Glioma Clinical Trial
Official title:
Multimodal Imaging of Hypoxia in Gliomas
The imaging of cerebral oxygenation is an extremely important tool in understanding the
pathophysiology of the tumor and for adaptation of therapies according to hypoxia. Currently,
imaging of cerebral oxygenation is mainly performed by the use of Positron Emission
Tomography (PET). Thus, the investigators have been able to show that the FMISO radiotracer
can reveal tumor hypoxia (HypOnco study, promotor: Caen University Hospital, main
investigator: J.S. Guillamo). After injection of the radiotracer, increased uptake is
observed in the regions for which the tissue oxygen pressure is less than 10 mmHg (the
healthy brain with a tissue oxygen pressure (ptO2) ≈ 40mmHg).
Although PET is a reference methodology, it is not widely practiced mainly because of
radioactive sources. Magnetic Resonance Imaging (MRI) would bypass the previously mentioned
PET limitations. The investigators have recently shown that a measure of local oxygen
saturation could be obtained by MRI.
This methodology has also been implemented at a clinical scale on lower field MRI magnets,
but its formal validation in a clinical situation remains to be demonstrated with respect to
FMISO.
The major advantage of this methodology is that MRI is already performed in routine practice
for patients. Measuring tissue oxygenation with MRI (SatO2-MRI) would not add additional
examination for the patient. In addition, MRI is a non-ionizing methodology with a very good
spatial resolution compared to PET, this should help to better understand intratumoral
heterogeneity. Similarly, in preclinical studies, the investigators have shown in a context
of mild hypoxia that SatO2-MRI may be more sensitive than PET.
The investigators propose a study to compare in patients with glial tumors, images obtained
by 3 Tesla MRI of SatO2-MRI to the hypoxia maps obtained by FMISO PET. These imaging studies
will be confronted with studies carried out in immunohistochemistry on biopsies / resection
allowing to reveal and to quantify by image analysis the expression of the factors induced by
hypoxia (HIF1, HIF2).
This study should include 20 patients with glioma (15 high-grade patients and 5 low-grade
patients) in pre-surgery. The aim is to show that SatO2-MRI is a relevant methodology (in
terms of sensitivity, specificity) for assessing intratumoral oxygenation in a context of
brain tumors. This fits perfectly into an era of personalized medicine where functional
imaging finds its meaning.
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