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www.totoku.eu Color Display Megapixel C M Y CM MY CY CMY K EuHos_Dec15.pdf 1 11.12.2015 10:53:42 EUROPEAN HOSPITAL  Vol 25 Issue 1/16 6 EH @ ECR The European Imaging Bio Biomarkers increase impact Report: Michael Krassnitzer ‘In imaging there is a trend towards quantification,’ said Professor Siegfried Trattnig, Medical Director of the High-Field MR Centre (HFMRC) at the Medical University Vienna, Austria. Whilst before, radi- ologists’ findings were subjective, qualitative results, based on signal intensity and grey scale, he point- ed out. ‘Today imaging can draw on quantifiable and comparable parameters with diagnostic value. Biomarkers are playing an increas- ingly important role in imaging,’ the professor emphasised. All imaging modalities use bio- markers, which can be defined as anatomic, physiologic, biochemical or molecular parameters detecta- ble with imaging methods used to establish the presence or severity of disease. Applying quantifiable parameters A very straightforward example of an imaging biomarker is the size and volume of a tumour deter- mined in computed tomography. But spectroscopy and nuclear medicine also apply quantifiable parameters. In tumours, for exam- ple, changes can occur in the cell membrane involving the metabo- lite choline: an increased choline concentration in tissue detected by spectroscopy indicates a malignant tumour. In nuclear medicine tracers that dock onto particular metabo- lites are injected into the body. In magnetic resonance imaging (MRI) – Trattnig’s specialty, T1 and T2 relaxation times and the appar- ent diffusion coefficient (ADC) are measured. ‘On the molecular level healthy and diseased tissues show very different diffusion characteris- tics,’ Trattnig explained. The more cells in the tissue, the higher the water diffusion and ‘since a tumour consists of many more cells than healthy tissue it shows different diffusion characteristics and thus pathological changes can be detect- ed much earlier than in a merely morphological analysis’. In cell diseases the ion pump becomes impaired The Trattnig team at Vienna’s High- Field MR Centre works on sodium MR imaging, which is based on Sodium cartilage transplant: a morphological MR image of a cartilage transplant (arrows indicate the boundaries) on the left, a proteoglycan-specific contrast enhancement (centre) and a sodium MR image that is also proteoglycan-specific (right). Sodium imaging can quantify the proteoglycan concentration, which is relevant since proteoglycan plays an important role for the biomechanical functioning of the cartilage transplant Sodium imaging allows the measurement of concentration characteristics of the kidney, differentiating between renal cortex and renal medulla. Sodium image of kidneys (left); conventional morphological MR image (centre) and a coloured overlay of the sodium image over the anatomical image Dr Siegfried Trattnig is a Professor of Radiology with a focus on high-field MRI at the Medical University in Vienna, Austria. He has been Medical Director of the high-field MRI research scanner since 2000 and, from its founding in 2003, of the High-Field MR Centre (HFMRC) at MedU Vienna. He is also a member of more than 50 scientific committees in all major international radiology, orthopaedics and MRI societies, and has chaired the European Imaging Biomarker Alliance (EIBALL) since its establishment in 2015. Images courtesy of the High Field MR Centre, Vienna © MedUni Wien / Hammerschmidt ECR 2016 Thursday 3 March 8:30–10:00 a.m. Studio 2016 PC 5 Personalised radiology: myth or reality? Continued from page 5 Personalised radiology: myth or reality? and different types of information should be integrated,’ he said. ‘In this way quantitative imaging bio- markers have been developed, and validated, that can predict disease with high accuracy; you can meas- ure the volume of certain brain areas and predict with a high probability the development of Alzheimer’s dis- ease. These biomarkers are now translated from research into daily practice.’ Algorithms automatically measure brain structures volume His team at Rotterdam has devel- oped automated image processing algorithms that allow radiologists to measure accurately, using full automation, the volume of different brain structures, using dedicated work stations that calculate auto- matically these volumes and allow a clinician to see whether they are within the age-related norm or below, meaning that the patient has a relevant atrophy predicting the development of Alzheimer’s disease. Another example is measuring coronary artery calcification as a strong prognostic factor for predict- ing those at risk of fatal coronary heart disease. Research has also shown great potential in the evaluation of ther- apy response of cancer patients by combining molecular information and imaging. Krestin believes this has already had an impact on daily practice. While RECIST is a recognised method for evaluating a certain lesion under cancer therapy, he believes more sophisticated ways of assessing response to treatment are already entering daily prac- tice, either with nuclear medicine methods such as the metabolism of lesions with PET-CT, or looking to the perfusion of lesions with dynamic contrast-enhanced MRI. He foresees more of these imag- ing biomarkers being validated and entering clinical practice with the combination of different diagnostic tools - not only for imaging but also molecular, biologic and biochemical tests - leading to integrated diag- nostics. Treatments will become more customised The evolution of a personalised approach combined with precision imaging will see fewer unneces- sary treatments and side effects for patients. ‘The whole treatment will be a lot of more customised and, because we are using personalised prediction, it will help to identify, much earlier, those individuals who may be at risk of developing dis- eases.’ Krestin also believes the shift to personalised and precision med- icine and imaging will be cost- effective. ‘An unselected use of very expensive drugs will be a lot more costly than the precise selection of those individuals who could benefit from a certain expensive treatment.’ Acknowledging that radiologists need more expertise in molecu- lar biology, he suggests that they should also apply more measure- ments in their daily practice, because it is more accurate than descriptive reports. ‘Structuring reports, includ- ing quantitative data, is helpful in order to really compare results and deliver the relevant information to the clinicians,’ he suggested. ‘I also think integration of other relevant findings from pathology or laboratory medicine into the final report in the sense of an integrated report is the way forward.’ A range of imaging methods will still play a role because each has benefits and drawbacks and many are complimentary, depending on whether radiologists want to ‘pre- dict, screen, make a diagnosis or monitor therapy’. Machine learning and Big Data will help manage the enormous amount of data and support the clinician in measurements, he said, as ‘perception with only the eyes will not reveal all the subtle find- ings. Some of these measurements are time-consuming, therefore algo- rithms based on machine learning and big data will help us to perform these relevant measurements in an automated or semi-automated fash- ion. ‘Big data will allow us to estab- lish correlations between our imag- ing biomarkers and other “omics” information, putting imaging into a crucial role of elucidating patho- physiology and assessing on an individual basis the relevance and extent of disease.’ Establishing a European bio An official collaboration between the European Society of Radiology (ESR) and the Biobanking and Biomolecular Resources Research Infrastructures – European Research Infrastructure Consortium (BBMRI- ERIC) began last November when the organisations signed a Memorandum of Understanding on to seal their partnership. Through its European Action Plan for Medical Imaging, launched in November 2014, the ESR has drawn the attention of EU institutions and other stakeholders to the impor- tance of integrating imaging and ‘omics’ data and the need for a structured repository for imaging data to facilitate personalised medi- cine, clinical trials, and new drugs evaluation. The society has since worked on a strategy to support the development of European biobanks in medical imaging to simplify access to knowl- edge, improve interoperability, standardisation, and data manage- ment, and to ensure a harmonised approach to data quality assurance. The immediate purpose of imaging biobanks will be to allow the gener- ation of imaging biomarkers for use in research studies and to support biological validation of existing and novel imaging biomarkers. The ESR reports that the soci- ety is particularly pleased with the BBMRI-ERIC collaboration, which will facilitate development in the Integrating and ‘omics EuHos_Dec15.pdf 111.12.201510:53:42

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