Amide Proton Transfer and tissue microstructural MRI biomarkers in brain tumors for improved diagnosis and treatment follow up

MRI, the modality for diagnosis and prognosis of brain tumors, based primarily on gadolinium (Gd) enhancement (a marker of blood-brain-barrier disruption (BBB)), has become more and more challenging.

This as 10% of glioblastoma and 30% of anaplastic astrocytoma demonstrate no Gd enhancement affecting the possibility to define the most malign area for biopsy and local therapy.

In addition, as Gd enhancement may occur in any etiologies with BBB barrier disruption, tumor recurrence, and treatment effects cannot reliably be distinguished. Recent reports about Gd deposits in the brain are also worrisome.

Relatively new non-invasive molecular imaging approaches such as Amide Proton Transfer weighted (APTw) and Multidimensional microstructural imaging (MMI) MRI have shown ability improve tumor characteristics, and assess treatment response.

In this study APTw and MMI MRI will be implemented (year 1-4) in adult patients with low and high-grade gliomas, brain metastasis as well as in adult patients with new Gd-enhancing lesions during or after treatment to distinguish recurrent tumor from treatment effects. We will also include pediatric brain tumor patients on our 3T MR scanner.

We believe these methods have the potential to enhance the noninvasive molecular diagnosis of brain tumors before and after treatment, reduce the necessity of repeated biopsies/surgery, decrease the need for Gd enhanced MRIs, improve the quality of life for patients, and reduce the cost of care.