Monitoring low grade tumour progression

Fast Facts

• Title: Making the invisible visible: In vivo mapping of molecular biomarkers in adult diffuse glioma with CEST MRI
• Lead Researchers: Professor Marion Smits
• Where: Erasmus Medical School
• When: October 2018- September 2021
• Cost: £119,250 over the grant period
• Research type: Adult, Low Grade, Clinical
• Grant round: Expanding theories

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What is it?

Previous research has shown that in parts of a tumour where the cells are multiplying rapidly, there’s a build-up of certain proteins. This project will use a new and non-invasive imaging technique called Chemical Exchange Saturation Transfer (CEST) to visualise and measure protein build-up in low grade diffuse gliomas.

The research team will then confirm their findings by comparing the images with protein measurements made from biopsies taken during surgery. This will show that the imaging technique accurately shows where the protein build-up is high and low within the tumour.

By measuring and monitoring protein build-up, researchers hope to be able to detect tumour growth and progression sooner and create more effective treatment plans.

What is CEST imaging?

MRI or Magnetic Resonance Imaging is the use of magnetic fields to build three-dimensional images of areas inside the body. But conventional MRI scans can only detect tumour growth once it has already happened.

CEST imaging is a technique that uses the same principles as conventional MRI but is made more sensitive to certain types of proteins found in the body. This sensitivity allow researchers to visualise the build-up of proteins and other substances. The ultimate goal is to see the proteins increasing before tumour growth so that doctors can predict when more aggressive treatment will be needed.

Why is it important?

Low grade diffuse gliomas are generally slow growing but have the potential to transform into faster growing, high grade brain tumours.

Currently the standard treatment for low grade diffuse tumours involves surgery, to remove as much of the tumour as possible, followed by a ’watch and wait’ policy – only starting further treatment when symptoms worsen or imaging tests, such as MRIs, show that the tumour has grown.

It’s vital that we develop more accurate ways of monitoring tumour growth in order to improve treatment plans, and ultimately improve outcomes for patients.

Who will it help?

This project will help people who have been or will be diagnosed with low grade diffuse gliomas. We hope it will mean earlier identification of tumour progression and that people are given appropriate treatments faster.

My work is focused at bringing new, advanced imaging techniques into clinical practice in order to improve the diagnosis and surveillance of brain tumours. I aim to provide more certainty to the patients and treating physicians about diagnosis, prognosis, and the effect of treatment.

Dr Marion Smits

Milestones

• Achieved
  • Defined the settings and analysis needed to use CEST MRI in a clinical setting. The team can now use this technique to tell the difference between healthy brain tissue and tumour tissue non-invasively. 
  • Despite recruitment being affected by the Covid-19 pandemic, Smits and her team have applied the CEST-MRI technique to 18 patients. They have found that it can identify changes that occur in both low- and high-grade gliomas compared to healthy brain tissue (with the full scan taking less than 4 minutes!).
• Upcoming
• Refining the CEST-MRI technique to allow measurement of the amount of proteins present.
  • Finalise the testing of this MRI technique in 20 patients with brain tumours, at Erasmus Medical Centre and Kings College London, before they undergo surgery.
  • Continue to investigate if the CEST-MRI technique is a good measure of tumour aggressiveness by comparing the level of proteins in brain tumour biopsies to the strength of the original CEST-MRI signal in these tissue samples. If the technique is shown to be successful, it could then be used as a biomarker for better diagnosis and treatment of brain tumour patients.