UCSF

The clinical paradigm for treating and monitoring cancer is evolving: an increasing number of targeted agents are available for treatment and, with them, an enhanced understanding of the genomic, epigenomic, and metabolic aspects of tumors. Novel, non-invasive imaging methods are required to keep pace with such advances and to allow for the personalization of treatment decisions based on the underlying features of the tumor. This is especially true for infiltrating gliomas, which are biologically heterogeneous in nature and highly complex in their clinical management.

Anatomic and functional magnetic resonance (MR) imaging is the clinical mainstay for monitoring patients with glioma, offering valuable information on the structural composition and vascularization of the tumor and surrounding tissue. Yet the decision of when to treat and which therapies to choose have remained controversial and have relied primarily on invasive neurosurgery, which carries significant risks to the patient. MR spectroscopy is a powerful metabolic imaging technique that is capable of measuring the biochemical compounds present in tissue. This dissertation has investigated the utility of in vivo and ex vivo spectroscopic profiling to characterize a large cohort of patients with recurrent glioma. The metabolic and physiological information obtained has provided critical insights as to the aggressiveness, histological subtype, and genotype of the tumors.

The results present in this dissertation strongly support the integration of MR spectroscopy into standard clinical protocols. The non-invasive and highly versatile nature of this approach would allow clinicians to better assess and manage this deadly disease. Most importantly, we hope that this study and others will ultimately improve the outcome and quality of life for these patients, as well as provide applications for other cancers.