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Development of an integrated SPECT/MRI system for enhanced stratification of brain tumour patients prior to patient-specific radio-chemo therapy and early assessment of treatment efficacy

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Improved imaging for cancer monitoring

Recurrent glioma, in both adults and children, is associated with a high mortality rate. With surgery being the only current treatment option, European researchers worked towards novel imaging tools that support personalised therapies.

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Cancer diagnosis and post-treatment monitoring pose significant challenges as they often rely on invasive procedures such as biopsies. When it comes to brain tumours, this is particularly difficult and necessitates novel less invasive approaches. The collaborative EU-funded INSERT project developed a multi-modality imaging tool that would not only aid cancer diagnosis but also enable clinical stratification of patients and facilitate personalised radio-chemo therapies. Researchers generated a single photon emission computed tomography (SPECT) system to be used as an insert to a magnetic resonance imaging (MRI) gantry. This hybrid system allowed simultaneous acquisition of images from the two systems, thereby providing both anatomical and functional tumour information. Following the design and assembly of the SPECT system, the consortium developed two types of imaging device prototypes, one for pre-clinical use and one for clinical applications. The imaging performance of the multimodal system was validated in a mouse model of glioma generated during the project. From a scientific perspective, researchers identified biomarkers and validated them using a plethora of techniques in cell and animal models. Important biomarkers were identified for the early estimation of glioma response to temozolomide (TMZ) treatment, while translational biomarkers that correlated with HIF-1a activity were detected using imaging techniques. Different probes were used to screen neoangiogenesis and HIF-1a activity, which correlated with different processes. Furthermore, the consortium found that treatment with TMZ reduces HIF-1a activity and that this reduction precedes cell death. Interestingly, HIF-1a inhibition in TMZ-resistant cells restored glioma sensitivity to this drug. INSERT has laid the foundation for long-term innovation in the field of treatment planning and response monitoring for glioma patients. The SPECT/MRI integrated system will help investigate tumour biology and give relevant information for patient stratification and personalised treatments. Ultimately, this will translate into better outcome in survival and quality-of-life for brain tumour patients.



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