Assessing Response to Therapy in Neuroblastoma with MRI T1 Mapping.

Abstract

HomeRadiology: Imaging CancerVol. 2, No. 5 Previous Research HighlightsFree AccessAssessing Response to Therapy in Neuroblastoma with MRI T1 MappingGary D. LukerGary D. LukerGary D. LukerPublished Online:Sep 25 2020https://doi.org/10.1148/rycan.2020209026MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Take-Away Points■ Major Focus: Investigating T1 mapping as a quantitative, functional MRI marker for response to targeted therapy in neuroblastoma.■ Key Result: Regions with high T1 corresponded with undifferentiated neuroblasts, which decreased with successful therapy.■ Impact: Clinical translation of T1 mapping may help improve precision medicine for children with neuroblastoma and other malignancies with similar pathologic features.Neuroblastoma is a childhood malignancy that arises from neural crest cells in the sympathetic nervous system. Amplification of the gene MYCN, the most common genetic abnormality in this cancer, marks patients with aggressive disease and poor prognosis. Trials with drugs designed to destabilize MYCN protein require functional imaging methods to measure response to therapy earlier and with greater sensitivity than changes in tumor volume. Imaging cell membrane transporters for norepinephrine or metabolism with metaiodobenzylguanidine (MIBG) or fluorine-18 2-fluoro-2-deoxyglucose PET/CT, respectively, provide functional information but expose children to additional radiation and imaging studies. Since the soft-tissue delineation of MRI makes it the preferred method for anatomic imaging of neuroblastoma, an MRI-based functional imaging method would streamline evaluation.Using a genetically engineered mouse model of MYCN neuroblastoma, Zormpas-Petridis et al discovered that T1 mapping from MRI detects tumor heterogeneity. Regions with high and low T1 signal corresponded to areas in tumors with large numbers of undifferentiated neuroblasts and more differentiated cancer cells, respectively. Treatment with targeted inhibitors against aurora A kinase (alisertib) or mTOR (vistusertib) reduced T1 signal due to death of undifferentiated neuroblasts. The authors proposed that undifferentiated neuroblasts produce high T1 signal because these cells have very large nuclei and minimal cytoplasm, similar to other “small round blue cell tumors” including medulloblastoma, Ewing sarcoma, and small cell lung cancer. These data support clinical trials using T1 mapping to monitor response to targeted therapies in neuroblastoma and suggest this MRI method may extend to other tumors in the group of small round blue cell tumors.Highlighted ArticleZormpas-Petridis K, Poon E, Clarke M, et al. Noninvasive MRI native T1 mapping detects response to MYCN-targeted therapies in the Th-MYCN model of neuroblastoma. Cancer Res 2020;80:3424–3435. doi: 10.1158/0008-5472.CAN-20-0133.Highlighted ArticleZormpas-Petridis K, Poon E, Clarke M, et al. Noninvasive MRI native T1 mapping detects response to MYCN-targeted therapies in the Th-MYCN model of neuroblastoma. Cancer Res 2020;80:3424–3435. doi: 10.1158/0008-5472.CAN-20-0133. Crossref, Medline, Google ScholarArticle HistoryPublished online: Sept 25 2020 FiguresReferencesRelatedDetailsRecommended Articles Updates in Diagnosis, Management, and Treatment of NeuroblastomaRadioGraphics2018Volume: 38Issue: 2pp. 566-580Extraskeletal Ewing Sarcoma from Head to Toe: Multimodality Imaging ReviewRadioGraphics2022Volume: 42Issue: 4pp. 1145-1160Current and Emerging Roles of Whole-Body MRI in Evaluation of Pediatric Cancer PatientsRadioGraphics2019Volume: 39Issue: 2pp. 516-534Pediatric Brain Tumor Genetics: What Radiologists Need to KnowRadioGraphics2018Volume: 38Issue: 7pp. 2102-2122MIBG in Neuroblastoma Diagnostic Imaging and TherapyRadioGraphics2016Volume: 36Issue: 1pp. 258-278See More RSNA Education Exhibits Big List of Malignant Small Round Cell Tumors: A Pictorial Exhibit on CTDigital Posters2018Stain Your Brain: Neuropathology of Pediatric Brain TumorsDigital Posters2018Li Fraumeni Syndrome: Genomics, Oncogenesis and Where to Look on Whole-Body Surveillance ImagingDigital Posters2019 RSNA Case Collection Ewing's sarcomaRSNA Case Collection2020Metastatic MedulloblastomaRSNA Case Collection2021Desmoplastic Small Round Cell Tumor RSNA Case Collection2021 Vol. 2, No. 5 Metrics Altmetric Score PDF download