Sodium Imaging as Cancer Biomarker Innovations and Solutions in Sodium Imaging: Part II Triple Modal Sodium MRI/CT-PET Imaging Clinical Applications, Physician Guideline, Neoadjuvant Chemotherapy Monitoring, Navigation, Treatment Response and Patient Outc

Abstract

A triple modal hybrid sodium magnetic resonance imaging (MRI) with positron emission tomography/computed tomography (PET/CT) biomarker protocol was proposed.

Aim: The protocol was proposed to monitor, navigate the in vivo cancer-specific bio signal to biosense the response of neoadjuvant chemotherapy treatment in patients receiving pre-surgery systemic therapy (PST) given to locally advanced prostate and breast cancer patients.

Protocol: Patients with a stage II or III brain, breast and prostate cancers receiving PST will be recommended for triple modal positron emission tomography (PET), magnetic resonance imaging (MRI), simultaneously with cancer biopsies at baseline and after the first cycle of PST (days 7–8) is proposed during the full course of treatment.

Materials and Methods: For PET/CT imaging, patients will be injected with 2-deoxy-2-[18F]-fluoro-D-glucose (18FDG, 0.22 mCi/kg) for standardized uptake value assessment (SUV) measurements. Diagnostic cancer sodium (23Na-MRI) at 7T will be used for total tissue sodium concentration (TSC), response criteria in solid tumors (RECIST), and tumor volume measurement. Chemotherapy treatment response will indicate by pathological assessment during surgery. Immunohistochemistry, proliferative index (Ki-67) will be performed for navigation on biopsy specimens.

Results: A typical protocol included eligible women (45 ± 11 years) who received PST will be scanned by radiological imaging of 18FDG-PET/CT and MRI for at least two cycles of treatment. The biomarkers will be: partial response (pPR) and pathological non-response (pNR), TSC decrease, sodium MRI visible size, reduction in SUV, proliferation index Ki-67 decline in responders in the first cycle but increased in the non-responders.

Discussion: Significant changes in tumor images, TSC, SUV, and Ki-67 in responders and non- responders may indicate the patient outcome. The triple-modal 23Na MRI, and PET/CT, immunostaining metrics may serve as robust physician guidelines of radio imaging monitoring the PST response in patients with operable brain, breast, and prostate cancers.

Conclusion: The protocol is suitable as physian’s guideline to assess cancer therapy.