Diagnosing childhood medulloblastomas by improved MRI scans

18 May 2015

Professor Andrew Peet, University of Birmingham

Medulloblastomas are the most common childhood malignant brain tumours and only around 60 per cent of young patients survive. Different medulloblastoma subtypes respond differently to treatment and rapid diagnosis is essential to aid treatment planning. Professor Peet is working with colleagues from other UK centres to develop a new tool to allow rapid, non-invasive diagnosis that can inform critical initial treatment decisions.

Amount of grant: £499,681 | Date of award: March 2015

Overview

Medulloblastomas are the most common malignant brain tumours in children. They have a poor prognosis, with a five-year survival rate of only around 60 per cent.

It has recently been shown that there are four main subtypes of medulloblastoma, each of which has its own underlying genetic makeup. Doctors are starting to treat each of the subtypes differently in order to improve the outcome for patients. Diagnosis is carried out by performing surgery to obtain a tumour sample, which is then sent to the lab for analysis.

In this project, Professor Peet and colleagues from centres in Nottingham, Newcastle, Liverpool, London and Birmingham will develop a new diagnostic tool that uses MRI scanning techniques instead of surgery.

A special type of MRI scan (called magnetic resonance spectroscopy, MRS) can detect differences in the chemical composition of tissue samples. The team will design an MRS test that can distinguish between the chemical profiles of the different medulloblastoma subtypes. To do this, they first need to build up a ‘reference library’ containing the chemical profiles of a large set of medulloblastomas.

Medulloblastoma tissue samples will be collected by the participating treatment centres and sent to the Peet laboratory in Birmingham, where the chemical profile of each sample will be determined by a technique known as magic angle spinning. At the same time the tumour samples will undergo a sophisticated set of tests in Newcastle to determine their genetic make-up and the subtype to which they belong. Computer software will then be used to define the chemical patterns that correspond to each of the four medulloblastoma subtypes.

The team expects to analyse 120 to 160 samples during the course of the project and the results will form the ‘reference library’ required for the development of the MRS test, ultimately allowing the subtypes to be determined using scans directly on the children.

About the research team

I suspect very few centres in the world will have this level of infrastructure, resources and expertise in medulloblastoma and advanced imaging to complete such investigations.
External reviewer
Andrew Peet is Professor of Paediatric Oncology at the University of Birmingham and Honorary Consultant at Birmingham Children’s Hospital. He is the lead of the Brain Tumour Research Group at the University of Birmingham, which is developing functional imaging for the diagnosis, understanding and management of childhood brain tumours.

In this project, Professor Peet builds on existing, successful collaborations between some of the UK’s major children’s cancer centres. In particular, the project builds on the long-standing collaboration between Birmingham’s Brain Tumour Research Group, the Children’s Brain Tumour Research Centre in Nottingham (Professor Richard Grundy) and the Medulloblastoma Biology Group at Newcastle University (Professor Steven Clifford).

These collaborations form an essential link between imaging and tumour biology and the team is well-placed to take methods such as those developed by the study and translate them into routine clinical practice.

What difference will this project make?

Non-invasive methods for diagnosing the medulloblastoma sub-groups will allow medical teams to plan treatment at the time the child is first referred, rather than waiting days or even weeks for surgery and subsequent processing of samples.

This earlier diagnosis should help to improve outcomes by allowing more informed initial treatment decisions and earlier treatment planning. It will also aid discussions with the child and family in the crucial early stages of their admission to hospital.

Early diagnosis of medulloblastoma subgroups may also help to avoid unnecessary surgery and some of the associated devastating complications such as Posterior Fossa Syndrome, a devastating complication of surgery leading to mutism and associated severe problems with swallowing and balance. Children may take years to recover from such complications.  

The insight that this project will give into the metabolism of medulloblastoma tumours may allow radically new treatment approaches to be taken. In future, accurate non-invasive diagnosis may avoid surgery altogether.

Read more: About childhood brain tumoursOther brain tumour research | Patient stories: brain tumours

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