Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Magn Reson. 2018 Jun;291:141-151. doi: 10.1016/j.jmr.2018.03.004. Epub 2018 Apr 26.
Most diseases, especially cancer, would significantly benefit from precision medicine where treatment is shaped for the individual. The concept of theragnostics or theranostics emerged around 2002 to describe the incorporation of diagnostic assays into the selection of therapy for this purpose. Increasingly, theranostics has been used for strategies that combine noninvasive imaging-based diagnostics with therapy. Within the past decade theranostic imaging has transformed into a rapidly expanding field that is located at the interface of diagnosis and therapy. A critical need in cancer treatment is to minimize damage to normal tissue. Molecular imaging can be applied to identify targets specific to cancer with imaging, design agents against these targets to visualize their delivery, and monitor response to treatment, with the overall purpose of minimizing collateral damage. Genomic and proteomic profiling can provide an extensive 'fingerprint' of each tumor. With this cancer fingerprint, theranostic agents can be designed to personalize treatment for precision medicine of cancer, and minimize damage to normal tissue. Here, for the first time, we have introduced the term 'metabolotheranostics' to describe strategies where disease-based alterations in metabolic pathways detected by MRS are specifically targeted with image-guided delivery platforms to achieve disease-specific therapy. The versatility of MRI and MRS in molecular and functional imaging makes these technologies especially important in theranostic MRI and 'metabolotheranostics'. Our purpose here is to provide insights into the capabilities and applications of this exciting new field in cancer treatment with a focus on MRI and MRS.
大多数疾病，特别是癌症，将从精准医疗中显著受益，这种医疗方式会根据个体情况进行治疗方案的制定。治疗诊断一体化（theragnostics 或 theranostics）的概念大约在 2002 年出现，用于描述将诊断检测纳入治疗选择的方法。越来越多的治疗诊断一体化策略将非侵入性成像诊断与治疗相结合。在过去十年中，治疗诊断一体化成像已发展成为一个快速扩张的领域，位于诊断和治疗的交界处。癌症治疗的一个关键需求是尽量减少对正常组织的损害。分子成像可用于通过成像识别针对癌症的特定靶点，设计针对这些靶点的药物以可视化其递呈，并监测治疗反应，从而尽量减少附带损害。基因组和蛋白质组分析可以提供每个肿瘤的广泛“指纹”。有了这个癌症指纹，治疗诊断一体化试剂可以设计用于癌症的精准医疗，尽量减少对正常组织的损害。在这里，我们首次提出“代谢治疗诊断一体化”这一术语，用于描述通过 MRS 检测到的代谢途径的疾病相关改变，并通过图像引导的递呈平台进行特异性靶向，以实现针对特定疾病的治疗。MRI 和 MRS 在分子和功能成像方面的多功能性使得这些技术在治疗诊断一体化 MRI 和“代谢治疗诊断一体化”中尤为重要。我们的目的是提供对这一令人兴奋的癌症治疗新领域的功能和应用的深入了解，重点关注 MRI 和 MRS。
