New MRI techniques to improve diagnosis and monitoring of childhood cancer

29 January 2016

Dr Patrick Hales, UCL Institute of Child Health

Patrick was awarded a Paul O’Gorman Research Fellowship in 2015 to support a programme of research that aims to develop MRI techniques for the earlier identification of high-risk tumour sub-types.

The aim is to enable the early stratification of patients into different treatment groups, so that each patient receives the most appropriate level of treatment.

Background – the need for early diagnosis of high-risk tumours

Patrick HalesA number of childhood cancers still carry a very poor prognosis – including the brain tumours high-grade glioma (HGG), diffuse intrinsic pontine glioma (DIPG) and medulloblastoma (MB).

Some of these tumours are known to have ‘sub-types’ that benefit from different types of treatment; the challenge is to identify them at an early stage so that treatment can be planned accordingly.

Magnetic resonance imaging (MRI) is an essential tool in the diagnosis of these tumours. But whilst conventional MRI techniques are good at telling us about size and location of tumour, they leave many questions answered – including questions about the tumour’s composition and blood supply. As such, it is often not possible to identify the sub-type and malignancy of a tumour with imaging and doctors must wait until after surgery, when the tumour can be examined in more detail.

Furthermore, DIPG and HGG are both tumours that infiltrate the white matter in the brain but the extent of infiltration is difficult to detect using conventional imaging. As such, it is difficult to define the tumour boundary, and following treatment the tumour recurs in the majority of patients.

The aim of this project is to develop and test advanced MRI techniques to help overcome these challenges.

How to diagnose tumours more accurately through imaging

I see the proposed work as highly relevant for deepening our understanding of tumour growth pattern, tumour response to treatment and imaging biomarkers for patient outcome. The results of the project can be expected to have immediate clinical impact and may be readily applicable to a wider range of other paediatric, and adult, tumour entities.
External reviewer
Patrick will use a technique called diffusion-weighted MRI (DWI), which can provide information about the cellular structure of the tumour. An extension of this technique, called diffusion tensor imaging (DTI) will be used to measure the integrity of the brain adjacent to the tumour.

He will also use a technique called arterial spin labelling (ASL) to measure blood flow in tumours.

He will use these techniques in children with neuroblastoma, DIPG and HGG to see if he can find biomarkers that help to predict outcome in these patients, and thus could help to personalise treatment in the future.

The techniques will be incorporated into a clinical drug trial in DIPG so that clinicians can measure how the tumour responds to treatment and whether the treatment affects the blood supply and cell structure.

Patrick will also investigate whether new biomarkers gained from DTI and ASL scans can help to identify the different genetic subtypes of medulloblastoma using imaging.

About Patrick

Through our Fellowships, we aim to support outstanding young scientists in the development of a career in childhood cancer research.

We seek to identify ‘research leaders of the future’ and provide them with the support they need to achieve their full potential, making sure their talents are retained within the childhood cancer field.

Patrick was awarded his Fellowship in 2015, out of our second round of Fellowship awards.

He completed his DPhil (PhD) in Physics at the University of Oxford in 2007. He remained in Oxford for a further three years, working as a post-doctoral research associate in the British Heart Foundation Magnetic Resonance Unit, before moving to the Developmental Imaging and Biophysics Section at the UCL Institute of Child Health in 2010.

This Fellowship will enable him to take forward the imaging and analysis techniques he has developed. He will remain at ICH, working closely with clinical colleagues at Great Ormond Street Hospital and building on existing collaborations with colleagues at Birmingham Children’s Hospital, including Professor Andrew Peet, who is carrying out related work with funding awarded under our brain tumour initiative. These collaborations mean that the imaging techniques can be implemented at two of the largest national referral centres for children with cancer and taken forward into wider clinical trial.

Read more: Professor Andrew Peet: Diagnosing childhood medulloblastomas by improved MRI scans

What difference will this work make?

Conventional imaging techniques can only provide limited information, meaning that clinicians must often wait until after surgery before they can plan a child’s individual treatment. In certain brain tumours, the tumour is simply not accessible surgically without risk of causing very serious harm to the patient.

The aim of this work is to give clinicians the tools to define tumours more precisely at an early stage in each child’s care.

By developing these techniques, Patrick and colleagues will be able to identify patients with high-risk tumour subtypes earlier on. These patients could then be stratified for more aggressive treatment and more frequent monitoring. Just as important, lower-risk patients could be spared these more aggressive therapies and the associated side-effects.

Advanced pre-operative imaging could also guide surgeons to the most malignant part of a tumour when performing biopsies or resections. Improved assessment of the tumour boundary could help surgeons remove all the tumour tissue without impinging unnecessarily on healthy brain tissue, reducing the risk of relapse after surgery as well as the risk of neurological damage.

Lastly, by applying advanced imaging techniques, which allow measurement of the cellular and vascular structure of a tumour in a non-invasive way, Patrick and colleagues can help monitor patients’ response to treatment.

Read more: Brain and spinal tumours

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