI biomarkers to monitor hypoxia modification, to stratify patients in clinical trials of hypoxia-modifying therapies, to identify patients with hypoxic tumors that may fail treatment with immunotherapy, and to guide adaptive radiotherapy by mapping regional hypoxia.
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Affiliation(s)
- Ahmed Salem
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
- Department of Clinical Oncology, The Christie Hospital NHS Trust, Manchester, United Kingdom
| | - Ross A Little
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Ayşe Latif
- Division of Pharmacy, University of Manchester, Manchester, United Kingdom
| | - Adam K Featherstone
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Muhammad Babur
- Division of Pharmacy, University of Manchester, Manchester, United Kingdom
| | - Isabel Peset
- Imaging and Flow Cytometry, Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Susan Cheung
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Yvonne Watson
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Victoria Tessyman
- Division of Pharmacy, University of Manchester, Manchester, United Kingdom
| | - Hitesh Mistry
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Division of Pharmacy, University of Manchester, Manchester, United Kingdom
| | - Garry Ashton
- Histology, Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Caron Behan
- Histology, Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Julian C Matthews
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Marie-Claude Asselin
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Robert G Bristow
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Clinical Oncology, The Christie Hospital NHS Trust, Manchester, United Kingdom
| | - Alan Jackson
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Geoff J M Parker
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
- Bioxydyn Limited, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Clinical Oncology, The Christie Hospital NHS Trust, Manchester, United Kingdom
| | - Kaye J Williams
- Division of Pharmacy, University of Manchester, Manchester, United Kingdom
| | - James P B O'Connor
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom. James.O'
- Department of Radiology, The Christie Hospital NHS Trust, Manchester, United Kingdom
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23
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Yang DM, Arai TJ, Campbell JW, Gerberich JL, Zhou H, Mason RP. Oxygen-sensitive MRI assessment of tumor response to hypoxic gas breathing challenge. NMR IN BIOMEDICINE 2019; 32:e4101. [PMID: 31062902 PMCID: PMC6581571 DOI: 10.1002/nbm.4101] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/16/2019] [Accepted: 03/08/2019] [Indexed: 06/09/2023]
Abstract
Oxygen-sensitive MRI has been extensively used to investigate tumor oxygenation based on the response (R2 * and/or R1 ) to a gas breathing challenge. Most studies have reported response to hyperoxic gas indicating potential biomarkers of hypoxia. Few studies have examined hypoxic gas breathing and we have now evaluated acute dynamic changes in rat breast tumors. Rats bearing syngeneic subcutaneous (n = 15) or orthotopic (n = 7) 13762NF breast tumors were exposed to a 16% O2 gas breathing challenge and monitored using blood oxygen level dependent (BOLD) R2 * and tissue oxygen level dependent (TOLD) T1 -weighted measurements at 4.7 T. As a control, we used a traditional hyperoxic gas breathing challenge with 100% O2 on a subset of the subcutaneous tumor bearing rats (n = 6). Tumor subregions identified as responsive on the basis of R2 * dynamics coincided with the viable tumor area as judged by subsequent H&E staining. As expected, R2 * decreased and T1 -weighted signal increased in response to 100% O2 breathing challenge. Meanwhile, 16% O2 breathing elicited an increase in R2 *, but divergent response (increase or decrease) in T1 -weighted signal. The T1 -weighted signal increase may signify a dominating BOLD effect triggered by 16% O2 in the relatively more hypoxic tumors, whereby the influence of increased paramagnetic deoxyhemoglobin outweighs decreased pO2 . The results emphasize the importance of combined BOLD and TOLD measurements for the correct interpretation of tumor oxygenation properties.
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Affiliation(s)
- Donghan M Yang
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Tatsuya J Arai
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - James W Campbell
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Heling Zhou
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ralph P Mason
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
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24
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Waterton JC, Hines CDG, Hockings PD, Laitinen I, Ziemian S, Campbell S, Gottschalk M, Green C, Haase M, Hassemer K, Juretschke HP, Koehler S, Lloyd W, Luo Y, Mahmutovic Persson I, O'Connor JPB, Olsson LE, Pindoria K, Schneider JE, Sourbron S, Steinmann D, Strobel K, Tadimalla S, Teh I, Veltien A, Zhang X, Schütz G. Repeatability and reproducibility of longitudinal relaxation rate in 12 small-animal MRI systems. Magn Reson Imaging 2019; 59:121-129. [PMID: 30872166 PMCID: PMC6477178 DOI: 10.1016/j.mri.2019.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 01/29/2019] [Accepted: 03/08/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many translational MR biomarkers derive from measurements of the water proton longitudinal relaxation rate R1, but evidence for between-site reproducibility of R1 in small-animal MRI is lacking. OBJECTIVE To assess R1 repeatability and multi-site reproducibility in phantoms for preclinical MRI. METHODS R1 was measured by saturation recovery in 2% agarose phantoms with five nickel chloride concentrations in 12 magnets at 5 field strengths in 11 centres on two different occasions within 1-13 days. R1 was analysed in three different regions of interest, giving 360 measurements in total. Root-mean-square repeatability and reproducibility coefficients of variation (CoV) were calculated. Propagation of reproducibility errors into 21 translational MR measurements and biomarkers was estimated. Relaxivities were calculated. Dynamic signal stability was also measured. RESULTS CoV for day-to-day repeatability (N = 180 regions of interest) was 2.34% and for between-centre reproducibility (N = 9 centres) was 1.43%. Mostly, these do not propagate to biologically significant between-centre error, although a few R1-based MR biomarkers were found to be quite sensitive even to such small errors in R1, notably in myocardial fibrosis, in white matter, and in oxygen-enhanced MRI. The relaxivity of aqueous Ni2+ in 2% agarose varied between 0.66 s-1 mM-1 at 3 T and 0.94 s-1 mM-1 at 11.7T. INTERPRETATION While several factors affect the reproducibility of R1-based MR biomarkers measured preclinically, between-centre propagation of errors arising from intrinsic equipment irreproducibility should in most cases be small. However, in a few specific cases exceptional efforts might be required to ensure R1-reproducibility.
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Affiliation(s)
- John C Waterton
- Bioxydyn Ltd, Manchester Science Park, Rutherford House, Pencroft Way, MANCHESTER M15 6SZ, United Kingdom; Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, MANCHESTER M13 9PL, United Kingdom.
| | | | - Paul D Hockings
- Antaros Medical, BioVenture Hub, 43183 Mölndal, Sweden; MedTech West, Chalmers University of Technology, Gothenburg, Sweden.
| | - Iina Laitinen
- Sanofi-Aventis Deutschland GmbH, R&D TIM - Bioimaging Germany, Industriepark Höchst, D-65926 Frankfurt am Main, Germany.
| | - Sabina Ziemian
- Bayer AG, Research and Development, Pharmaceuticals, MR and CT Contrast Media Research, Müllerstraße 178, D-13353 Berlin, Germany.
| | - Simon Campbell
- In-Vivo Bioimaging UK, RD Platform Technology & Science, GSK Medicines Research Centre, Gunnels Wood Road, STEVENAGE, Hertfordshire, SG1 2NY, United Kingdom.
| | - Michael Gottschalk
- Lund University BioImaging Center, Klinikgatan 32, SE-222-42 Lund, Sweden.
| | - Claudia Green
- Bayer AG, Research and Development, Pharmaceuticals, MR and CT Contrast Media Research, Müllerstraße 178, D-13353 Berlin, Germany.
| | - Michael Haase
- In-Vivo Bioimaging UK, RD Platform Technology & Science, GSK Medicines Research Centre, Gunnels Wood Road, STEVENAGE, Hertfordshire, SG1 2NY, United Kingdom.
| | - Katja Hassemer
- Sanofi-Aventis Deutschland GmbH, R&D TIM - Bioimaging Germany, Industriepark Höchst, D-65926 Frankfurt am Main, Germany.
| | - Hans-Paul Juretschke
- Sanofi-Aventis Deutschland GmbH, R&D TIM - Bioimaging Germany, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Sascha Koehler
- Bruker BioSpin MRI GmbH, Rudolf-Plank-Straße 23, D-76275 Ettlingen, Germany.
| | - William Lloyd
- Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, MANCHESTER M13 9PL, United Kingdom.
| | - Yanping Luo
- iSAT Discovery, Abbvie, 1 North Waukegan Road, North Chicago, IL, 60064-1802, United States of America.
| | - Irma Mahmutovic Persson
- Department of Translational Sciences, Medical Radiation Physics, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.
| | - James P B O'Connor
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, MANCHESTER M20 4BX, United Kingdom. james.o'
| | - Lars E Olsson
- Department of Translational Sciences, Medical Radiation Physics, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.
| | - Kashmira Pindoria
- In-Vivo Bioimaging UK, RD Platform Technology & Science, GSK Medicines Research Centre, Gunnels Wood Road, STEVENAGE, Hertfordshire, SG1 2NY, United Kingdom.
| | - Jurgen E Schneider
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Steven Sourbron
- Leeds Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, LIGHT Labs, Clarendon Way, LEEDS LS2 9JT, United Kingdom.
| | - Denise Steinmann
- Sanofi-Aventis Deutschland GmbH, R&D TIM - Bioimaging Germany, Industriepark Höchst, D-65926 Frankfurt am Main, Germany.
| | - Klaus Strobel
- Bruker BioSpin MRI GmbH, Rudolf-Plank-Straße 23, D-76275 Ettlingen, Germany.
| | - Sirisha Tadimalla
- Leeds Imaging Biomarkers Group, Department of Biomedical Imaging Sciences, University of Leeds, LIGHT Labs, Clarendon Way, LEEDS LS2 9JT, United Kingdom.
| | - Irvin Teh
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Andor Veltien
- Radboud university medical center, Radiology (766), P.O.Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - Xiaomeng Zhang
- iSAT Discovery, Abbvie, 1 North Waukegan Road, North Chicago, IL, 60064-1802, United States of America.
| | - Gunnar Schütz
- Bayer AG, Research and Development, Pharmaceuticals, MR and CT Contrast Media Research, Müllerstraße 178, D-13353 Berlin, Germany.
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25
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O'Connor JPB, Robinson SP, Waterton JC. Imaging tumour hypoxia with oxygen-enhanced MRI and BOLD MRI. Br J Radiol 2019; 92:20180642. [PMID: 30272998 PMCID: PMC6540855 DOI: 10.1259/bjr.20180642] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 01/06/2023] Open
Abstract
Hypoxia is known to be a poor prognostic indicator for nearly all solid tumours and also is predictive of treatment failure for radiotherapy, chemotherapy, surgery and targeted therapies. Imaging has potential to identify, spatially map and quantify tumour hypoxia prior to therapy, as well as track changes in hypoxia on treatment. At present no hypoxia imaging methods are available for routine clinical use. Research has largely focused on positron emission tomography (PET)-based techniques, but there is gathering evidence that MRI techniques may provide a practical and more readily translational alternative. In this review we focus on the potential for imaging hypoxia by measuring changes in longitudinal relaxation [R1; termed oxygen-enhanced MRI or tumour oxygenation level dependent (TOLD) MRI] and effective transverse relaxation [R2*; termed blood oxygenation level dependent (BOLD) MRI], induced by inhalation of either 100% oxygen or the radiosensitising hyperoxic gas carbogen. We explain the scientific principles behind oxygen-enhanced MRI and BOLD and discuss significant studies and their limitations. All imaging biomarkers require rigorous validation in order to translate into clinical use and the steps required to further develop oxygen-enhanced MRI and BOLD MRI into decision-making tools are discussed.
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Affiliation(s)
| | - Simon P Robinson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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26
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Clinical and Pre-clinical Methods for Quantifying Tumor Hypoxia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1136:19-41. [PMID: 31201714 DOI: 10.1007/978-3-030-12734-3_2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hypoxia, a prevalent characteristic of most solid malignant tumors, contributes to diminished therapeutic responses and more aggressive phenotypes. The term hypoxia has two definitions. One definition would be a physiologic state where the oxygen partial pressure is below the normal physiologic range. For most normal tissues, the normal physiologic range is between 10 and 20 mmHg. Hypoxic regions develop when there is an imbalance between oxygen supply and demand. The impact of hypoxia on cancer therapeutics is significant: hypoxic tissue is 3× less radiosensitive than normoxic tissue, the impaired blood flow found in hypoxic tumor regions influences chemotherapy delivery, and the immune system is dependent on oxygen for functionality. Despite the clinical implications of hypoxia, there is not a universal, ideal method for quantifying hypoxia, particularly cycling hypoxia because of its complexity and heterogeneity across tumor types and individuals. Most standard imaging techniques can be modified and applied to measuring hypoxia and quantifying its effects; however, the benefits and challenges of each imaging modality makes imaging hypoxia case-dependent. In this chapter, a comprehensive overview of the preclinical and clinical methods for quantifying hypoxia is presented along with the advantages and disadvantages of each.
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27
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Suh JY, Cho G, Song Y, Woo DC, Choi YS, Ryu EK, Park BW, Shim WH, Kim YR, Kim JK. Hyperoxia-Induced ΔR 1. Stroke 2018; 49:3012-3019. [PMID: 30571431 DOI: 10.1161/strokeaha.118.021469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Acceleration of longitudinal relaxation under hyperoxic challenge (ie, hyperoxia-induced ΔR1) indicates oxygen accumulation and reflects baseline tissue oxygenation. We evaluated the feasibility of hyperoxia-induced ΔR1 for evaluating cerebral oxygenation status and degree of ischemic damage in stroke. Methods- In 24-hour transient stroke rat models (n=13), hyperoxia-induced ΔR1, ischemic severity (apparent diffusion coefficient [ADC]), vasogenic edema (R2), total and microvascular blood volume (superparamagnetic iron oxide-driven ΔR2* and ΔR2, respectively), and glucose metabolism activity (18F-fluorodeoxyglucose uptake on positron emission tomography) were measured. The distribution of these parameters according to hyperoxia-induced ΔR1 was analyzed. The partial pressure of tissue oxygen change during hyperoxic challenge was measured using fiberoptic tissue oximetry. In 4-hour stroke models (n=6), ADC and hyperoxia-induced ΔR1 was analyzed with 2,3,5-triphenyltetrazolium chloride staining being a criterion of infarction. Results- Ischemic hemisphere showed significantly higher hyperoxia-induced ΔR1 than nonischemic brain in a pattern depending on ADC. During hyperoxic challenge, ischemic hemisphere demonstrated uncontrolled increase of partial pressure of tissue oxygen, whereas contralateral hemisphere rapidly plateaued. Ischemic hemisphere also demonstrated significant correlation between hyperoxia-induced ΔR1 and R2. Hyperoxia-induced ΔR1 showed a significant negative correlation with 18F-fluorodeoxyglucose uptake. The ADC, R2, ΔR2, and 18F-fluorodeoxyglucose uptake showed a dichotomized distribution according to the hyperoxia-induced ΔR1 as their slopes and values were higher at low hyperoxia-induced ΔR1 (<50 ms-1) than at high ΔR1. In 4-hour stroke rats, the distribution of ADC according to the hyperoxia-induced ΔR1 was similar with 24-hour stroke rats. The hyperoxia-induced ΔR1 was greater in the infarct area (47±10 ms-1) than in peri-infarct area (16±4 ms-1; P<0.01). Conclusions- Hyperoxia-induced ΔR1 adequately indicates cerebral oxygenation and can be a feasible biomarker to classify the degree of ischemia-induced damage in neurovascular function and metabolism in stroke brain.
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Affiliation(s)
- Ji-Yeon Suh
- From the Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.-Y.S., D.-C.W., B.W.P., W.H.S., J.K.K.).,Bioimaging Research Team, Korea Basic Science Institute, Ochang Cheongwon, Chungbuk, Korea (J.-Y.S., G.C., Y.S., E.K.R.)
| | - Gyunggoo Cho
- Bioimaging Research Team, Korea Basic Science Institute, Ochang Cheongwon, Chungbuk, Korea (J.-Y.S., G.C., Y.S., E.K.R.)
| | - Youngkyu Song
- Bioimaging Research Team, Korea Basic Science Institute, Ochang Cheongwon, Chungbuk, Korea (J.-Y.S., G.C., Y.S., E.K.R.)
| | - Dong-Cheol Woo
- From the Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.-Y.S., D.-C.W., B.W.P., W.H.S., J.K.K.)
| | - Yoon Seok Choi
- Medical Research Institute, Gangneung Asan Hospital, Gangwon-do, South Korea (Y.S.C.)
| | - Eun Kyung Ryu
- Bioimaging Research Team, Korea Basic Science Institute, Ochang Cheongwon, Chungbuk, Korea (J.-Y.S., G.C., Y.S., E.K.R.)
| | - Bum Woo Park
- From the Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.-Y.S., D.-C.W., B.W.P., W.H.S., J.K.K.)
| | - Woo Hyun Shim
- From the Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.-Y.S., D.-C.W., B.W.P., W.H.S., J.K.K.)
| | - Young Ro Kim
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (Y.R.K.)
| | - Jeong Kon Kim
- From the Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.-Y.S., D.-C.W., B.W.P., W.H.S., J.K.K.)
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28
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Moosvi F, Baker JH, Yung A, Kozlowski P, Minchinton AI, Reinsberg SA. Fast and sensitive dynamic oxygen‐enhanced MRI with a cycling gas challenge and independent component analysis. Magn Reson Med 2018; 81:2514-2525. [DOI: 10.1002/mrm.27584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/04/2018] [Accepted: 10/07/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Firas Moosvi
- Department of Physics & Astronomy University of British Columbia Vancouver Canada
| | - Jennifer H.E. Baker
- Radiation Biology Unit British Columbia Cancer Research Centre Vancouver Canada
| | - Andrew Yung
- UBC MRI Research Centre Life Sciences Centre Vancouver Canada
| | - Piotr Kozlowski
- UBC MRI Research Centre Life Sciences Centre Vancouver Canada
- Department of Radiology University of British Columbia Vancouver Canada
| | | | - Stefan A. Reinsberg
- Department of Physics & Astronomy University of British Columbia Vancouver Canada
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29
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Little RA, Jamin Y, Boult JKR, Naish JH, Watson Y, Cheung S, Holliday KF, Lu H, McHugh DJ, Irlam J, West CML, Betts GN, Ashton G, Reynolds AR, Maddineni S, Clarke NW, Parker GJM, Waterton JC, Robinson SP, O’Connor JPB. Mapping Hypoxia in Renal Carcinoma with Oxygen-enhanced MRI: Comparison with Intrinsic Susceptibility MRI and Pathology. Radiology 2018; 288:739-747. [PMID: 29869970 PMCID: PMC6122194 DOI: 10.1148/radiol.2018171531] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/21/2017] [Indexed: 12/28/2022]
Abstract
Purpose To cross-validate T1-weighted oxygen-enhanced (OE) MRI measurements of tumor hypoxia with intrinsic susceptibility MRI measurements and to demonstrate the feasibility of translation of the technique for patients. Materials and Methods Preclinical studies in nine 786-0-R renal cell carcinoma (RCC) xenografts and prospective clinical studies in eight patients with RCC were performed. Longitudinal relaxation rate changes (∆R1) after 100% oxygen inhalation were quantified, reflecting the paramagnetic effect on tissue protons because of the presence of molecular oxygen. Native transverse relaxation rate (R2*) and oxygen-induced R2* change (∆R2*) were measured, reflecting presence of deoxygenated hemoglobin molecules. Median and voxel-wise values of ∆R1 were compared with values of R2* and ∆R2*. Tumor regions with dynamic contrast agent-enhanced MRI perfusion, refractory to signal change at OE MRI (referred to as perfused Oxy-R), were distinguished from perfused oxygen-enhancing (perfused Oxy-E) and nonperfused regions. R2* and ∆R2* values in each tumor subregion were compared by using one-way analysis of variance. Results Tumor-wise and voxel-wise ∆R1 and ∆R2* comparisons did not show correlative relationships. In xenografts, parcellation analysis revealed that perfused Oxy-R regions had faster native R2* (102.4 sec-1 vs 81.7 sec-1) and greater negative ∆R2* (-22.9 sec-1 vs -5.4 sec-1), compared with perfused Oxy-E and nonperfused subregions (all P < .001), respectively. Similar findings were present in human tumors (P < .001). Further, perfused Oxy-R helped identify tumor hypoxia, measured at pathologic analysis, in both xenografts (P = .002) and human tumors (P = .003). Conclusion Intrinsic susceptibility biomarkers provide cross validation of the OE MRI biomarker perfused Oxy-R. Consistent relationship to pathologic analyses was found in xenografts and human tumors, demonstrating biomarker translation. Published under a CC BY 4.0 license. Online supplemental material is available for this article.
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Affiliation(s)
- Ross A. Little
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Yann Jamin
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Jessica K. R. Boult
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Josephine H. Naish
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Yvonne Watson
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Susan Cheung
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Katherine F. Holliday
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Huiqi Lu
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Damien J. McHugh
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Joely Irlam
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Catharine M. L. West
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Guy N. Betts
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Garry Ashton
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | | | - Satish Maddineni
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Noel W. Clarke
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Geoff J. M. Parker
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - John C. Waterton
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - Simon P. Robinson
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
| | - James P. B. O’Connor
- From the Centre for Imaging Sciences (R.A.L., J.H.N., Y.W., S.C.,
K.F.H., H.L., D.J.M., G.J.M.P., J.C.W.) and Division of Cancer Sciences (J.I.,
C.M.L.W., N.W.C., J.P.B.O.), University of Manchester, Manchester, England;
Division of Radiotherapy and Imaging, The Institute of Cancer Research, London,
England (Y.J., J.K.R.B., S.P.R.); Department of Pathology, Central Manchester
University Hospitals NHS Foundation Trust, Manchester, England (G.N.B.);
Department of Histology, CRUK Manchester Institute, Manchester, England (G.A.);
Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The
Institute of Cancer Research, London, England (A.R.R.); Department of Urology,
Salford Royal Hospitals NHS Foundation Trust, Salford, England (S.M., N.W.C.);
Bioxydyn Ltd, Manchester, England (G.J.M.P., J.C.W.); and Department of
Radiology, The Christie NHS Foundation Trust, Manchester, England
(J.P.B.O.)
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Stieb S, Eleftheriou A, Warnock G, Guckenberger M, Riesterer O. Longitudinal PET imaging of tumor hypoxia during the course of radiotherapy. Eur J Nucl Med Mol Imaging 2018; 45:2201-2217. [PMID: 30128659 DOI: 10.1007/s00259-018-4116-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/30/2018] [Indexed: 12/11/2022]
Abstract
Hypoxia results from an imbalance between oxygen supply and consumption. It is a common phenomenon in solid malignant tumors such as head and neck cancer. As hypoxic cells are more resistant to therapy, tumor hypoxia is an indicator for poor prognosis. Several techniques have been developed to measure tissue oxygenation. These are the Eppendorf O2 polarographic needle electrode, immunohistochemical analysis of endogenous (e.g., hypoxia-inducible factor-1α (HIF-1a)) and exogenous markers (e.g., pimonidazole) as well as imaging methods such as functional magnetic resonance imaging (e.g., blood oxygen level dependent (BOLD) imaging, T1-weighted imaging) and hypoxia positron emission tomography (PET). Among the imaging modalities, only PET is sufficiently validated to detect hypoxia for clinical use. Hypoxia PET tracers include 18F-fluoromisonidazole (FMISO), the most commonly used hypoxic marker, 18F-flouroazomycin arabinoside (FAZA), 18Ffluoroerythronitroimidazole (FETNIM), 18F-2-nitroimidazolpentafluoropropylacetamide (EF5) and 18F-flortanidazole (HX4). As technical development provides the opportunity to increase the radiation dose to subregions of the tumor, such as hypoxic areas, it has to be ensured that these regions are stable not only from imaging to treatment but also through the course of radiotherapy. The aim of this review is therefore to characterize the behavior of tumor hypoxia during radiotherapy for the whole tumor and for subregions by using hypoxia PET tracers, with focus on head and neck cancer patients.
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Affiliation(s)
- Sonja Stieb
- Department of Radiation Oncology, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. .,Institute of Diagnostic and Interventional Radiology, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Afroditi Eleftheriou
- Department of Pharmacology and Toxicology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Geoffrey Warnock
- Department of Pharmacology and Toxicology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.,Department of Nuclear Medicine, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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31
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Emerging Magnetic Resonance Imaging Technologies for Radiation Therapy Planning and Response Assessment. Int J Radiat Oncol Biol Phys 2018; 101:1046-1056. [DOI: 10.1016/j.ijrobp.2018.03.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 12/27/2022]
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Baker LCJ, Sikka A, Price JM, Boult JKR, Lepicard EY, Box G, Jamin Y, Spinks TJ, Kramer-Marek G, Leach MO, Eccles SA, Box C, Robinson SP. Evaluating Imaging Biomarkers of Acquired Resistance to Targeted EGFR Therapy in Xenograft Models of Human Head and Neck Squamous Cell Carcinoma. Front Oncol 2018; 8:271. [PMID: 30083516 PMCID: PMC6064942 DOI: 10.3389/fonc.2018.00271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/02/2018] [Indexed: 01/18/2023] Open
Abstract
Background: Overexpression of EGFR is a negative prognostic factor in head and neck squamous cell carcinoma (HNSCC). Patients with HNSCC who respond to EGFR-targeted tyrosine kinase inhibitors (TKIs) eventually develop acquired resistance. Strategies to identify HNSCC patients likely to benefit from EGFR-targeted therapies, together with biomarkers of treatment response, would have clinical value. Methods: Functional MRI and 18F-FDG PET were used to visualize and quantify imaging biomarkers associated with drug response within size-matched EGFR TKI-resistant CAL 27 (CALR) and sensitive (CALS) HNSCC xenografts in vivo, and pathological correlates sought. Results: Intrinsic susceptibility, oxygen-enhanced and dynamic contrast-enhanced MRI revealed significantly slower baseline R 2 ∗ , lower hyperoxia-induced Δ R 2 ∗ and volume transfer constant Ktrans in the CALR tumors which were associated with significantly lower Hoechst 33342 uptake and greater pimonidazole-adduct formation. There was no difference in oxygen-induced ΔR1 or water diffusivity between the CALR and CALS xenografts. PET revealed significantly higher relative uptake of 18F-FDG in the CALR cohort, which was associated with significantly greater Glut-1 expression. Conclusions: CALR xenografts established from HNSCC cells resistant to EGFR TKIs are more hypoxic, poorly perfused and glycolytic than sensitive CALS tumors. MRI combined with PET can be used to non-invasively assess HNSCC response/resistance to EGFR inhibition.
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Affiliation(s)
- Lauren C. J. Baker
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Arti Sikka
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Jonathan M. Price
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Jessica K. R. Boult
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Elise Y. Lepicard
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Gary Box
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Yann Jamin
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Terry J. Spinks
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Gabriela Kramer-Marek
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Martin O. Leach
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Suzanne A. Eccles
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Carol Box
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
- Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Simon P. Robinson
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
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Featherstone AK, O'Connor JP, Little RA, Watson Y, Cheung S, Babur M, Williams KJ, Matthews JC, Parker GJ. Data-driven mapping of hypoxia-related tumor heterogeneity using DCE-MRI and OE-MRI. Magn Reson Med 2018; 79:2236-2245. [PMID: 28856728 PMCID: PMC5836865 DOI: 10.1002/mrm.26860] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/13/2017] [Accepted: 07/13/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE Previous work has shown that combining dynamic contrast-enhanced (DCE)-MRI and oxygen-enhanced (OE)-MRI binary enhancement maps can identify tumor hypoxia. The current work proposes a novel, data-driven method for mapping tissue oxygenation and perfusion heterogeneity, based on clustering DCE/OE-MRI data. METHODS DCE-MRI and OE-MRI were performed on nine U87 (glioblastoma) and seven Calu6 (non-small cell lung cancer) murine xenograft tumors. Area under the curve and principal component analysis features were calculated and clustered separately using Gaussian mixture modelling. Evaluation metrics were calculated to determine the optimum feature set and cluster number. Outputs were quantitatively compared with a previous non data-driven approach. RESULTS The optimum method located six robustly identifiable clusters in the data, yielding tumor region maps with spatially contiguous regions in a rim-core structure, suggesting a biological basis. Mean within-cluster enhancement curves showed physiologically distinct, intuitive kinetics of enhancement. Regions of DCE/OE-MRI enhancement mismatch were located, and voxel categorization agreed well with the previous non data-driven approach (Cohen's kappa = 0.61, proportional agreement = 0.75). CONCLUSION The proposed method locates similar regions to the previous published method of binarization of DCE/OE-MRI enhancement, but renders a finer segmentation of intra-tumoral oxygenation and perfusion. This could aid in understanding the tumor microenvironment and its heterogeneity. Magn Reson Med 79:2236-2245, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Affiliation(s)
- Adam K. Featherstone
- Division of Informatics, Imaging & Data SciencesThe University of ManchesterManchesterUK
- CRUK & EPSRC Cancer Imaging Centre in Cambridge and Manchester, Cambridge and ManchesterUK
| | - James P.B. O'Connor
- CRUK & EPSRC Cancer Imaging Centre in Cambridge and Manchester, Cambridge and ManchesterUK
- Division of Cancer StudiesThe University of ManchesterManchesterUK
- Department of RadiologyChristie NHS Foundation TrustManchesterUK
| | - Ross A. Little
- Division of Informatics, Imaging & Data SciencesThe University of ManchesterManchesterUK
| | - Yvonne Watson
- Division of Informatics, Imaging & Data SciencesThe University of ManchesterManchesterUK
| | - Sue Cheung
- Division of Informatics, Imaging & Data SciencesThe University of ManchesterManchesterUK
| | - Muhammad Babur
- Division of Pharmacy & OptometryThe University of ManchesterManchesterUK
| | - Kaye J. Williams
- CRUK & EPSRC Cancer Imaging Centre in Cambridge and Manchester, Cambridge and ManchesterUK
- Division of Pharmacy & OptometryThe University of ManchesterManchesterUK
| | - Julian C. Matthews
- Division of Informatics, Imaging & Data SciencesThe University of ManchesterManchesterUK
- CRUK & EPSRC Cancer Imaging Centre in Cambridge and Manchester, Cambridge and ManchesterUK
| | - Geoff J.M. Parker
- Division of Informatics, Imaging & Data SciencesThe University of ManchesterManchesterUK
- CRUK & EPSRC Cancer Imaging Centre in Cambridge and Manchester, Cambridge and ManchesterUK
- Bioxydyn LtdManchesterUK
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Fan Q, Tang CY, Gu D, Zhu J, Li G, Wu Y, Tao X. Investigation of hypoxia conditions using oxygen-enhanced magnetic resonance imaging measurements in glioma models. Oncotarget 2018; 8:31864-31875. [PMID: 28418866 PMCID: PMC5458254 DOI: 10.18632/oncotarget.16256] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/20/2017] [Indexed: 11/25/2022] Open
Abstract
The objective of this study was to determine whether using oxygen-enhanced magnetic resonance imaging (OE-MRI) to assess hypoxia is feasible and whether historical measurements, pO2 changes, and percentage of signal intensity changes (PSIC) are correlated in an animal model of glioma. A total of 25 Sprague-Dawley rats were used to establish C6 brain or subcutaneous glioma model. Nine rats with brain gliomas underwent OE-MRI followed by histopathologic analysis to assess microvessel density and hypoxia. Another 11 rats were underwent OE-MRI and were followed for a survival analysis. Time-T1-weighted MR signal intensity (SI) curves and PSIC maps were derived from the OE-MRI data. High-regions of interests (ROI-h; PSIC > 10%) and low-ROIs (ROI-l; PSIC < 10%) were defined on the PSIC maps. To validate the PSIC map for identifying tumor hypoxia, we subjected an additional 5 rats with subcutaneous glioma to OE-MRI and pO2 measurements. All tumors showed regional heterogeneity on the PSIC maps. For the brain tumors, the time-SI curves for the ROIs-h showed a greater increase in SI than those for the ROIs-l did. The percentage of tumor area with a low PSIC was significantly correlated with the percentage of hypoxia staining and necrosis (r =0.71; P<0.05). ROIs with a higher PSIC typically had more vessels (r=0.88; P<0.05). A significant difference in survival was shown (log-rank P = 0.035). The time-pO2 curves of the subcutaneous tumors were similar to the time-SI curves. PSIC was significantly correlated with pO2 changes (r =0.82; P<0.05). These findings suggest that OE-MRI measurements can be used to assess hypoxia in C6 glioma models. In these models, the PSIC value was correlated with survival, indicating that PSIC could serve as a prognostic marker for glioma.
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Affiliation(s)
- Qi Fan
- Radiology Department, Shanghai People's Ninth Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Cheuk Ying Tang
- Radiology Department, Mount Sinai School of Medicine, New York, NY, USA
| | - Di Gu
- Department of Urology, Shanghai First People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jinyu Zhu
- Radiology Department, Shanghai People's Ninth Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Guojun Li
- Departments of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yingwei Wu
- Radiology Department, Shanghai People's Ninth Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiaofeng Tao
- Radiology Department, Shanghai People's Ninth Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Little RA, Barjat H, Hare JI, Jenner M, Watson Y, Cheung S, Holliday K, Zhang W, O'Connor JPB, Barry ST, Puri S, Parker GJM, Waterton JC. Evaluation of dynamic contrast-enhanced MRI biomarkers for stratified cancer medicine: How do permeability and perfusion vary between human tumours? Magn Reson Imaging 2018; 46:98-105. [PMID: 29154898 DOI: 10.1016/j.mri.2017.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Solid tumours exhibit enhanced vessel permeability and fenestrated endothelium to varying degree, but it is unknown how this varies in patients between and within tumour types. Dynamic contrast-enhanced (DCE) MRI provides a measure of perfusion and permeability, the transfer constant Ktrans, which could be employed for such comparisons in patients. AIM To test the hypothesis that different tumour types exhibit systematically different Ktrans. MATERIALS AND METHODS DCE-MRI data were retrieved from 342 solid tumours in 230 patients. These data were from 18 previous studies, each of which had had a different analysis protocol. All data were reanalysed using a standardised workflow using an extended Tofts model. A model of the posterior density of median Ktrans was built assuming a log-normal distribution and fitting a simple Bayesian hierarchical model. RESULTS 12 histological tumour types were included. In glioma, median Ktrans was 0.016min-1 and for non-glioma tumours, median Ktrans ranged from 0.10 (cervical) to 0.21min-1 (prostate metastatic to bone). The geometric mean (95% CI) across all the non-glioma tumours was 0.15 (0.05, 0.45)min-1. There was insufficient separation between the posterior densities to be able to predict the Ktrans value of a tumour given the tumour type, except that the median Ktrans for gliomas was below 0.05min-1 with 80% probability, and median Ktrans measurements for the remaining tumour types were between 0.05 and 0.4min-1 with 80% probability. CONCLUSION With the exception of glioma, our hypothesis that different tumour types exhibit different Ktrans was not supported. Studies in which tumour permeability is believed to affect outcome should not simply seek tumour types thought to exhibit high permeability. Instead, Ktrans is an idiopathic parameter, and, where permeability is important, Ktrans should be measured in each tumour to personalise that treatment.
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Affiliation(s)
- Ross A Little
- Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK.
| | - Hervé Barjat
- Formerly AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK.
| | - Jennifer I Hare
- IMED Oncology, AstraZeneca, Li Ka Shing Centre, Cambridge CB2 0RE, UK.
| | - Mary Jenner
- Formerly AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - Yvonne Watson
- Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK.
| | - Susan Cheung
- Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK.
| | - Katherine Holliday
- Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK.
| | - Weijuan Zhang
- Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK.
| | - James P B O'Connor
- Division of Cancer Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Oxford Road, Manchester M13 9PL, UK. James.O'
| | - Simon T Barry
- IMED Oncology, AstraZeneca, Li Ka Shing Centre, Cambridge CB2 0RE, UK.
| | - Sanyogitta Puri
- AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK.
| | - Geoffrey J M Parker
- Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK; Bioxydyn Ltd., Rutherford House, Manchester M15 6SZ, UK.
| | - John C Waterton
- Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK; Formerly AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK; Bioxydyn Ltd., Rutherford House, Manchester M15 6SZ, UK.
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Miranda-Gonçalves V, Granja S, Martinho O, Honavar M, Pojo M, Costa BM, Pires MM, Pinheiro C, Cordeiro M, Bebiano G, Costa P, Reis RM, Baltazar F. Hypoxia-mediated upregulation of MCT1 expression supports the glycolytic phenotype of glioblastomas. Oncotarget 2018; 7:46335-46353. [PMID: 27331625 PMCID: PMC5216802 DOI: 10.18632/oncotarget.10114] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/02/2016] [Indexed: 01/09/2023] Open
Abstract
Background Glioblastomas (GBM) present a high cellular heterogeneity with conspicuous necrotic regions associated with hypoxia, which is related to tumor aggressiveness. GBM tumors exhibit high glycolytic metabolism with increased lactate production that is extruded to the tumor microenvironment through monocarboxylate transporters (MCTs). While hypoxia-mediated regulation of MCT4 has been characterized, the role of MCT1 is still controversial. Thus, we aimed to understand the role of hypoxia in the regulation of MCT expression and function in GBM, MCT1 in particular. Methods Expression of hypoxia- and glycolytic-related markers, as well as MCT1 and MCT4 isoforms was assessed in in vitro and in vivo orthotopic glioma models, and also in human GBM tissues by immunofluorescence/immunohistochemistry and Western blot. Following MCT1 inhibition, either pharmacologically with CHC (α-cyano-4-hydroxynnamic acid) or genetically with siRNAs, we assessed GBM cell viability, proliferation, metabolism, migration and invasion, under normoxia and hypoxia conditions. Results Hypoxia induced an increase in MCT1 plasma membrane expression in glioma cells, both in in vitro and in vivo models. Additionally, treatment with CHC and downregulation of MCT1 in glioma cells decreased lactate production, cell proliferation and invasion under hypoxia. Moreover, in the in vivo orthotopic model and in human GBM tissues, there was extensive co-expression of MCT1, but not MCT4, with the GBM hypoxia marker CAIX. Conclusion Hypoxia-induced MCT1 supports GBM glycolytic phenotype, being responsible for lactate efflux and an important mediator of cell survival and aggressiveness. Therefore, MCT1 constitutes a promising therapeutic target in GBM.
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Affiliation(s)
- Vera Miranda-Gonçalves
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Sara Granja
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Olga Martinho
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Mrinalini Honavar
- Department of Pathology, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Marta Pojo
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Bruno M Costa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Manuel M Pires
- Unit of Neuropathology, Centro Hospitalar do Porto, Porto, Portugal
| | - Célia Pinheiro
- Department of Neurosurgery, Centro Hospitalar do Porto, Porto, Portugal
| | | | - Gil Bebiano
- Hospital Dr. Nélio Mendonça, Funchal, Madeira, Portugal
| | - Paulo Costa
- Radiotherapy Service, Centro Hospitalar do Montijo, Setúbal, Portugal
| | - Rui M Reis
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Fátima Baltazar
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Salem A, Asselin MC, Reymen B, Jackson A, Lambin P, West CML, O'Connor JPB, Faivre-Finn C. Targeting Hypoxia to Improve Non-Small Cell Lung Cancer Outcome. J Natl Cancer Inst 2018; 110:4096546. [PMID: 28922791 DOI: 10.1093/jnci/djx160] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/03/2017] [Indexed: 12/18/2022] Open
Abstract
Oxygen deprivation (hypoxia) in non-small cell lung cancer (NSCLC) is an important factor in treatment resistance and poor survival. Hypoxia is an attractive therapeutic target, particularly in the context of radiotherapy, which is delivered to more than half of NSCLC patients. However, NSCLC hypoxia-targeted therapy trials have not yet translated into patient benefit. Recently, early termination of promising evofosfamide and tarloxotinib bromide studies due to futility highlighted the need for a paradigm shift in our approach to avoid disappointments in future trials. Radiotherapy dose painting strategies based on hypoxia imaging require careful refinement prior to clinical investigation. This review will summarize the role of hypoxia, highlight the potential of hypoxia as a therapeutic target, and outline past and ongoing hypoxia-targeted therapy trials in NSCLC. Evidence supporting radiotherapy dose painting based on hypoxia imaging will be critically appraised. Carefully selected hypoxia biomarkers suitable for integration within future NSCLC hypoxia-targeted therapy trials will be examined. Research gaps will be identified to guide future investigation. Although this review will focus on NSCLC hypoxia, more general discussions (eg, obstacles of hypoxia biomarker research and developing a framework for future hypoxia trials) are applicable to other tumor sites.
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Affiliation(s)
- Ahmed Salem
- Division of Cancer Sciences and Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK; Department of Radiation Oncology (MAASTRO Lab), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marie-Claude Asselin
- Division of Cancer Sciences and Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK; Department of Radiation Oncology (MAASTRO Lab), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bart Reymen
- Division of Cancer Sciences and Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK; Department of Radiation Oncology (MAASTRO Lab), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Alan Jackson
- Division of Cancer Sciences and Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK; Department of Radiation Oncology (MAASTRO Lab), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Philippe Lambin
- Division of Cancer Sciences and Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK; Department of Radiation Oncology (MAASTRO Lab), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Catharine M L West
- Division of Cancer Sciences and Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK; Department of Radiation Oncology (MAASTRO Lab), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - James P B O'Connor
- Division of Cancer Sciences and Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK; Department of Radiation Oncology (MAASTRO Lab), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Corinne Faivre-Finn
- Division of Cancer Sciences and Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK; Department of Radiation Oncology (MAASTRO Lab), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
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Bainbridge H, Salem A, Tijssen RHN, Dubec M, Wetscherek A, Van Es C, Belderbos J, Faivre-Finn C, McDonald F. Magnetic resonance imaging in precision radiation therapy for lung cancer. Transl Lung Cancer Res 2017; 6:689-707. [PMID: 29218271 PMCID: PMC5709138 DOI: 10.21037/tlcr.2017.09.02] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/08/2017] [Indexed: 12/25/2022]
Abstract
Radiotherapy remains the cornerstone of curative treatment for inoperable locally advanced lung cancer, given concomitantly with platinum-based chemotherapy. With poor overall survival, research efforts continue to explore whether integration of advanced radiation techniques will assist safe treatment intensification with the potential for improving outcomes. One advance is the integration of magnetic resonance imaging (MRI) in the treatment pathway, providing anatomical and functional information with excellent soft tissue contrast without exposure of the patient to radiation. MRI may complement or improve the diagnostic staging accuracy of F-18 fluorodeoxyglucose position emission tomography and computerized tomography imaging, particularly in assessing local tumour invasion and is also effective for identification of nodal and distant metastatic disease. Incorporating anatomical MRI sequences into lung radiotherapy treatment planning is a novel application and may improve target volume and organs at risk delineation reproducibility. Furthermore, functional MRI may facilitate dose painting for heterogeneous target volumes and prediction of normal tissue toxicity to guide adaptive strategies. MRI sequences are rapidly developing and although the issue of intra-thoracic motion has historically hindered the quality of MRI due to the effect of motion, progress is being made in this field. Four-dimensional MRI has the potential to complement or supersede 4D CT and 4D F-18-FDG PET, by providing superior spatial resolution. A number of MR-guided radiotherapy delivery units are now available, combining a radiotherapy delivery machine (linear accelerator or cobalt-60 unit) with MRI at varying magnetic field strengths. This novel hybrid technology is evolving with many technical challenges to overcome. It is anticipated that the clinical benefits of MR-guided radiotherapy will be derived from the ability to adapt treatment on the fly for each fraction and in real-time, using 'beam-on' imaging. The lung tumour site group of the Atlantic MR-Linac consortium is working to generate a challenging MR-guided adaptive workflow for multi-institution treatment intensification trials in this patient group.
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Affiliation(s)
- Hannah Bainbridge
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Ahmed Salem
- The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | | | - Michael Dubec
- The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Andreas Wetscherek
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Corinne Van Es
- The University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jose Belderbos
- The Netherlands Cancer Institute and The Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Corinne Faivre-Finn
- The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Fiona McDonald
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK
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Bindra RS, Chalmers AJ, Evans S, Dewhirst M. GBM radiosensitizers: dead in the water…or just the beginning? J Neurooncol 2017; 134:513-521. [PMID: 28762004 DOI: 10.1007/s11060-017-2427-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/11/2017] [Indexed: 12/22/2022]
Abstract
The finding that most GBMs recur either near or within the primary site after radiotherapy has fueled great interest in the development of radiosensitizers to enhance local control. Unfortunately, decades of clinical trials testing a wide range of novel therapeutic approaches have failed to yield any clinically viable radiosensitizers. However, many of the previous radiosensitizing strategies were not based on clear pre-clinical evidence, and in many cases blood-barrier penetration was not considered. Furthermore, DNA repair inhibitors have only recenly arrived in the clinic, and likely represent potent agents for glioma radiosensitization. Here, we present recent progress in the use of small molecule DNA damage response inhibitors as GBM radiosensitizers. In addition, we discuss the latest progress in targeting hypoxia and oxidative stress for GBM radiosensitization.
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Affiliation(s)
- Ranjit S Bindra
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, 06520, USA.
| | - Anthony J Chalmers
- Institute of Cancer Sciences & Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | - Sydney Evans
- Department of Radiation Oncology, University of Pennsylvania, School of Medicine, Philadelphia, PA, 19081, USA
| | - Mark Dewhirst
- Radiation Oncology Department, Duke University School of Medicine, Durham, NC, USA
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Abstract
There is interest in identifying and quantifying tumor heterogeneity at the genomic, tissue pathology and clinical imaging scales, as this may help better understand tumor biology and may yield useful biomarkers for guiding therapy-based decision making. This review focuses on the role and value of using x-ray, CT, MRI and PET based imaging methods that identify, measure and map tumor heterogeneity. In particular we highlight the potential value of these techniques and the key challenges required to validate and qualify these biomarkers for clinical use.
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Affiliation(s)
- James P B O'Connor
- Institute of Cancer Sciences, University of Manchester, Manchester, UK; Department of Radiology, The Christie Hospital NHS Trust, Manchester, UK.
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41
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Colliez F, Gallez B, Jordan BF. Assessing Tumor Oxygenation for Predicting Outcome in Radiation Oncology: A Review of Studies Correlating Tumor Hypoxic Status and Outcome in the Preclinical and Clinical Settings. Front Oncol 2017; 7:10. [PMID: 28180110 PMCID: PMC5263142 DOI: 10.3389/fonc.2017.00010] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/10/2017] [Indexed: 12/30/2022] Open
Abstract
Tumor hypoxia is recognized as a limiting factor for the efficacy of radiotherapy, because it enhances tumor radioresistance. It is strongly suggested that assessing tumor oxygenation could help to predict the outcome of cancer patients undergoing radiation therapy. Strategies have also been developed to alleviate tumor hypoxia in order to radiosensitize tumors. In addition, oxygen mapping is critically needed for intensity modulated radiation therapy (IMRT), in which the most hypoxic regions require higher radiation doses and the most oxygenated regions require lower radiation doses. However, the assessment of tumor oxygenation is not yet included in day-to-day clinical practice. This is due to the lack of a method for the quantitative and non-invasive mapping of tumor oxygenation. To fully integrate tumor hypoxia parameters into effective improvements of the individually tailored radiation therapy protocols in cancer patients, methods allowing non-invasively repeated, safe, and robust mapping of changes in tissue oxygenation are required. In this review, non-invasive methods dedicated to assessing tumor oxygenation with the ultimate goal of predicting outcome in radiation oncology are presented, including positron emission tomography used with nitroimidazole tracers, magnetic resonance methods using endogenous contrasts (R1 and R2*-based methods), and electron paramagnetic resonance oximetry; the goal is to highlight results of studies establishing correlations between tumor hypoxic status and patients’ outcome in the preclinical and clinical settings.
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Affiliation(s)
- Florence Colliez
- Biomedical Magnetic Resonance Group, Louvain Drug Research Institute, Université Catholique de Louvain , Brussels , Belgium
| | - Bernard Gallez
- Biomedical Magnetic Resonance Group, Louvain Drug Research Institute, Université Catholique de Louvain , Brussels , Belgium
| | - Bénédicte F Jordan
- Biomedical Magnetic Resonance Group, Louvain Drug Research Institute, Université Catholique de Louvain , Brussels , Belgium
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May JP, Hysi E, Wirtzfeld LA, Undzys E, Li SD, Kolios MC. Photoacoustic Imaging of Cancer Treatment Response: Early Detection of Therapeutic Effect from Thermosensitive Liposomes. PLoS One 2016; 11:e0165345. [PMID: 27788199 PMCID: PMC5082794 DOI: 10.1371/journal.pone.0165345] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/10/2016] [Indexed: 12/11/2022] Open
Abstract
Imaging methods capable of indicating the potential for success of an individualized treatment course, during or immediately following the treatment, could improve therapeutic outcomes. Temperature Sensitive Liposomes (TSLs) provide an effective way to deliver chemotherapeutics to a localized tumoral area heated to mild-hyperthermia (HT). The high drug levels reached in the tumor vasculature lead to increased tumor regression via the cascade of events during and immediately following treatment. For a TSL carrying doxorubicin (DOX) these include the rapid and intense exposure of endothelial cells to high drug concentrations, hemorrhage, blood coagulation and vascular shutdown. In this study, ultrasound-guided photoacoustic imaging was used to probe the changes to tumors following treatment with the TSL, HaT-DOX (Heat activated cytoToxic). Levels of oxygen saturation (sO2) were studied in a longitudinal manner, from 30 min pre-treatment to 7 days post-treatment. The efficacious treatments of HT-HaT-DOX were shown to induce a significant drop in sO2 (>10%) as early as 30 min post-treatment that led to tumor regression (in 90% of cases); HT-Saline and non-efficacious HT-HaT-DOX (10% of cases) treatments did not show any significant change in sO2 at these timepoints. The changes in sO2 were further corroborated with histological data, using the vascular and perfusion markers CD31 and FITC-lectin. These results allowed us to further surmise a plausible mechanism of the cellular events taking place in the TSL treated tumor regions over the first 24 hours post-treatment. The potential for using photoacoustic imaging to measure tumor sO2 as a surrogate prognostic marker for predicting therapeutic outcome with a TSL treatment is demonstrated.
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Affiliation(s)
- Jonathan P. May
- Drug Discovery and Formulation Group, Drug Discovery Program, Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Eno Hysi
- Department of Physics, Ryerson University, Toronto, ON, Canada
- Institute for Biomedical Engineering, Science and Technology, Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, ON, Canada
| | - Lauren A. Wirtzfeld
- Department of Physics, Ryerson University, Toronto, ON, Canada
- Institute for Biomedical Engineering, Science and Technology, Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, ON, Canada
| | - Elijus Undzys
- Drug Discovery and Formulation Group, Drug Discovery Program, Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Shyh-Dar Li
- Drug Discovery and Formulation Group, Drug Discovery Program, Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Michael C. Kolios
- Department of Physics, Ryerson University, Toronto, ON, Canada
- Institute for Biomedical Engineering, Science and Technology, Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, ON, Canada
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43
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White DA, Zhang Z, Li L, Gerberich J, Stojadinovic S, Peschke P, Mason RP. Developing oxygen-enhanced magnetic resonance imaging as a prognostic biomarker of radiation response. Cancer Lett 2016; 380:69-77. [PMID: 27267808 DOI: 10.1016/j.canlet.2016.06.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 11/19/2022]
Abstract
Oxygen-Enhanced Magnetic Resonance Imaging (OE-MRI) techniques were evaluated as potential non-invasive predictive biomarkers of radiation response. Semi quantitative blood-oxygen level dependent (BOLD) and tissue oxygen level dependent (TOLD) contrast, and quantitative responses of relaxation rates (ΔR1 and ΔR2*) to an oxygen breathing challenge during hypofractionated radiotherapy were applied. OE-MRI was performed on subcutaneous Dunning R3327-AT1 rat prostate tumors (n=25) at 4.7 T prior to each irradiation (2F × 15 Gy) to the gross tumor volume. Response to radiation, while inhaling air or oxygen, was assessed by tumor growth delay measured up to four times the initial irradiated tumor volume (VQT). Radiation-induced hypoxia changes were confirmed using a double hypoxia marker assay. Inhaling oxygen during hypofractionated radiotherapy significantly improved radiation response. A correlation was observed between the difference in the 2nd and 1st ΔR1 (ΔΔR1) and VQT for air breathing rats. The TOLD response before the 2nd fraction showed a moderate correlation with VQT for oxygen breathing rats. The correlations indicate useful prognostic factors to predict tumor response to hypofractionation and could readily be applied for patient stratification and personalized radiotherapy treatment planning.
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Affiliation(s)
- Derek A White
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas 75390, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, Texas 76019, USA
| | - Zhang Zhang
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Li Li
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Jeni Gerberich
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Strahinja Stojadinovic
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | | | - Ralph P Mason
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas 75390, USA.
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44
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Cao-Pham TT, Tran LBA, Colliez F, Joudiou N, El Bachiri S, Grégoire V, Levêque P, Gallez B, Jordan BF. Monitoring Tumor Response to Carbogen Breathing by Oxygen-Sensitive Magnetic Resonance Parameters to Predict the Outcome of Radiation Therapy: A Preclinical Study. Int J Radiat Oncol Biol Phys 2016; 96:149-60. [PMID: 27511852 DOI: 10.1016/j.ijrobp.2016.04.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 04/25/2016] [Accepted: 04/30/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE In an effort to develop noninvasive in vivo methods for mapping tumor oxygenation, magnetic resonance (MR)-derived parameters are being considered, including global R1, water R1, lipids R1, and R2*. R1 is sensitive to dissolved molecular oxygen, whereas R2* is sensitive to blood oxygenation, detecting changes in dHb. This work compares global R1, water R1, lipids R1, and R2* with pO2 assessed by electron paramagnetic resonance (EPR) oximetry, as potential markers of the outcome of radiation therapy (RT). METHODS AND MATERIALS R1, R2*, and EPR were performed on rhabdomyosarcoma and 9L-glioma tumor models, under air and carbogen breathing conditions (95% O2, 5% CO2). Because the models demonstrated different radiosensitivity properties toward carbogen, a growth delay (GD) assay was performed on the rhabdomyosarcoma model and a tumor control dose 50% (TCD50) was performed on the 9L-glioma model. RESULTS Magnetic resonance imaging oxygen-sensitive parameters detected the positive changes in oxygenation induced by carbogen within tumors. No consistent correlation was seen throughout the study between MR parameters and pO2. Global and lipids R1 were found to be correlated to pO2 in the rhabdomyosarcoma model, whereas R2* was found to be inversely correlated to pO2 in the 9L-glioma model (P=.05 and .03). Carbogen increased the TCD50 of 9L-glioma but did not increase the GD of rhabdomyosarcoma. Only R2* was predictive (P<.05) for the curability of 9L-glioma at 40 Gy, a dose that showed a difference in response to RT between carbogen and air-breathing groups. (18)F-FAZA positron emission tomography imaging has been shown to be a predictive marker under the same conditions. CONCLUSION This work illustrates the sensitivity of oxygen-sensitive R1 and R2* parameters to changes in tumor oxygenation. However, R1 parameters showed limitations in terms of predicting the outcome of RT in the tumor models studied, whereas R2* was found to be correlated with the outcome in the responsive model.
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Affiliation(s)
- Thanh-Trang Cao-Pham
- Université Catholique de Louvain, Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group, Brussels, Belgium
| | - Ly-Binh-An Tran
- Université Catholique de Louvain, Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group, Brussels, Belgium
| | - Florence Colliez
- Université Catholique de Louvain, Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group, Brussels, Belgium
| | - Nicolas Joudiou
- Université Catholique de Louvain, Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group, Brussels, Belgium
| | - Sabrina El Bachiri
- Université Catholique de Louvain, IMMAQ Technological Platform, Methodology and Statistical Support, Louvain-la-Neuve, Belgium
| | - Vincent Grégoire
- Université Catholique de Louvain, Institute of Experimental and Clinical Research, Center for Molecular Imaging, Radiotherapy and Oncology, Brussels, Belgium
| | - Philippe Levêque
- Université Catholique de Louvain, Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group, Brussels, Belgium
| | - Bernard Gallez
- Université Catholique de Louvain, Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group, Brussels, Belgium
| | - Bénédicte F Jordan
- Université Catholique de Louvain, Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group, Brussels, Belgium.
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45
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O'Connor JPB, Boult JKR, Jamin Y, Babur M, Finegan KG, Williams KJ, Little RA, Jackson A, Parker GJM, Reynolds AR, Waterton JC, Robinson SP. Oxygen-Enhanced MRI Accurately Identifies, Quantifies, and Maps Tumor Hypoxia in Preclinical Cancer Models. Cancer Res 2016; 76:787-95. [PMID: 26659574 PMCID: PMC4757751 DOI: 10.1158/0008-5472.can-15-2062] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/09/2015] [Indexed: 01/10/2023]
Abstract
There is a clinical need for noninvasive biomarkers of tumor hypoxia for prognostic and predictive studies, radiotherapy planning, and therapy monitoring. Oxygen-enhanced MRI (OE-MRI) is an emerging imaging technique for quantifying the spatial distribution and extent of tumor oxygen delivery in vivo. In OE-MRI, the longitudinal relaxation rate of protons (ΔR1) changes in proportion to the concentration of molecular oxygen dissolved in plasma or interstitial tissue fluid. Therefore, well-oxygenated tissues show positive ΔR1. We hypothesized that the fraction of tumor tissue refractory to oxygen challenge (lack of positive ΔR1, termed "Oxy-R fraction") would be a robust biomarker of hypoxia in models with varying vascular and hypoxic features. Here, we demonstrate that OE-MRI signals are accurate, precise, and sensitive to changes in tumor pO2 in highly vascular 786-0 renal cancer xenografts. Furthermore, we show that Oxy-R fraction can quantify the hypoxic fraction in multiple models with differing hypoxic and vascular phenotypes, when used in combination with measurements of tumor perfusion. Finally, Oxy-R fraction can detect dynamic changes in hypoxia induced by the vasomodulator agent hydralazine. In contrast, more conventional biomarkers of hypoxia (derived from blood oxygenation-level dependent MRI and dynamic contrast-enhanced MRI) did not relate to tumor hypoxia consistently. Our results show that the Oxy-R fraction accurately quantifies tumor hypoxia noninvasively and is immediately translatable to the clinic.
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Affiliation(s)
- James P B O'Connor
- Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom. Centre for Imaging Sciences, University of Manchester, Manchester, United Kingdom. Department of Radiology, Christie NHS Foundation Trust, Manchester, United Kingdom. james.o'
| | - Jessica K R Boult
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Yann Jamin
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Muhammad Babur
- Manchester Pharmacy School, University of Manchester, Manchester, United Kingdom
| | - Katherine G Finegan
- Manchester Pharmacy School, University of Manchester, Manchester, United Kingdom
| | - Kaye J Williams
- Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom. Manchester Pharmacy School, University of Manchester, Manchester, United Kingdom
| | - Ross A Little
- Centre for Imaging Sciences, University of Manchester, Manchester, United Kingdom
| | - Alan Jackson
- Centre for Imaging Sciences, University of Manchester, Manchester, United Kingdom
| | - Geoff J M Parker
- Centre for Imaging Sciences, University of Manchester, Manchester, United Kingdom
| | - Andrew R Reynolds
- Tumour Biology Team, Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - John C Waterton
- Centre for Imaging Sciences, University of Manchester, Manchester, United Kingdom
| | - Simon P Robinson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
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46
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Dewhirst MW, Birer SR. Oxygen-Enhanced MRI Is a Major Advance in Tumor Hypoxia Imaging. Cancer Res 2016; 76:769-72. [PMID: 26837768 DOI: 10.1158/0008-5472.can-15-2818] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022]
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47
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Safronova MM, Colliez F, Magat J, Joudiou N, Jordan BF, Raftopoulos C, Gallez B, Duprez T. Mapping of global R1 and R2* values versus lipids R1 values as potential markers of hypoxia in human glial tumors: A feasibility study. Magn Reson Imaging 2016; 34:105-13. [DOI: 10.1016/j.mri.2015.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/25/2015] [Accepted: 10/25/2015] [Indexed: 01/08/2023]
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48
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Zhao D, Pacheco-Torres J, Hallac RR, White D, Peschke P, Cerdán S, Mason RP. Dynamic oxygen challenge evaluated by NMR T1 and T2*--insights into tumor oxygenation. NMR IN BIOMEDICINE 2015; 28:937-947. [PMID: 26058575 PMCID: PMC4506740 DOI: 10.1002/nbm.3325] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 04/10/2015] [Accepted: 04/14/2015] [Indexed: 05/03/2023]
Abstract
There is intense interest in developing non-invasive prognostic biomarkers of tumor response to therapy, particularly with regard to hypoxia. It has been suggested that oxygen sensitive MRI, notably blood oxygen level-dependent (BOLD) and tissue oxygen level-dependent (TOLD) contrast, may provide relevant measurements. This study examined the feasibility of interleaved T2*- and T1-weighted oxygen sensitive MRI, as well as R2* and R1 maps, of rat tumors to assess the relative sensitivity to changes in oxygenation. Investigations used cohorts of Dunning prostate R3327-AT1 and R3327-HI tumors, which are reported to exhibit distinct size-dependent levels of hypoxia and response to hyperoxic gas breathing. Proton MRI R1 and R2* maps were obtained for tumors of anesthetized rats (isoflurane/air) at 4.7 T. Then, interleaved gradient echo T2*- and T1-weighted images were acquired during air breathing and a 10 min challenge with carbogen (95% O2 -5% CO2). Signals were stable during air breathing, and each type of tumor showed a distinct signal response to carbogen. T2* (BOLD) response preceded T1 (TOLD) responses, as expected. Smaller HI tumors (reported to be well oxygenated) showed the largest BOLD and TOLD responses. Larger AT1 tumors (reported to be hypoxic and resist modulation by gas breathing) showed the smallest response. There was a strong correlation between BOLD and TOLD signal responses, but ΔR2* and ΔR1 were only correlated for the HI tumors. The magnitude of BOLD and TOLD signal responses to carbogen breathing reflected expected hypoxic fractions and oxygen dynamics, suggesting potential value of this test as a prognostic biomarker of tumor hypoxia.
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Affiliation(s)
- Dawen Zhao
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
| | - Jesús Pacheco-Torres
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
- Laboratory for Imaging and Spectroscopy by Magnetic Resonance LISMAR, Instituto de Investigaciones Biomédicas “Alberto Sols” CSIC/UAM, Arturo Duperier 4, Madrid 28029, Spain
| | - Rami R. Hallac
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
| | - Derek White
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
| | - Peter Peschke
- Clinical Cooperation Unit Molecular Radiooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Cerdán
- Laboratory for Imaging and Spectroscopy by Magnetic Resonance LISMAR, Instituto de Investigaciones Biomédicas “Alberto Sols” CSIC/UAM, Arturo Duperier 4, Madrid 28029, Spain
| | - Ralph P. Mason
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
- To whom correspondence should be addressed: Ralph P. Mason, PhD Department of Radiology UT Southwestern Medical Center 5323 Harry Hines Blvd. Dallas, TX 75390-9058 USA Phone: +1 (214) 648-8926 Fax: +1 (214) 648-2991
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Abstract
Glioma is a heterogeneous disease process with differential histology and treatment response. It was previously thought that the histological features of glial tumors indicated their cell of origin. However, the discovery of continuous neuro-gliogenesis in the normal adult brain and the identification of brain tumor stem cells within glioma have led to the hypothesis that these brain tumors originate from multipotent neural stem or progenitor cells, which primarily divide asymmetrically during the postnatal period. Asymmetric cell division allows these cell types to concurrently self-renew whilst also producing cells for the differentiation pathway. It has recently been shown that increased symmetrical cell division, favoring the self-renewal pathway, leads to oligodendroglioma formation from oligodendrocyte progenitor cells. In contrast, there is some evidence that asymmetric cell division maintenance in tumor stem-like cells within astrocytoma may lead to acquisition of treatment resistance. Therefore cell division mode in normal brain stem and progenitor cells may play a role in setting tumorigenic potential and the type of tumor formed. Moreover, heterogeneous tumor cell populations and their respective cell division mode may confer differential sensitivity to therapy. This review aims to shed light on the controllers of cell division mode which may be therapeutically targeted to prevent glioma formation and improve treatment response.
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