Project details


Differentiation of tumourprogression and treatment induced changes on imaging in patients with gliomas.

Advanced imaging Treatment response Gliomas

prof. dr. R.A. Dierckx
dr. A van der Hoorn
dr. P.J. van Laar
drs. R.W.J. van Rheenen

Nature of the research:
The medical imaging department in the UMCG is equipped with advanced MRI scanner. Radiology and nuclear medicine work together with other clinical department as neurology, oncology and radiotherapy

Fields of study:
neurology oncology radiology

Background / introduction
High grade gliomas are the most common primary brain tumour. High-grade gliomas are accompanied by a high morbidity and mortality. Despite standard extensive multimodal treatment regimes, they are inevitable fatal mostly within two years. After the initiation of treatment, patients will be monitored using conventional anatomical MR imaging. In case of progression on MR imaging, differentiation should be made between true progressive disease and treatment induced imaging changes. The latter represents a wanted treatment response of radiation therapy and chemotherapy. Treatment induced imaging changes does not represent disease progression, but it has a similar appearance on MR imaging. It can be accompanied by symptoms that also accompany true tumour progression. It follows that differentiation between therapy induced imaging changes and true tumour progression is currently unable with conventional MR imaging and clinical symptoms, which represents a major clinical problem. The lack of this essential information makes it impossible for the clinician to decide the best treatment strategy. Furthermore, large uncertainties may upset the patients and those close to him. In addition, new treatments are hard to develop as only patients with tumour progression should be included in clinical trials.

To resolve these problems, the development and implementation of more advanced imaging techniques is required (see figure). The current multimodal research using advanced MRI and MET-PET is focussed thereat. This research enables the differentiation of tumour progression from treatment induced imaging changes in order to develop and apply diagnostic imaging for an accurate diagnosis resulting in the best treatment decision and to enable accurate development of new treatments to eventually improve clinical outcome.
Research question / problem definition
Differentiation of tumourprogression and treatment induced imaging changes using advanced MRI sequences and MET-PET.
Currently, there are several options to participate in research within this project. We are running a pilot study in which we compare the MET-PET with advanced MRI sequences in patients with high-grade gliomas directly postoperative.. Furthermore, there is existing data which can be used to study the impact of follow-up MRI scans on treatment decisions in patients with glioblastoma in patients (see also project The impact of follow-up MRI scans on treatment decisions in patients with glioblastoma). A meta-analysis can also be performed to compare all PET tracers for differentiating tumour progression form treatment induced imaging changes. Depending on the students personal interest, the student can participate in several parts of the research as analyzing the data and work towards a research article.
Brandsma et al. 2008. Clinical features, mechanisms, and management of pseudoprogression in malignant gliomas. Lancet Oncol 9; 453-461.
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