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实时多模态成像在脑胶质瘤肿瘤切除和复发中的应用。

Real-time multi-modality imaging of glioblastoma tumor resection and recurrence.

机构信息

Molecular Neurotherapy and Imaging Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.

出版信息

J Neurooncol. 2013 Jan;111(2):153-61. doi: 10.1007/s11060-012-1008-z. Epub 2012 Dec 16.

Abstract

The lack of relevant pre-clinical animal models incorporating the clinical scenario of Glioblastoma multiforme (GBM) resection and recurrence has contributed significantly to the inability to successfully treat GBM. A multi-modality imaging approach that allows real-time assessment of tumor resection during surgery and non-invasive detection of post-operative tumor volumes is urgently needed. In this study, we report the development and implementation of an optical imaging and magnetic resonance imaging (MRI) approach to guide GBM resection during surgery and track tumor recurrence at multiple resolutions in mice. Intra-operative fluorescence-guided surgery allowed real-time monitoring of intracranial tumor removal and led to greater than 90 % removal of established intracranial human GBM. The fluorescent signal clearly delineated tumor margins, residual tumor, and correlated closely with the clinically utilized fluorescence surgical marker 5-aminolevulinic acid/porphyrin. Post-operative non-invasive optical imaging and MRI confirmed near-complete tumor removal, which was further validated by immunohistochemistry (IHC). Longitudinal non-invasive imaging and IHC showed rapid recurrence of multi-focal tumors that exhibited a faster growth rate and altered blood-vessel density compared to non-resected tumors. Surgical tumor resection significantly extended long-term survival, however mice ultimately succumbed to the recurrent GBM. This multi-modality imaging approach to GBM resection and recurrence in mice should provide an important platform for investigating multiple aspects of GBM and ultimately evaluating novel therapeutics.

摘要

由于缺乏将胶质母细胞瘤(GBM)切除和复发的临床情况纳入的相关临床前动物模型,因此无法成功治疗 GBM。目前迫切需要一种多模态成像方法,以便在手术过程中实时评估肿瘤切除情况,并在术后非侵入性地检测肿瘤体积。在本研究中,我们报告了一种光学成像和磁共振成像(MRI)方法的开发和实施,该方法可在手术过程中指导 GBM 切除,并在小鼠中以多种分辨率跟踪肿瘤复发。术中荧光引导手术可实时监测颅内肿瘤切除情况,并使已建立的颅内人 GBM 的切除率超过 90%。荧光信号清楚地描绘了肿瘤边界、残留肿瘤,并且与临床上使用的荧光手术标记物 5-氨基乙酰丙酸/卟啉密切相关。术后非侵入性光学成像和 MRI 证实了肿瘤的近乎完全切除,免疫组织化学(IHC)进一步验证了这一点。纵向非侵入性成像和 IHC 显示多灶性肿瘤快速复发,与未切除的肿瘤相比,这些肿瘤的生长速度更快,血管密度也发生了改变。手术切除肿瘤显著延长了长期存活时间,但小鼠最终死于复发性 GBM。这种用于小鼠 GBM 切除和复发的多模态成像方法应为研究 GBM 的多个方面提供重要平台,并最终评估新的治疗方法。

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