Evaluation of brain tumours with perfusion MRI with focus on prediction and evaluation of treatment response

This research project concentrates on the role of perfusion weighted MRI (PWI) in evaluating neovascularization and hypoxia in primary brain tumors. 

The aim of the study is to investigate new and more precise methods to identify the most aggressive parts of brain tumors, which would improve our understanding of tumor biology and could entail better treatment options for these patients. 

More than one thousand individuals are diagnosed with primary brain tumours in Denmark each year. To date, conventional Magnetic Resonance Imaging (MRI) is the cornerstone of tumour evaluation describing size, localization and morphological characteristics. Recently, several advanced MRI techniques have been developed, which promise a disruptive change in diagnostics, permitting tumour evaluation in unprecedented detail.

A particularly promising approach is Perfusion-weighted Imaging (PWI) assessing neovascularization and vessel permeability. The objective of this study is to investigate the clinical impact of PWI in primary brain tumours. To this end, we propose to combine basic PWI estimates as cerebral blood volume and flow with model calculation for capillary transit time heterogeneity and oxygen extraction capacity as a measure of tissue oxygenation obtained from clinical PWI data. This calculational approach has been developed in our centre and will further be improved in an interdisciplinary effort involving physicians, mathematicians, physicists and engineers. We study if these metrics can describe tumour biology even more precise allowing a more specific pre-surgical diagnosis regarding tumour type, tumour grade and extend of white matter infiltration. 

We also combine PWI with Diffusion-weighted Imaging (DWI), a technique that permits an estimate of cellularity and white matter fibre integrity. 

Moreover, we compare 11C-methionine Positron Emission Tomography with our PWI and DWI data in a subset of patients in order to gain further insight into the metabolic changes in primary brain tumors. 

PWI might improve delineation of targets in tissue sampling in order to achieve the most representative biopsies. It is also very likely that PWI and the aforementioned physiological parameters, related to indices of resistance to radio- and chemotherapy, allow more detailed treatment evaluation, a fact that may allow more specific and individual therapy adjustment in the future.

 

Anna Tietze, MD, PhD

Pure profile fore Anna Tietze

Revised: 7 April 2017