WO2025026987A1 - Mri method for quantifying the concentration of a contrast agent and associated device - Google Patents
Mri method for quantifying the concentration of a contrast agent and associated device Download PDFInfo
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- G—PHYSICS
- G01—MEASURING; TESTING
- G01R—MEASURING ELECTRIC VARIABLES; MEASURING MAGNETIC VARIABLES
- G01R33/00—Arrangements or instruments for measuring magnetic variables
- G01R33/20—Arrangements or instruments for measuring magnetic variables involving magnetic resonance
- G01R33/44—Arrangements or instruments for measuring magnetic variables involving magnetic resonance using nuclear magnetic resonance [NMR]
- G01R33/48—NMR imaging systems
- G01R33/50—NMR imaging systems based on the determination of relaxation times, e.g. T1 measurement by IR sequences; T2 measurement by multiple-echo sequences
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- G—PHYSICS
- G01—MEASURING; TESTING
- G01R—MEASURING ELECTRIC VARIABLES; MEASURING MAGNETIC VARIABLES
- G01R33/00—Arrangements or instruments for measuring magnetic variables
- G01R33/20—Arrangements or instruments for measuring magnetic variables involving magnetic resonance
- G01R33/44—Arrangements or instruments for measuring magnetic variables involving magnetic resonance using nuclear magnetic resonance [NMR]
- G01R33/48—NMR imaging systems
- G01R33/54—Signal processing systems, e.g. using pulse sequences ; Generation or control of pulse sequences; Operator console
- G01R33/56—Image enhancement or correction, e.g. subtraction or averaging techniques, e.g. improvement of signal-to-noise ratio and resolution
- G01R33/5601—Image enhancement or correction, e.g. subtraction or averaging techniques, e.g. improvement of signal-to-noise ratio and resolution involving use of a contrast agent for contrast manipulation, e.g. a paramagnetic, super-paramagnetic, ferromagnetic or hyperpolarised contrast agent
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- G—PHYSICS
- G01—MEASURING; TESTING
- G01R—MEASURING ELECTRIC VARIABLES; MEASURING MAGNETIC VARIABLES
- G01R33/00—Arrangements or instruments for measuring magnetic variables
- G01R33/20—Arrangements or instruments for measuring magnetic variables involving magnetic resonance
- G01R33/44—Arrangements or instruments for measuring magnetic variables involving magnetic resonance using nuclear magnetic resonance [NMR]
- G01R33/48—NMR imaging systems
- G01R33/54—Signal processing systems, e.g. using pulse sequences ; Generation or control of pulse sequences; Operator console
- G01R33/56—Image enhancement or correction, e.g. subtraction or averaging techniques, e.g. improvement of signal-to-noise ratio and resolution
- G01R33/5602—Image enhancement or correction, e.g. subtraction or averaging techniques, e.g. improvement of signal-to-noise ratio and resolution by filtering or weighting based on different relaxation times within the sample, e.g. T1 weighting using an inversion pulse
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- G—PHYSICS
- G01—MEASURING; TESTING
- G01R—MEASURING ELECTRIC VARIABLES; MEASURING MAGNETIC VARIABLES
- G01R33/00—Arrangements or instruments for measuring magnetic variables
- G01R33/20—Arrangements or instruments for measuring magnetic variables involving magnetic resonance
- G01R33/44—Arrangements or instruments for measuring magnetic variables involving magnetic resonance using nuclear magnetic resonance [NMR]
- G01R33/48—NMR imaging systems
- G01R33/54—Signal processing systems, e.g. using pulse sequences ; Generation or control of pulse sequences; Operator console
- G01R33/56—Image enhancement or correction, e.g. subtraction or averaging techniques, e.g. improvement of signal-to-noise ratio and resolution
- G01R33/561—Image enhancement or correction, e.g. subtraction or averaging techniques, e.g. improvement of signal-to-noise ratio and resolution by reduction of the scanning time, i.e. fast acquiring systems, e.g. using echo-planar pulse sequences
- G01R33/5615—Echo train techniques involving acquiring plural, differently encoded, echo signals after one RF excitation, e.g. using gradient refocusing in echo planar imaging [EPI], RF refocusing in rapid acquisition with relaxation enhancement [RARE] or using both RF and gradient refocusing in gradient and spin echo imaging [GRASE]
- G01R33/5617—Echo train techniques involving acquiring plural, differently encoded, echo signals after one RF excitation, e.g. using gradient refocusing in echo planar imaging [EPI], RF refocusing in rapid acquisition with relaxation enhancement [RARE] or using both RF and gradient refocusing in gradient and spin echo imaging [GRASE] using RF refocusing, e.g. RARE
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- G—PHYSICS
- G01—MEASURING; TESTING
- G01R—MEASURING ELECTRIC VARIABLES; MEASURING MAGNETIC VARIABLES
- G01R33/00—Arrangements or instruments for measuring magnetic variables
- G01R33/20—Arrangements or instruments for measuring magnetic variables involving magnetic resonance
- G01R33/44—Arrangements or instruments for measuring magnetic variables involving magnetic resonance using nuclear magnetic resonance [NMR]
- G01R33/48—NMR imaging systems
- G01R33/58—Calibration of imaging systems, e.g. using test probes, Phantoms; Calibration objects or fiducial markers such as active or passive RF coils surrounding an MR active material
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
- A61N2005/1092—Details
- A61N2005/1098—Enhancing the effect of the particle by an injected agent or implanted device
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- G—PHYSICS
- G01—MEASURING; TESTING
- G01R—MEASURING ELECTRIC VARIABLES; MEASURING MAGNETIC VARIABLES
- G01R33/00—Arrangements or instruments for measuring magnetic variables
- G01R33/20—Arrangements or instruments for measuring magnetic variables involving magnetic resonance
- G01R33/44—Arrangements or instruments for measuring magnetic variables involving magnetic resonance using nuclear magnetic resonance [NMR]
- G01R33/48—NMR imaging systems
- G01R33/4808—Multimodal MR, e.g. MR combined with positron emission tomography [PET], MR combined with ultrasound or MR combined with computed tomography [CT]
- G01R33/4812—MR combined with X-ray or computed tomography [CT]
Definitions
- the technical field of the invention is the quantification of a contrast agent in a human or animal body.
- Radiotherapy is a treatment commonly applied to cancer. Radiotherapy may be one of the only treatments applicable in certain types of cancer, particularly cancers that are difficult to operate and/or take the form of diffuse tumors. This is particularly the case for certain brain tumors.
- nanoparticles have the ability to increase, by radiobiological effect, the damage induced to a tumor during exposure to ionizing electromagnetic radiation of type X or gamma. This is called a radiosensitizing effect or an increase in dose deposition leading to harmful biological effects on tumor cells.
- These nanoparticles can also have the properties of contrast agents for MRI (Magnetic Resonance Imaging). They are then called “theranostic” agents, due to their combined application in the field of therapy and diagnosis by MRI imaging.
- Nanoparticles referred to as AGulX (Activation and Guidance of Irradiation by X-ray), concentrate a large number of Gd 3+ ions in nanoparticles with a diameter of less than 10 nm.
- These particles consist of a polymer core, on the surface of which are chelated metal ions, the atomic number of which is high. It has been shown that this type of nanoparticle makes it possible to increase radiation-induced damage in brain tumors, in particular by radiobiological effect, while providing protection with respect to surrounding healthy tissues, due to the high atomic number.
- Such particles are for example described in WO2022/106788, WO2011135101, WO2018224684 or WO2019008040. They are currently administered intravenously to patients prior to radiotherapy as part of their treatment pathway.
- the concentration in the tumor tissues to be treated of the previously administered theranostic contrast agent In order to guide radiotherapy, it is necessary to know the concentration in the tumor tissues to be treated of the previously administered theranostic contrast agent.
- MRI can be implemented, before and after administration. of the contrast agent, so as to obtain a spatial distribution of the longitudinal relaxation time Ti.
- the concentration of the contrast agent is estimated according to the expression: Or
- Ti, pre and Ti,p 0S t are the times 7 respectively before and after the administration of the contrast agent (unit: s); is a longitudinal relaxivity constant of the contrast agent (unit: mW 1 s" 1), and whose value is assumed to be known
- C is the concentration of the contrast agent (unit: mM)
- the VFA (Variable Flip Angle) sequence allows to obtain a 3D mapping of the relaxation time Tl.
- the VFA sequence requires multiple successive spoiled gradient echo acquisitions (group of fast gradient echo sequences including a phase-shifting gradient called spoiler), by varying the excitation angle.
- the VFA sequence is known to be sensitive to magnetic field inhomogeneities, which generates measurement errors.
- VFA sequence Another disadvantage of the VFA sequence is a too long acquisition time, which results in an occupancy time of the imaging device too long for routine use.
- Clinical MRI imaging protocols for patients with brain metastases are primarily intended to obtain good anatomical representation, and in particular good discrimination between metastases and healthy tissues, particularly in the context of diagnosis and possibly pre-therapeutic assessment.
- the MPRAGE (Magnetization-Prepared Rapid Gradient Echo) acquisition sequence is a potentially usable gradient echo sequence.
- the MPRAGE sequence can induce confusion between a brain metastasis and a blood vessel, which can generate false positives.
- Tl-weighted 3D TSE Transcription-based Transcription-based MRI
- SPACE CUBE
- VISTA FASE3D mVox
- FASE3D mVox FASE3D mVox by leading MRI manufacturers.
- the Tl-weighted 3D TSE sequence is known to generate an accurate anatomical representation.
- the TSE sequence provides good discrimination between metastases and blood vessels. It is therefore particularly suitable for detecting metastases.
- the inventors propose a method for establishing the concentration of a contrast agent by implementing a routine MRI sequence, of the fast spin echo type.
- the concentration is obtained by measuring the relaxation time Tl from the intensity of an image of a section. This involves going beyond the simple comparison of sequences.
- a first object of the invention is a method for measuring a concentration of a contrast agent in at least one body area of a living human or animal individual, the method comprising:
- steps a) to b) being implemented before and after an administration of a contrast agent to the individual, so as to obtain an estimation of relaxation times Tl, in the body area, respectively before and after the administration of the contrast agent;
- the magnetic resonance imaging modality is a Tl-weighted fast spin echo modality, for example Tl-weighted 3D TSE;
- each step c) is implemented using a calibration function, establishing a correspondence between the intensity of an image of the body area and the relaxation time Tl, the calibration function being obtained, prior to step c), during a calibration phase comprising:
- step a) the body area is placed in a tunnel, subjected to a magnetic field;
- the phantom is placed in the tunnel, in place of the body area.
- different compartments of the phantom respectively comprise different chemical species or different concentrations of the same chemical species, so that the relaxation times Tl of said compartments are different from each other.
- different compartments of the phantom have the same concentration of the same chemical species.
- the calibration function is established by a regression, from the pairs (signal intensity of an image of the compartment - relaxation time Tl of the compartment) taken into account during step iv) of the calibration phase.
- the contrast agent may be a radiosensitizing agent.
- the method may comprise, following step d), a determination of an irradiation dose in different parts of the body area, as a function of the concentrations of the contrast agent resulting from step d).
- Another object of the invention is a processing unit, configured to process an image acquired by a magnetic resonance imaging device, according to a fast spin echo acquisition modality, for example of the 3D TSE type, weighted in Tl, the processing unit being programmed to apply, to the acquired image, a calibration function resulting from an implementation of a calibration phase comprising:
- Figure 1 shows a schematic of an MRI imaging device, allowing implementation of the invention.
- Figure 2A shows a stack of plates forming a calibration phantom.
- Figure 2B shows the plates arranged in an envelope, the envelope allowing manipulation of the phantom.
- Figure 2C shows an example of a plate configuration.
- Figure 2D shows an image of the compartments embedded in a plaque obtained by an MRI modality using a Tl-weighted 3D TSE sequence.
- Figure 3 shows the establishment of a bijective calibration function to relate the relaxation time Tl to the intensity on an image resulting from a fast spin echo sequence, for example Tl-weighted 3D TSE.
- Figure 4 shows schematically the main steps of implementing a method according to the invention.
- Figure 1 shows a device 1 allowing an implementation of the invention.
- the device is an MRI imaging device, comprising a cylindrical magnet extending around a tunnel 2.
- the tunnel extends around a central axis A.
- the device is intended to produce images of sections of biological tissues, in particular of the body areas of a living human or animal individual.
- the hydrogen nuclei of the body area emit a radiofrequency signal, the latter being measured by receiving antennas of the device 1.
- the device 1 forms anatomical sections of the body area examined.
- the sections are two-dimensional images, in which the intensity depends on the composition of the body area examined.
- the device 1 comprises a central unit 3, programmed to generate the images from detected radiofrequency signals.
- the central unit can be formed by a microprocessor or different microprocessors.
- the central unit is to be considered as the set of calculation means allowing the formation and processing of the images.
- Tl-weighted 3D TSE modality allows rapid obtaining of anatomical images of a body area.
- the obtained images can be displayed in sections of the body areas in any plane relative to the central axis A of the tunnel.
- the inventors chose to establish, experimentally, a calibration function making it possible to establish a relationship between the intensity, at each point of a section image, and the relaxation time Tl. To do this, they designed a phantom, shown in FIGS. 2A to 2C.
- the phantom 10 is intended to be placed in the tunnel, in place of the individual examined.
- the phantom 10 is formed of three identical plates 11, 12, 13 stacked on top of each other.
- Each plate is composed of compartments 20, comprising compositions having relaxation times T1 that are known and different from each other.
- the compartments 20 comprise solutions of paramagnetic chemical species whose composition and concentration are known.
- each plate comprises 48 different tubes, arranged in a regular matrix arrangement. Each tube forms a compartment containing a solution of known composition.
- the tubes of the same plate comprise either the same chemical species, with respectively different concentrations, or different chemical species. The arrangement of the plates is described in more detail in connection with FIG. 2C.
- chemical species we mean a molecule or a chemical element or an ionic compound.
- the three plates 11, 12, 13 are stacked on top of each other, along a stacking axis Z.
- the assembly is held in a solid transparent cylindrical envelope 14, made of cast PMMA (poly methyl methacrylate acrylic), filled with 9 g/L salt water to simulate the electromagnetic properties of biological tissues.
- Each plate extends along a length L, parallel to a longitudinal axis X and a width l, parallel to a lateral axis Y.
- the Length and width are sized so that the surface area of each plate is comparable to a cross-section of the body area of the individual to be studied. In this case, the body area of interest is the brain.
- the length of each plate is between 10 cm and 15 cm. The same is true for the width.
- the diameter of the envelope 14 is typically between 15 cm and 25 cm;
- the phantom 10 is sized so as to replace the organ to be imaged.
- the targeted body area is surrounded by a receiving antenna.
- the receiving antenna delimits a volume, intended to be occupied by the imaged body area.
- the phantom is preferably sized so as to occupy at least 50% or even 80% of the volume delimited by the receiving antenna.
- the various compartments 11, 12 and 13 and the envelope 20 are watertight.
- the phantom is thus easily transportable.
- the phantom 10 is intended to be placed in the tunnel 2, in place of an individual being examined.
- the Z axis of the phantom then extends parallel to the central axis A of the tunnel 2.
- FIG. 2C shows a possible arrangement of the plates and compartments.
- Each compartment 20 can contain: either a CuSO 4 solution, symbolized by the letter C; or a MnCL solution, symbolized by the letter M; or a NiCL solution, symbolized by the letter N.
- the CuSO 4 concentration is identical. For example, it is 1 mM. Compartments with identical CuSO 4 concentrations ensure the spatial homogeneity of the MRI measurement.
- the compartments containing the NiCL solutions have variable NiCL concentrations, so as to obtain relaxation times Tl at least between 0.5 s and 2.5 s. These are time corresponding to the Tl range of biological tissues.
- NiCl 2 concentrations varied between 0.03 and 4.73 mM.
- the compartments are arranged in concentration increments of 0.1 mM.
- the compartments containing the MnCI 2 solutions have varying MnCI 2 concentrations, so as to obtain relaxation times Tl at least between 0.5 and 3 s.
- the MnCI 2 concentrations varied between 0.002 and 0.472 mM.
- the compartments are arranged in concentration increments of 0.01 mM.
- each compartment of the phantom has a known composition, and therefore known relaxation times Tl.
- Figure 2D is an example of a section of a phantom plate, obtained by a Tl-weighted 3D TSE sequence. It is observed that at the level of each compartment of the phantom, the signal intensity, i.e. the gray level, is homogeneous. The signal intensity can be correlated to the relaxation time Tl, the latter being known, because the composition of each compartment is known.
- the Tl-weighted 3D TSE sequence allows to obtain 144 different gray levels, each of which can be associated with a chemical species and a known concentration, therefore known Tl relaxation times. It is thus possible to establish, at the level of each compartment of the phantom, a pair (Tl relaxation time, intensity).
- each pair (relaxation time Tl, intensity) has been plotted.
- the abscissa axis corresponds to the relaxation time Tl (unit: second).
- the ordinate axis corresponds to the measured gray level (arbitrary units).
- the solid disks correspond to the compartments containing NiCI 2 and the circles correspond to MnCI 2 .
- An important aspect of the invention is that it is not necessary to use the phantom during each use.
- the inventors have found that the same phantom can be used to establish a calibration function of an MRI device.
- the same calibration function can be used to quantify the relaxation time Tl of different individuals successively examined. Thus, it is not necessary to perform a calibration prior to the examination of each individual.
- the calibration can be renewed at regular intervals, for example every week or every month.
- the invention makes it possible to estimate, from a routine MRI imaging modality, for example the Tl-weighted 3D TSE sequence, a spatial distribution of Tl relaxation times, and this before and after the administration of a contrast agent. This makes it possible to estimate, at each point of an image, a concentration of contrast agent by implementing the expression (1) described in the prior art.
- the contrast agents may be nanoparticles on the surface of which metal ions, for example Gd 3+ , are chelated.
- the nanoparticles passively but specifically target tumors by EPR (Enhanced Permeability and Retention) effect.
- Figure 4 shows the main steps of implementing the invention.
- Step 100 arrangement of an individual in tunnel 2 of a device according to the invention and implementation of an MRI modality according to a 3D TSE sequence weighted in Tl.
- Step 110 from radiofrequency signals emitted by a body area of the individual, obtaining images of sections of the body area in an axial, coronal or sagittal plane. Step 110 is implemented by the processing unit 3. The images can be normalized to the values of the proton density, obtained experimentally or predefined.
- Steps 100 and 110 are performed prior to and subsequent to an administration of a contrast agent.
- the administration of the contrast agent is not part of the invention.
- Step 120 estimation of a relaxation time Tl at different points of each image resulting from step 110.
- the estimation can be adjusted by taking into account a healthy area of tissue, whose relaxation time Tl is known, for example gray matter or white matter.
- Step 130 from the relaxation times Tl resulting from step 120, determination of a concentration of contrast agent at the different points of each image.
- Step 120 implements the calibration function -1 previously described.
- the calibration function is implemented by the processing unit 3, in which the calibration function has previously been stored.
- the calibration function is established during a calibration phase which comprises the following steps
- Step 90 Arrange the phantom in the device tunnel and implement an MRI modality according to a Tl-weighted fast spin echo imaging sequence, for example a Tl-weighted 3D TSE sequence.
- a Tl-weighted fast spin echo imaging sequence for example a Tl-weighted 3D TSE sequence.
- Step 91 from radiofrequency signals emitted by each compartment of the phantom, obtaining images of sections of the phantom in an axial, coronal or sagittal plane.
- Step 92 definition of couples (intensity - relaxation time Tl) from the images resulting from step 91
- Step 93 determination, by adjustment or regression, of a calibration function linking the intensity to the relaxation time Tl.
- the calibration function is preferably continuous over a range of relaxation times Tl varying from 0.1 s to 2.5s or 3s.
- Steps 90 to 93 constitute a calibration phase.
- the calibration phase is not repeated for each examination of a new individual.
- the same calibration function is used to interpret different images of different individuals.
- Maps of concentrations of Gd 3+ chelated on AGulX nanoparticles as described in the prior art were compared, using a method as previously described, as well as on the basis of a determination of the relaxation time Tl of a VFA modality. Images were also acquired on individuals with brain metastases. Brain metastases were systematically identified using the invention, i.e. on the basis of an estimation of the concentration of contrast agent carried out from determinations of the relaxation time Tl on images acquired according to the Tl-weighted 3D TSE modality.
- estimates of contrast agent concentrations based on Tl relaxation times on images acquired using the VFA modality did not reveal the presence of metastases.
- each Tl-weighted 3D TSE acquisition was 4 minutes 57 seconds, compared to 11 minutes and 24 seconds for the VFA modality.
- the thickness of each Tl-weighted 3D TSE slice was 1 mm, compared to 4 mm for the VFA modality.
- the inter-slice spacing was 0 mm for the Tl-weighted 3D TSE modality, compared to 2 mm for the VFA modality.
- Tl-weighted 3D TSE sequence for the estimation of Tl relaxation time before and after the administration of a contrast agent, followed by an estimation of the contrast agent concentration, therefore seems particularly relevant.
- Tl relaxation time of the administration of a contrast agent on healthy tissues was also estimated.
- the Tl-weighted 3D TSE sequence was used: no significant increase was observed on white matter and gray matter.
- the VFA method was also used: increases of the order of 300 to 500 ms were measured on white matter and gray matter, while these are healthy tissues. It seems that the estimates of Tl relaxation times using the invention (TSE sequence + application of an empirical calibration function, obtained on a phantom) are more consistent than with the VFA modality.
- the invention can be applied to Gd-based contrast agents of the gadoteric acid type such as gadopentetate dimeglumine, gadobutrol, gadopiclenol or contrast agents based on manganese complex, USPIO (Ultrasmall superparamagnetic iron oxide) and SPIO (superparamagnetic iron oxide), this list not being exhaustive.
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Abstract
Description
PROCEDE IRM DE QUANTIFICATION DE LA CONCENTRATION D'UN AGENT DE CONTRASTE ET DISPOSITIF ASSOCIE MRI METHOD FOR QUANTIFYING THE CONCENTRATION OF A CONTRAST AGENT AND ASSOCIATED DEVICE
Description Description
DOMAINE TECHNIQUE TECHNICAL AREA
Le domaine technique de l'invention est la quantification d'un agent de contraste dans un corps humain ou animal. The technical field of the invention is the quantification of a contrast agent in a human or animal body.
ART ANTERIEUR PRIOR ART
La radiothérapie est un traitement usuellement appliqué au cancer. La radiothérapie peut être un des seuls traitements applicables dans certains types de cancer, en particulier des cancers difficilement opérables et/ou prenant la forme de tumeurs diffuses. C'est notamment le cas de certaines tumeurs du cerveau. Radiotherapy is a treatment commonly applied to cancer. Radiotherapy may be one of the only treatments applicable in certain types of cancer, particularly cancers that are difficult to operate and/or take the form of diffuse tumors. This is particularly the case for certain brain tumors.
Certaines nanoparticules ont la capacité d'augmenter, par effet radio-biologique, les dommages induits à une tumeur lors d'une exposition à un rayonnement électromagnétique ionisant de type X ou gamma. On parle d'effet radio-sensibilisant ou d'augmentation de dépôt de dose entraînant des effets biologiques délétères aux cellules tumorales. Ces nanoparticules peuvent également avoir des propriétés d'agents de contraste pour l'IRM (Imagerie par Résonance Magnétique). Elles sont alors qualifiées d'agents « théranostiques », en raison de leur application combinée dans le domaine de la thérapie et du diagnostic par imagerie IRM. Some nanoparticles have the ability to increase, by radiobiological effect, the damage induced to a tumor during exposure to ionizing electromagnetic radiation of type X or gamma. This is called a radiosensitizing effect or an increase in dose deposition leading to harmful biological effects on tumor cells. These nanoparticles can also have the properties of contrast agents for MRI (Magnetic Resonance Imaging). They are then called "theranostic" agents, due to their combined application in the field of therapy and diagnosis by MRI imaging.
Des nanoparticules, désignées par le terme AGulX (Activation and Guidance of Irradiation by X- ray) concentrent un grand nombre d'ions Gd3+ dans des nanoparticules de diamètre inférieur à 10 nm. Ces particules sont constituées d'un cœur en polymère, à la surface duquel sont chélatés des ions métalliques, dont le numéro atomique est élevé. Il a été montré que ce type de nanoparticule permet d'augmenter les dommages radio-induits dans des tumeurs cérébrales, notamment par effet radio-biologique, tout en conférant une protection à l'égard des tissus sains environnants, du fait du numéro atomique élevé. De telles particules sont par exemple décrites dans WO2022/106788, W02011135101, WO2018224684 ou W02019008040. Elles sont actuellement administrées par voie intraveineuse à des patients préalablement à une radiothérapie dans le cadre de leur parcours de soin. Nanoparticles, referred to as AGulX (Activation and Guidance of Irradiation by X-ray), concentrate a large number of Gd 3+ ions in nanoparticles with a diameter of less than 10 nm. These particles consist of a polymer core, on the surface of which are chelated metal ions, the atomic number of which is high. It has been shown that this type of nanoparticle makes it possible to increase radiation-induced damage in brain tumors, in particular by radiobiological effect, while providing protection with respect to surrounding healthy tissues, due to the high atomic number. Such particles are for example described in WO2022/106788, WO2011135101, WO2018224684 or WO2019008040. They are currently administered intravenously to patients prior to radiotherapy as part of their treatment pathway.
Afin de guider la radiothérapie, il est nécessaire de connaître la concentration dans les tissus tumoraux à traiter, de l'agent de contraste à effet théranostique préalablement administré. A cette fin, l'IRM peut être mise en œuvre, préalablement et postérieurement à l'administration de l'agent de contraste, de façon à obtenir une distribution spatiale du temps de relaxation longitudinal Ti. La concentration de l'agent de contraste est estimée selon l'expression : où In order to guide radiotherapy, it is necessary to know the concentration in the tumor tissues to be treated of the previously administered theranostic contrast agent. For this purpose, MRI can be implemented, before and after administration. of the contrast agent, so as to obtain a spatial distribution of the longitudinal relaxation time Ti. The concentration of the contrast agent is estimated according to the expression: Or
Ti, pre et Ti,p0St sont 'es temps 7 respectivement avant et après l'administration de l'agent de contraste (unité : s); est une constante de relaxivité longitudinale de l'agent de contraste (unité : mW1 s" 1), et dont la valeur est supposée connue Ti, pre and Ti,p 0S t are the times 7 respectively before and after the administration of the contrast agent (unit: s); is a longitudinal relaxivity constant of the contrast agent (unit: mW 1 s" 1), and whose value is assumed to be known
C est la concentration de l'agent de contraste (unité : mM) C is the concentration of the contrast agent (unit: mM)
Cependant, la plupart des modalités d'IRM, permettant d'obtenir une cartographie du temps de relaxation Tl, mettent en oeuvre des séquences inversion récupération ou saturation récupération, dont les temps d'acquisitions sont trop longs pour que ces séquences soient appliquées, in vivo, en routine clinique. However, most MRI modalities, allowing to obtain a mapping of the relaxation time Tl, implement inversion recovery or saturation recovery sequences, whose acquisition times are too long for these sequences to be applied, in vivo, in clinical routine.
Parmi d'autres modalités la séquence VFA (Variable Flip Angle - angle de bascule variable) permet d'obtenir une cartographie 3D du temps de relaxation Tl. Cependant, la séquence VFA nécessite des acquisitions multiples de type spoiled gradient echo successives (groupe de séquences d'écho de gradient rapides comportant un gradient déphaseur appelé spoiler), en faisant varier l'angle d'excitation. De plus, la séquence VFA est réputée sensible aux inhomogénéités de champ magnétique, ce qui génère des erreurs de mesure. Among other modalities, the VFA (Variable Flip Angle) sequence allows to obtain a 3D mapping of the relaxation time Tl. However, the VFA sequence requires multiple successive spoiled gradient echo acquisitions (group of fast gradient echo sequences including a phase-shifting gradient called spoiler), by varying the excitation angle. In addition, the VFA sequence is known to be sensitive to magnetic field inhomogeneities, which generates measurement errors.
Le document US20130200900 décrit par exemple l'établissement d'une cartographie 3D du temps de relaxation Tl dans un sein, en mettant en oeuvre une séquence VFA. Dans ce document, un fantôme, comportant différentes concentrations de Gd, est disposé autour du sein. Document US20130200900 describes for example the establishment of a 3D mapping of the relaxation time Tl in a breast, by implementing a VFA sequence. In this document, a phantom, comprising different concentrations of Gd, is placed around the breast.
Un autre inconvénient de la séquence VFA est une durée d'acquisition trop longue, ce qui se traduit par un temps d'occupation du dispositif d'imagerie trop important pour une utilisation en routine. Another disadvantage of the VFA sequence is a too long acquisition time, which results in an occupancy time of the imaging device too long for routine use.
Les protocoles d'imagerie IRM cliniques pour les patients porteurs de métastases cérébrales sont avant tout destinés à obtenir une bonne représentation anatomique, et en particulier une bonne discrimination entre des métastases et les tissus sains notamment dans le cadre du diagnostic et éventuellement du bilan pré-thérapeutique. La séquence d'acquisition MPRAGE (Magnetization-Prepared Rapid Gradient Echo), est une séquence de type écho de gradient potentiellement utilisable. Cependant, la séquence MPRAGE peut induire une confusion entre une métastase cérébrale et un vaisseau sanguin, ce qui peut générer des faux positifs. Clinical MRI imaging protocols for patients with brain metastases are primarily intended to obtain good anatomical representation, and in particular good discrimination between metastases and healthy tissues, particularly in the context of diagnosis and possibly pre-therapeutic assessment. The MPRAGE (Magnetization-Prepared Rapid Gradient Echo) acquisition sequence is a potentially usable gradient echo sequence. However, the MPRAGE sequence can induce confusion between a brain metastasis and a blood vessel, which can generate false positives.
La publication Wright PJ. "Water proton Tl measurements in brain tissue at 7, 3, and 1.5T using IR-EPI, IR-TSE, and MPRAGE: results and optimization" décrit une comparaison du temps de relaxation Tl obtenu par différentes modalités d'IRM appliquées soit sur des fantômes, de composition connue, soit sur des structures cérébrales. Les modalités comparées sont TSE et MPRAGE, la modalité EPI (Echo Planar Imaging) étant considérée comme une modalité de référence. The publication Wright PJ. "Water proton Tl measurements in brain tissue at 7, 3, and 1.5T using IR-EPI, IR-TSE, and MPRAGE: results and optimization" describes a comparison of the Tl relaxation time obtained by different MRI modalities applied either to phantoms, of known composition, or to brain structures. The modalities compared are TSE and MPRAGE, with the EPI (Echo Planar Imaging) modality being considered as a reference modality.
Parmi les autres séquences les plus utilisées pour l'IRM des métastases cérébrales, citons la séquence 3D TSE (Turbo Spin Echo - echos de spin turbo) pondérée en Tl, pouvant être dénommée SPACE, CUBE, VISTA ou FASE3D mVox chez les principaux constructeurs IRM. La séquence 3D TSE pondérée en Tl est connue pour générer une représentation anatomique précise. De plus, contrairement à la séquence MPRAGE, la séquence TSE permet une bonne discrimination entre des métastases et des vaisseaux sanguins. Elle est donc particulièrement adaptée à la détection de métastases. Other commonly used sequences for MRI of brain metastases include the Tl-weighted 3D TSE (Turbo Spin Echo) sequence, which may be referred to as SPACE, CUBE, VISTA, or FASE3D mVox by leading MRI manufacturers. The Tl-weighted 3D TSE sequence is known to generate an accurate anatomical representation. In addition, unlike the MPRAGE sequence, the TSE sequence provides good discrimination between metastases and blood vessels. It is therefore particularly suitable for detecting metastases.
Cependant, pour une séquence de type 3D TSE pondérée en Tl, il n'existe pas de modèle analytique permettant d'obtenir la valeur de Tl à partir de l'intensité d'une image d'une coupe anatomique. However, for a Tl-weighted 3D TSE sequence, there is no analytical model to obtain the Tl value from the intensity of an image of an anatomical section.
Les inventeurs proposent un procédé, permettant d'établir la concentration d'un agent de contraste en mettant en œuvre une séquence d'IRM de routine, de type écho de spin rapide. La concentration est obtenue en mesurant le temps de relaxation Tl à partir de l'intensité d'une image d'une coupe. Il s'agit d'aller au-delà de la simple comparaison de séquences. The inventors propose a method for establishing the concentration of a contrast agent by implementing a routine MRI sequence, of the fast spin echo type. The concentration is obtained by measuring the relaxation time Tl from the intensity of an image of a section. This involves going beyond the simple comparison of sequences.
EXPOSE DE L'INVENTION PRESENTATION OF THE INVENTION
Un premier objet de l'invention est un procédé de mesure d'une concentration d'un agent de contraste dans au moins une zone corporelle d'un individu humain ou animal vivant, le procédé comportant : A first object of the invention is a method for measuring a concentration of a contrast agent in at least one body area of a living human or animal individual, the method comprising:
- a) acquisition de signaux radiofréquences émis par l'organe, soumis à une modalité d'imagerie par résonance magnétique ; - a) acquisition of radiofrequency signals emitted by the organ, subjected to a magnetic resonance imaging modality;
- b) à partir des signaux radiofréquences résultant de a), obtention d'images de la zone corporelle ; - c) à partir des images résultant de b), estimation d'un temps de relaxation Tl en différentes parties de la zone corporelle ; les étapes a) à b) étant mises en oeuvre antérieurement et postérieurement à une administration d'un agent de contraste à l'individu, de façon à obtenir une estimation de temps de relaxation Tl, dans la zone corporelle, respectivement antérieurs et postérieurs à l'administration de l'agent de contraste; - b) from the radiofrequency signals resulting from a), obtaining images of the body area; - c) from the images resulting from b), estimation of a relaxation time Tl in different parts of the body area; steps a) to b) being implemented before and after an administration of a contrast agent to the individual, so as to obtain an estimation of relaxation times Tl, in the body area, respectively before and after the administration of the contrast agent;
- d) à partir des temps de relaxation Tl estimés respectivement antérieurement et postérieurement à l'administration de l'agent de contraste, détermination d'une concentration de l'agent de contraste des différentes parties de la zone corporelle ; le procédé étant caractérisé en ce que - d) from the relaxation times Tl estimated respectively before and after the administration of the contrast agent, determination of a concentration of the contrast agent of the different parts of the body area; the method being characterized in that
- lors de chaque étape a), la modalité d'imagerie par résonance magnétique est une modalité de type écho de spin rapide, pondérée en Tl, par exemple 3D TSE pondérée en Tl ; - in each step a), the magnetic resonance imaging modality is a Tl-weighted fast spin echo modality, for example Tl-weighted 3D TSE;
- chaque étape c) est mise en oeuvre en utilisant une fonction de calibration, établissant une correspondance entre l'intensité d'une image de la zone corporelle et le temps de relaxation Tl, la fonction de calibration étant obtenue, préalablement à l'étape c), au cours d'une phase de calibration comportant : - each step c) is implemented using a calibration function, establishing a correspondence between the intensity of an image of the body area and the relaxation time Tl, the calibration function being obtained, prior to step c), during a calibration phase comprising:
• i) disposition d'un fantôme, comportant différents compartiments comprenant respectivement différentes compositions dont les temps de relaxation Tl sont connus et différents les uns des autres ; • i) arrangement of a phantom, comprising different compartments respectively comprising different compositions whose relaxation times Tl are known and different from each other;
• ii) acquisition de signaux radiofréquences émis par le fantôme, soumis à la modalité d'imagerie par résonance magnétique ; • ii) acquisition of radiofrequency signals emitted by the phantom, subjected to the magnetic resonance imaging modality;
• iii) à partir des signaux radiofréquences acquis lors de ii), obtention d'images des différents compartiments du fantôme ; • iii) from the radiofrequency signals acquired during ii), obtaining images of the different compartments of the phantom;
• iv) établissement de la fonction de calibration à partir de l'intensité du signal dans lesdits compartiments du fantôme en prenant en compte, pour chaque compartiment, un couple de valeurs formé par l'intensité du signal d'une image du compartiment et le temps de relaxation Tl de la composition dudit compartiment. • iv) establishing the calibration function from the intensity of the signal in said compartments of the phantom by taking into account, for each compartment, a pair of values formed by the intensity of the signal of an image of the compartment and the relaxation time Tl of the composition of said compartment.
Selon une possibilité : According to one possibility:
- lors de l'étape a), la zone corporelle est disposée dans un tunnel, soumis à un champ magnétique ; - in step a), the body area is placed in a tunnel, subjected to a magnetic field;
- lors de l'étape i) de la phase de calibration, le fantôme est disposé dans le tunnel, à la place de la zone corporelle. Selon une possibilité, différents compartiments du fantôme comportent respectivement différentes espèces chimiques ou différentes concentrations d'une même espèce chimique, de façon que les temps de relaxation Tl desdits compartiments soient différents les uns des autres. - during step i) of the calibration phase, the phantom is placed in the tunnel, in place of the body area. According to one possibility, different compartments of the phantom respectively comprise different chemical species or different concentrations of the same chemical species, so that the relaxation times Tl of said compartments are different from each other.
Selon une possibilité, différents compartiments du fantôme comportent une même concentration d'une même espèce chimique. According to one possibility, different compartments of the phantom have the same concentration of the same chemical species.
Selon une possibilité, la fonction de calibration est établie par une régression, à partir des couples (intensité du signal d'une image du compartiment - temps de relaxation Tl du compartiment) pris en compte lors de l'étape iv) de la phase de calibration. According to one possibility, the calibration function is established by a regression, from the pairs (signal intensity of an image of the compartment - relaxation time Tl of the compartment) taken into account during step iv) of the calibration phase.
Selon une possibilité : According to one possibility:
- les étapes a) à d) sont mises en oeuvre successivement pour différents individus ; - steps a) to d) are implemented successively for different individuals;
- la fonction de calibration mise en oeuvre dans chaque étape c) est identique pour les différents individus, et résulte d'une même phase de calibration. - the calibration function implemented in each step c) is identical for the different individuals, and results from the same calibration phase.
L'agent de contraste peut être un agent radiosensibilisant. Le procédé peut comporter, suite à l'étape d), une détermination d'une dose d'irradiation en différentes parties de la zone corporelle, en fonction des concentrations de l'agent de contraste résultant de l'étape d). The contrast agent may be a radiosensitizing agent. The method may comprise, following step d), a determination of an irradiation dose in different parts of the body area, as a function of the concentrations of the contrast agent resulting from step d).
Un autre objet de l'invention est une unité de traitement, configurée pour traiter une image acquise par un dispositif d'imagerie par résonance magnétique, selon une modalité d'acquisition d'écho de spin rapide, par exemple de type 3D TSE, pondérée en Tl, l'unité de traitement étant programmée pour appliquer, à l'image acquise, une fonction de calibration résultant d'une mise en oeuvre d'une phase de calibration comportant : Another object of the invention is a processing unit, configured to process an image acquired by a magnetic resonance imaging device, according to a fast spin echo acquisition modality, for example of the 3D TSE type, weighted in Tl, the processing unit being programmed to apply, to the acquired image, a calibration function resulting from an implementation of a calibration phase comprising:
• disposition d'un fantôme dans le dispositif d'imagerie par résonance magnétique, le fantôme comportant différents compartiments comprenant respectivement différentes compositions dont les temps de relaxation Tl sont connus et différents les uns des autres; • arrangement of a phantom in the magnetic resonance imaging device, the phantom comprising different compartments respectively comprising different compositions whose relaxation times Tl are known and different from each other;
• acquisition de signaux radiofréquences émis par le fantôme, soumis à la modalité d'imagerie par résonance magnétique de type écho de spin rapide ; • acquisition of radiofrequency signals emitted by the phantom, subjected to the fast spin echo type magnetic resonance imaging modality;
• à partir des signaux radiofréquences acquis lors de l'étape précédente, obtention d'images des différents compartiments du fantôme; • from the radiofrequency signals acquired during the previous step, obtaining images of the different compartments of the phantom;
• établissement de la fonction de calibration à partir de l'intensité du signal dans lesdits compartiments du fantôme en prenant en compte, pour chaque compartiment, un couple de valeurs formé par l'intensité du signal d'une image du compartiment et le temps de relaxation Tl de la composition dudit compartiment. • establishing the calibration function from the intensity of the signal in said compartments of the phantom, taking into account, for each compartment, a pair of values formed by the signal intensity of an image of the compartment and the relaxation time Tl of the composition of said compartment.
FIGURES FIGURES
La figure 1 schématise un dispositif d'imagerie par IRM, permettant une mise en oeuvre de l'invention. Figure 1 shows a schematic of an MRI imaging device, allowing implementation of the invention.
La figure 2A montre un empilement de plaques formant un fantôme de calibration. Figure 2A shows a stack of plates forming a calibration phantom.
La figure 2B montre les plaques agencées dans une enveloppe, l'enveloppe permettant une manipulation du fantôme. Figure 2B shows the plates arranged in an envelope, the envelope allowing manipulation of the phantom.
La figure 2C montre un exemple de configuration d'une plaque. Figure 2C shows an example of a plate configuration.
La figure 2D montre une image des compartiments intégrés dans une plaque obtenue par une modalité d'IRM selon une séquence de type 3D TSE pondérée en Tl. Figure 2D shows an image of the compartments embedded in a plaque obtained by an MRI modality using a Tl-weighted 3D TSE sequence.
La figure 3 montre l'établissement d'une fonction de calibration bijective permettant de relier le temps de relaxation Tl à l'intensité sur une image résultant d'une séquence d'écho de spin rapide, par exemple 3D TSE pondérée en Tl. Figure 3 shows the establishment of a bijective calibration function to relate the relaxation time Tl to the intensity on an image resulting from a fast spin echo sequence, for example Tl-weighted 3D TSE.
La figure 4 schématise les principales étapes de mise en oeuvre d'un procédé selon l'invention. Figure 4 shows schematically the main steps of implementing a method according to the invention.
EXPOSE DE MODES DE REALISATION PARTICULIERS PRESENTATION OF SPECIFIC EMBODIMENTS
La figure 1 représente un dispositif 1 permettant une mise en oeuvre de l'invention. Le dispositif est un dispositif d'imagerie par IRM, comportant un aimant cylindrique s'étendant autour d'un tunnel 2. Le tunnel s'étend autour d'un axe central A. Le dispositif est destiné à produire des images de coupes de tissus biologiques, en particulier des zones corporelles d'un individu humain ou animal vivant. Figure 1 shows a device 1 allowing an implementation of the invention. The device is an MRI imaging device, comprising a cylindrical magnet extending around a tunnel 2. The tunnel extends around a central axis A. The device is intended to produce images of sections of biological tissues, in particular of the body areas of a living human or animal individual.
De façon connue, sous l'effet d'un champ magnétique intense, produit par l'aimant, et de signaux radiofréquence émis par des émetteurs, à la fréquence de Larmor du noyau d'hydrogène, les noyaux d'hydrogène de la zone corporelle émettent un signal radiofréquence, ce dernier étant mesuré par des antennes de réception du dispositif 1. En fonction des signaux radiofréquences mesurés, le dispositif 1 forme des coupes anatomiques de la zone corporelle examinée. Les coupes sont des images bidimensionnelles, dans lesquelles l'intensité dépend de la composition de la zone corporelle examinée. Le dispositif 1 comporte une unité centrale 3, programmée pour générer les images à partir de signaux radiofréquences détectés. L'unité centrale peut être formée par un microprocesseur ou différents microprocesseurs. L'unité centrale est à considérer comme l'ensemble des moyens de calcul permettant la formation et le traitement des images. Comme décrit en lien avec l'art antérieur, plusieurs modalités d'imagerie par IRM sont disponibles. Parmi ces dernières, la modalité dite 3D TSE pondérée en Tl permet d'obtenir rapidement des images anatomiques d'une zone corporelle. Les images obtenues peuvent être affichées dans des coupes des zones corporelles dans un plan quelconque par rapport à l'axe central A du tunnel. In a known manner, under the effect of an intense magnetic field, produced by the magnet, and of radiofrequency signals emitted by transmitters, at the Larmor frequency of the hydrogen nucleus, the hydrogen nuclei of the body area emit a radiofrequency signal, the latter being measured by receiving antennas of the device 1. Depending on the measured radiofrequency signals, the device 1 forms anatomical sections of the body area examined. The sections are two-dimensional images, in which the intensity depends on the composition of the body area examined. The device 1 comprises a central unit 3, programmed to generate the images from detected radiofrequency signals. The central unit can be formed by a microprocessor or different microprocessors. The central unit is to be considered as the set of calculation means allowing the formation and processing of the images. As described in connection with the prior art, several MRI imaging modalities are available. Among these, the so-called Tl-weighted 3D TSE modality allows rapid obtaining of anatomical images of a body area. The obtained images can be displayed in sections of the body areas in any plane relative to the central axis A of the tunnel.
Comme mentionné dans l'art antérieur, lorsque l'on considère la séquence d'acquisition 3D TSE pondérée en Tl, il n'existe pas de modèle analytique, permettant d'estimer le temps de relaxation Tl (temps de relaxation longitudinal). Lorsque l'IRM est mise en oeuvre postérieurement à une administration de l'agent de contraste, la connaissance des temps de relaxation Tl respectivement antérieurs et postérieurs à l'administration de l'agent de contraste permet une estimation de la concentration de ce dernier, et cela en chaque point de chaque image de coupe. Cf. équation (1) de la section décrivant l'art antérieur. As mentioned in the prior art, when considering the Tl-weighted 3D TSE acquisition sequence, there is no analytical model for estimating the relaxation time Tl (longitudinal relaxation time). When the MRI is implemented after administration of the contrast agent, knowledge of the relaxation times Tl respectively before and after administration of the contrast agent allows an estimation of the concentration of the latter, and this at each point of each slice image. See equation (1) of the section describing the prior art.
Les inventeurs ont choisi d'établir, de façon expérimentale, une fonction de calibration permettant d'établir une relation entre l'intensité, en chaque point d'une image de coupe, et le temps de relaxation Tl. Pour cela, ils ont conçu un fantôme, représenté sur les figures 2A à 2C. Le fantôme 10 est destiné à être disposé dans le tunnel, à la place de l'individu examiné. The inventors chose to establish, experimentally, a calibration function making it possible to establish a relationship between the intensity, at each point of a section image, and the relaxation time Tl. To do this, they designed a phantom, shown in FIGS. 2A to 2C. The phantom 10 is intended to be placed in the tunnel, in place of the individual examined.
Le fantôme 10 est formé de trois plaques identiques 11, 12, 13 empilées les unes sur les autres. Chaque plaque est composée de compartiments 20, comportant des compositions présentant des temps de relaxation Tl connus et différents les uns des autres. Dans cet exemple, les compartiments 20 comprennent des solutions d'espèces chimiques paramagnétiques dont la composition et la concentration sont connues. Dans l'exemple représenté sur les figures 2A à 2C, chaque plaque comporte 48 tubes différents, disposées selon un arrangement matriciel régulier. Chaque tube forme un compartiment contenant une solution de composition connue. Les tubes d'une même plaque comportent soit la même espèce chimique, avec des concentrations respectivement différentes, soit différentes espèces chimiques. L'agencement des plaques est décrit plus en détail en lien avec la figure 2C. The phantom 10 is formed of three identical plates 11, 12, 13 stacked on top of each other. Each plate is composed of compartments 20, comprising compositions having relaxation times T1 that are known and different from each other. In this example, the compartments 20 comprise solutions of paramagnetic chemical species whose composition and concentration are known. In the example shown in FIGS. 2A to 2C, each plate comprises 48 different tubes, arranged in a regular matrix arrangement. Each tube forms a compartment containing a solution of known composition. The tubes of the same plate comprise either the same chemical species, with respectively different concentrations, or different chemical species. The arrangement of the plates is described in more detail in connection with FIG. 2C.
Par espèce chimique, on entend une molécule ou un élément chimique ou un composé ionique.By chemical species we mean a molecule or a chemical element or an ionic compound.
Les trois plaques 11, 12, 13 sont empilées l'une sur l'autre, selon un axe d'empilement Z. L'ensemble est maintenu dans une enveloppe cylindrique transparente solide 14, en PMMA coulé (poly méthacrylate de méthyle acrylique), remplie d'eau salée à 9 g/L pour simuler les propriétés électromagnétiques de tissus biologiques. Chaque plaque s'étend selon une longueur L, parallèlement un axe longitudinal X et une largeur l, parallèlement à un axe latéral Y. La longueur et la largeur sont dimensionnées de façon que la surface de chaque plaque soit comparable à une section transversale de la zone corporelle de l'individu que l'on souhaite étudier. Dans ce cas, la zone corporelle d'intérêt est le cerveau. La longueur de chaque plaque est comprise entre 10 cm et 15 cm. Il en est de même de la largeur. The three plates 11, 12, 13 are stacked on top of each other, along a stacking axis Z. The assembly is held in a solid transparent cylindrical envelope 14, made of cast PMMA (poly methyl methacrylate acrylic), filled with 9 g/L salt water to simulate the electromagnetic properties of biological tissues. Each plate extends along a length L, parallel to a longitudinal axis X and a width l, parallel to a lateral axis Y. The Length and width are sized so that the surface area of each plate is comparable to a cross-section of the body area of the individual to be studied. In this case, the body area of interest is the brain. The length of each plate is between 10 cm and 15 cm. The same is true for the width.
Le diamètre de l'enveloppe 14 est typiquement compris entre 15 cm et 25 cm; Ainsi, le fantôme 10 est dimensionné de façon à se substituer à l'organe à imager. Lors de l'acquisition d'une image IRM, la zone corporelle ciblée est entourée d'une antenne de réception. L'antenne de réception délimite un volume, destiné à être occupé par la zone corporelle imagée. Le fantôme est de préférence dimensionné de façon à occuper au moins 50% voire 80% du volume délimité par l'antenne de réception. The diameter of the envelope 14 is typically between 15 cm and 25 cm; Thus, the phantom 10 is sized so as to replace the organ to be imaged. When acquiring an MRI image, the targeted body area is surrounded by a receiving antenna. The receiving antenna delimits a volume, intended to be occupied by the imaged body area. The phantom is preferably sized so as to occupy at least 50% or even 80% of the volume delimited by the receiving antenna.
Les différents compartiments 11, 12 et 13 et l'enveloppe 20 sont étanches. Le fantôme est ainsi aisément transportable. The various compartments 11, 12 and 13 and the envelope 20 are watertight. The phantom is thus easily transportable.
Le fantôme 10 est destiné à être disposé dans le tunnel 2, à la place d'un individu examiné. L'axe Z du fantôme s'étend alors parallèlement avec l'axe central A du tunnel 2. The phantom 10 is intended to be placed in the tunnel 2, in place of an individual being examined. The Z axis of the phantom then extends parallel to the central axis A of the tunnel 2.
La figure 2C schématise un agencement possible des plaques et des compartiments. Chaque compartiment 20 peut contenir : soit une solution de CuSO4, symbolisée par la lettre C ; soit une solution de MnCL, symbolisée par la lettre M ; soit une solution de NiCL, symbolisée par la lettre N. Figure 2C shows a possible arrangement of the plates and compartments. Each compartment 20 can contain: either a CuSO 4 solution, symbolized by the letter C; or a MnCL solution, symbolized by the letter M; or a NiCL solution, symbolized by the letter N.
Sur la figure 2C, on observe que l'agencement choisi ici pour chaque plaque est symétrique, les compartiments de la plaque comportant la même espèce chimique étant agencées symétriquement par rapport au centre de la plaque, symbolisé par une croix. In Figure 2C, we observe that the arrangement chosen here for each plate is symmetrical, the compartments of the plate containing the same chemical species being arranged symmetrically with respect to the center of the plate, symbolized by a cross.
Les solutions d'espèces chimiques C, M, N ont été choisies pour leur excellente stabilité au cours du temps, ainsi que leur paramagnétisme à l'origine de leur contraste IRM et de la faible sensibilité de leur paramagnétisme aux variations de température. Ces trois agents de contraste permettent d'obtenir des solutions couvrant une large gamme de temps de relaxation Tl.The solutions of chemical species C, M, N were chosen for their excellent stability over time, as well as their paramagnetism at the origin of their MRI contrast and the low sensitivity of their paramagnetism to temperature variations. These three contrast agents make it possible to obtain solutions covering a wide range of relaxation times Tl.
Pour les compartiments contenant du CuSO4, la concentration en CuSO4 est identique. Elle est par exemple de 1 mM. Les compartiments de concentration identiques de CuSO4 permettent de s'assurer de l'homogénéité spatiale de la mesure IRM. For compartments containing CuSO 4 , the CuSO 4 concentration is identical. For example, it is 1 mM. Compartments with identical CuSO 4 concentrations ensure the spatial homogeneity of the MRI measurement.
Les compartiments contenant les solutions de NiCL ont des concentrations en NiCL variables, de façon à obtenir des temps de relaxation Tl au moins compris entre 0.5 s et 2.5 s. Il s'agit de temps correspondant à la gamme Tl des tissus biologiques. Dans cet exemple, les concentrations de NiCI2 variaient entre 0.03 et 4.73 mM. Les compartiments sont agencés par incréments de concentrations de 0.1 mM. The compartments containing the NiCL solutions have variable NiCL concentrations, so as to obtain relaxation times Tl at least between 0.5 s and 2.5 s. These are time corresponding to the Tl range of biological tissues. In this example, NiCl 2 concentrations varied between 0.03 and 4.73 mM. The compartments are arranged in concentration increments of 0.1 mM.
Les compartiments contenant les solutions de MnCI2 ont des concentrations en MnCI2 variables, de façon à obtenir des temps de relaxation Tl au moins compris entre 0.5 et 3 s. Dans cet exemple, les concentrations de MnCI2 variaient entre 0.002 et 0.472 mM. Les compartiments sont agencés par incréments de concentrations de 0.01 mM. The compartments containing the MnCI 2 solutions have varying MnCI 2 concentrations, so as to obtain relaxation times Tl at least between 0.5 and 3 s. In this example, the MnCI 2 concentrations varied between 0.002 and 0.472 mM. The compartments are arranged in concentration increments of 0.01 mM.
D'une façon générale, chaque compartiment du fantôme a une composition connue, et, de ce fait, des temps de relaxation Tl connus. Generally speaking, each compartment of the phantom has a known composition, and therefore known relaxation times Tl.
La figure 2D est un exemple d'une coupe d'une plaque d'un fantôme, obtenue par une séquence 3D TSE pondérée en Tl. On observe qu'au niveau de chaque compartiment du fantôme, l'intensité du signal, c'est-à-dire le niveau de gris, est homogène. L'intensité du signal peut être corrélée au temps de relaxation Tl, ce dernier étant connu, du fait que la composition de chaque compartiment soit connue. Figure 2D is an example of a section of a phantom plate, obtained by a Tl-weighted 3D TSE sequence. It is observed that at the level of each compartment of the phantom, the signal intensity, i.e. the gray level, is homogeneous. The signal intensity can be correlated to the relaxation time Tl, the latter being known, because the composition of each compartment is known.
Sur la figure 2D, on observe que l'intensité de l'image, pour chaque compartiment, dépend de la composition de chaque compartiment : molécule utilisée et concentration. Pour une même molécule, plus la concentration est élevée, plus le temps Tl est court, et plus le signal, sur l'image, est intense. In Figure 2D, we observe that the intensity of the image, for each compartment, depends on the composition of each compartment: molecule used and concentration. For the same molecule, the higher the concentration, the shorter the time Tl, and the more intense the signal, on the image, is.
Appliquée à l'ensemble du fantôme, la séquence 3D TSE pondérée en Tl permet d'obtenir 144 niveaux de gris différents, chacun pouvant être associé à une espèce chimique et à une concentration connue, donc des temps de relaxation Tl connus. On peut ainsi établir, au niveau de chaque compartiment du fantôme, un couple (temps de relaxation Tl, intensité). Applied to the entire phantom, the Tl-weighted 3D TSE sequence allows to obtain 144 different gray levels, each of which can be associated with a chemical species and a known concentration, therefore known Tl relaxation times. It is thus possible to establish, at the level of each compartment of the phantom, a pair (Tl relaxation time, intensity).
Sur la figure 3, chaque couple (temps de relaxation Tl, intensité) a été reporté. Sur la figure 3, l'axe des abscisses correspond au temps de relaxation Tl (unité : seconde). L'axe des ordonnées correspond au niveau de gris mesuré (unités arbitraires). Sur la figure 3, les disques pleins correspondent aux compartiments comportant NiCI2 et les cercles correspondent à MnCI2.In Figure 3, each pair (relaxation time Tl, intensity) has been plotted. In Figure 3, the abscissa axis corresponds to the relaxation time Tl (unit: second). The ordinate axis corresponds to the measured gray level (arbitrary units). In Figure 3, the solid disks correspond to the compartments containing NiCI 2 and the circles correspond to MnCI 2 .
A partir de chaque couple (Tlt intensité), on a déterminé, par ajustement, une fonction f, bijective, telle que I = f T^. L'inverse -1 de cette fonction constitue une fonction de calibration du dispositif 1, permettant d'estimer, en tout point d'une image, de coordonnées (%, y), le temps de relaxation T± à partir de l'intensité : T^Oy y) = -1(/(x, y)). La fonction de calibration f 1 l x, y)) est une fonction déterminée expérimentalement. La fonction est de préférence continue sur la plage des temps de relaxation Tl considérée. From each pair (T lt intensity), we determined, by adjustment, a bijective function f, such that I = f T^. The inverse -1 of this function constitutes a calibration function of the device 1, allowing to estimate, at any point of an image, of coordinates (%, y), the relaxation time T ± from the intensity: T^Oy y) = -1 (/(x, y)). The function of calibration f 1 lx, y)) is an experimentally determined function. The function is preferably continuous over the range of relaxation times Tl considered.
Un aspect important de l'invention est qu'il n'est pas nécessaire d'utiliser le fantôme lors de chaque utilisation. Les inventeurs ont constaté qu'un même fantôme peut être utilisé pour établir une fonction de calibration d'un dispositif d'IRM. La même fonction de calibration peut être utilisée pour quantifier le temps de relaxation Tl de différents individus successivement examinés. Ainsi, il n'est pas nécessaire d'effectuer une calibration préalablement à l'examen de chaque individu. La calibration peut être renouvelée à intervalles réguliers, par exemple chaque semaine ou chaque mois. An important aspect of the invention is that it is not necessary to use the phantom during each use. The inventors have found that the same phantom can be used to establish a calibration function of an MRI device. The same calibration function can be used to quantify the relaxation time Tl of different individuals successively examined. Thus, it is not necessary to perform a calibration prior to the examination of each individual. The calibration can be renewed at regular intervals, for example every week or every month.
L'invention permet d'estimer, à partir d'une modalité d'imagerie IRM de routine, par exemple la séquence 3D TSE pondérée en Tl, une distribution spatiale de temps de relaxation Tl, et cela antérieurement et postérieurement à l'administration d'un agent de contraste. Cela permet d'estimer, en chaque point d'une image, une concentration en agent de contraste en mettant en oeuvre l'expression (1) décrite dans l'art antérieur. The invention makes it possible to estimate, from a routine MRI imaging modality, for example the Tl-weighted 3D TSE sequence, a spatial distribution of Tl relaxation times, and this before and after the administration of a contrast agent. This makes it possible to estimate, at each point of an image, a concentration of contrast agent by implementing the expression (1) described in the prior art.
Comme mentionné dans l'art antérieur, les agents de contraste peuvent être des nanoparticules à la surface desquelles sont chélatés des ions métalliques, par exemple Gd3+. Les nanoparticules ciblent passivement mais spécifiquement, par effet EPR (Enhanced Permeability and Retention - perméabilité et rétention améliorée, ou ciblage passif), les tumeurs. Lorsque les nanoparticules ont un effet théranostique, la connaissance de leur concentration permet d'ajuster la dose d'irradiation lors d'un traitement par radiothérapie, permettant la mise en oeuvre de nouvelles stratégies thérapeutiques : (i) maintenir la dose de radiothérapie du standard de traitement et utiliser l'effet radio sensibilisant de l'agent de contraste à effet theranostique pour améliorer l'efficacité du traitement sur la destruction des cellules tumorales, (ii) diminuer la dose de radiothérapie du standard de traitement et utiliser l'effet radio sensibilisant de l'agent de contraste à effet theranostique pour maintenir l'efficacité du traitement sur la destruction des cellules tumorales tout en limitant l'exposition des tissus sains à proximité (iii)permettre que deux parties différentes de la zone tumorale examinée, présentant une concentration différente d'agent de contraste, puissent être irradiées de façon à délivrer deux doses différentes. As mentioned in the prior art, the contrast agents may be nanoparticles on the surface of which metal ions, for example Gd 3+ , are chelated. The nanoparticles passively but specifically target tumors by EPR (Enhanced Permeability and Retention) effect. When nanoparticles have a theranostic effect, knowledge of their concentration makes it possible to adjust the irradiation dose during radiotherapy treatment, allowing the implementation of new therapeutic strategies: (i) maintaining the radiotherapy dose of the treatment standard and using the radiosensitizing effect of the contrast agent with theranostic effect to improve the effectiveness of the treatment on the destruction of tumor cells, (ii) reducing the radiotherapy dose of the treatment standard and using the radiosensitizing effect of the contrast agent with theranostic effect to maintain the effectiveness of the treatment on the destruction of tumor cells while limiting the exposure of healthy tissues nearby (iii) allowing two different parts of the tumor area examined, having a different concentration of contrast agent, to be irradiated so as to deliver two different doses.
Cela peut permettre soit de mieux éradiquer la tumeur, soit de diminuer l'impact du traitement sur les tissus sains et les organes à risque situés à proximité des parties irradiées de la zone corporelle, pour augmenter la survie et la qualité de vie La figure 4 représente les principales étapes de mise en œuvre de l'invention. This can either help to better eradicate the tumor or reduce the impact of the treatment on healthy tissues and organs at risk located near the irradiated parts of the body area, to increase survival and quality of life. Figure 4 shows the main steps of implementing the invention.
Etape 100 : disposition d'un individu dans le tunnel 2 d'un dispositif selon l'invention et mise en œuvre d'une modalité d'IRM selon une séquence 3D TSE pondérée en Tl. Step 100: arrangement of an individual in tunnel 2 of a device according to the invention and implementation of an MRI modality according to a 3D TSE sequence weighted in Tl.
Etape 110 : à partir de signaux radiofréquences émis par une zone corporelle de l'individu, obtention d'images de coupes de la zone corporelle dans un plan axial, coronal ou sagittal. L'étape 110 est mise en œuvre par l'unité de traitement 3. Les images peuvent être normalisées des valeurs de la densité de protons, obtenues expérimentalement ou prédéfinies. Step 110: from radiofrequency signals emitted by a body area of the individual, obtaining images of sections of the body area in an axial, coronal or sagittal plane. Step 110 is implemented by the processing unit 3. The images can be normalized to the values of the proton density, obtained experimentally or predefined.
Les étapes 100 et 110 sont mises en œuvre antérieurement et postérieurement à une administration d'un agent de contraste. L'administration de l'agent de contraste ne fait pas partie de l'invention. Steps 100 and 110 are performed prior to and subsequent to an administration of a contrast agent. The administration of the contrast agent is not part of the invention.
Etape 120 : estimation d'un temps de relaxation Tl en différents points de chaque image résultant de l'étape 110. L'estimation peut être recalée en prenant en compte une zone saine de tissu, dont le temps de relaxation Tl est connue, par exemple la matière grise ou la matière blanche. Step 120: estimation of a relaxation time Tl at different points of each image resulting from step 110. The estimation can be adjusted by taking into account a healthy area of tissue, whose relaxation time Tl is known, for example gray matter or white matter.
Etape 130 : à partir des temps de relaxation Tl résultant de l'étape 120, détermination d'une concentration en agent de contraste aux différents points de chaque image. Step 130: from the relaxation times Tl resulting from step 120, determination of a concentration of contrast agent at the different points of each image.
L'étape 120 met en œuvre la fonction de calibration -1 préalablement décrite. La fonction de calibration est mise en œuvre par l'unité de traitement 3, dans laquelle la fonction de calibration a préalablement été mémorisée. La fonction de calibration est établie au cours d'une phase de calibration qui comporte les étapes suivantes Step 120 implements the calibration function -1 previously described. The calibration function is implemented by the processing unit 3, in which the calibration function has previously been stored. The calibration function is established during a calibration phase which comprises the following steps
Etape 90 : disposition du fantôme dans le tunnel du dispositif et mise en œuvre d'une modalité d'IRM selon une séquence d'imagerie de spin écho rapide pondérée en Tl, par exemple une séquence de type 3D TSE pondérée en Tl. Step 90: Arrange the phantom in the device tunnel and implement an MRI modality according to a Tl-weighted fast spin echo imaging sequence, for example a Tl-weighted 3D TSE sequence.
Etape 91 : à partir de signaux radiofréquences émis par chaque compartiment du fantôme, obtention d'images de coupes du fantôme dans un plan axial, coronal ou sagittal. Step 91: from radiofrequency signals emitted by each compartment of the phantom, obtaining images of sections of the phantom in an axial, coronal or sagittal plane.
Etape 92 : définition de couples (intensité -temps de relaxation Tl) à partir des images résultant de l'étape 91 Step 92: definition of couples (intensity - relaxation time Tl) from the images resulting from step 91
Etape 93 : détermination, par ajustement ou régression, d'une fonction de calibration reliant l'intensité au temps de relaxation Tl. La fonction de calibration est de préférence continue selon une plage de temps de relaxation Tl variant de 0.1 s à 2.5s ou 3s. Les étapes 90 à 93 constituent une phase de calibration. De préférence, la phase de calibration n'est pas renouvelée à chaque examen d'un nouvel individu. Ainsi, la même fonction de calibration est utilisée pour interpréter différentes images de différents individus. Step 93: determination, by adjustment or regression, of a calibration function linking the intensity to the relaxation time Tl. The calibration function is preferably continuous over a range of relaxation times Tl varying from 0.1 s to 2.5s or 3s. Steps 90 to 93 constitute a calibration phase. Preferably, the calibration phase is not repeated for each examination of a new individual. Thus, the same calibration function is used to interpret different images of different individuals.
On a comparé des cartes de concentrations de Gd3+ chélatés sur des nanoparticules AGulX telles que décrites dans l'art antérieur, en mettant en oeuvre un procédé tel que précédemment décrit, ainsi que sur la base d'une détermination de temps de relaxation Tl d'une modalité VFA. Des images ont également été acquises sur des individus porteurs de métastases cérébrales. Les métastases cérébrales ont systématiquement été identifiées en mettant en oeuvre l'invention, c'est-à-dire sur la base d'une estimation de la concentration en agent de contraste effectuée à partir de déterminations du temps de relaxation Tl sur des images acquises selon la modalité 3D TSE pondérée en Tl. Maps of concentrations of Gd 3+ chelated on AGulX nanoparticles as described in the prior art were compared, using a method as previously described, as well as on the basis of a determination of the relaxation time Tl of a VFA modality. Images were also acquired on individuals with brain metastases. Brain metastases were systematically identified using the invention, i.e. on the basis of an estimation of the concentration of contrast agent carried out from determinations of the relaxation time Tl on images acquired according to the Tl-weighted 3D TSE modality.
Dans certaines occurrences, les estimations de concentrations d'agent de contraste réalisées sur la base de temps de relaxation Tl sur des images acquises selon la modalité VFA n'ont pas révélé la présence de métastases. In some instances, estimates of contrast agent concentrations based on Tl relaxation times on images acquired using the VFA modality did not reveal the presence of metastases.
La durée de chaque acquisition 3D TSE pondérée en Tl était de 4 minutes 57 secondes, contre 11 minutes et 24 secondes pour la modalité VFA. L'épaisseur de chaque coupe 3D TSE pondérée en Tl était de 1mm, contre 4 mm pour la modalité VFA. L'espace entre les coupes était de 0mm pour la modalité 3D TSE pondérée en Tl, contre 2 mm pour la modalité VFA. Ainsi, la séquence 3D TSE pondérée en Tl permet de disposer d'une mesure de Tl avec une résolution spatiale supérieure, en moins de temps. The duration of each Tl-weighted 3D TSE acquisition was 4 minutes 57 seconds, compared to 11 minutes and 24 seconds for the VFA modality. The thickness of each Tl-weighted 3D TSE slice was 1 mm, compared to 4 mm for the VFA modality. The inter-slice spacing was 0 mm for the Tl-weighted 3D TSE modality, compared to 2 mm for the VFA modality. Thus, the Tl-weighted 3D TSE sequence provides a Tl measurement with higher spatial resolution in less time.
Le recours à une séquence 3D TSE pondérée en Tl pour l'estimation de temps de relaxation Tl antérieurement et postérieurement à l'administration d'un agent de contraste, suivie d'une estimation de la concentration en agent de contraste, semble donc particulièrement pertinente.The use of a Tl-weighted 3D TSE sequence for the estimation of Tl relaxation time before and after the administration of a contrast agent, followed by an estimation of the contrast agent concentration, therefore seems particularly relevant.
On a également estimé l'impact, en matière de temps de relaxation Tl, de l'administration d'un agent de contraste, sur des tissus sains. On a mis en oeuvre la séquence 3D TSE pondérée en Tl : aucune augmentation significative n'a été constatée sur de la matière blanche et sur de la matière grise. On a également mis en oeuvre la méthode VFA : des augmentations de l'ordre de 300 à 500 ms ont été mesurées sur la matière blanche et la matière grise, alors qu'il s'agit de tissus sains. Il semble que les estimations des temps de relaxation Tl en mettant en oeuvre l'invention (séquence TSE + application d'une fonction de calibration empirique, obtenue sur fantôme) sont plus cohérentes qu'avec la modalité VFA. Bien que décrite en lien avec des nanoparticules de type radiosensibilisant, l'invention peut s'appliquer à des agents de contraste à base de Gd de type acide gadotérique de type gadopentétate de diméglumine, gadobutrol, gadopiclénol ou des agents de contraste à base de complexe de manganèse, USPIO (Ultrasmall superparamagnetic iron oxide - nanoparticules d'oxyde de fer superparamagnétique) et SPIO (superparamagnetic iron oxide - oxyde de fer superparamagétique) cette liste n'étant pas exhaustive. The impact on Tl relaxation time of the administration of a contrast agent on healthy tissues was also estimated. The Tl-weighted 3D TSE sequence was used: no significant increase was observed on white matter and gray matter. The VFA method was also used: increases of the order of 300 to 500 ms were measured on white matter and gray matter, while these are healthy tissues. It seems that the estimates of Tl relaxation times using the invention (TSE sequence + application of an empirical calibration function, obtained on a phantom) are more consistent than with the VFA modality. Although described in connection with radiosensitizing nanoparticles, the invention can be applied to Gd-based contrast agents of the gadoteric acid type such as gadopentetate dimeglumine, gadobutrol, gadopiclenol or contrast agents based on manganese complex, USPIO (Ultrasmall superparamagnetic iron oxide) and SPIO (superparamagnetic iron oxide), this list not being exhaustive.
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| WO2011135101A2 (en) | 2010-04-30 | 2011-11-03 | Nanoh | Ultrafine nanoparticles comprising a functionalized polyorganosiloxane matrix and including metal complexes; method for obtaining same and uses thereof in medical imaging and/or therapy |
| US20130200900A1 (en) | 2010-10-13 | 2013-08-08 | Koninklijke Philips Electronics N.V. | Mri phantom with a plurality of compartments for t1 calibration |
| WO2018224684A2 (en) | 2017-06-09 | 2018-12-13 | Nh Theraguix | Method for synthesizing silica nanoparticles |
| WO2019008040A1 (en) | 2017-07-05 | 2019-01-10 | Nh Theraguix | Methods for treating tumors |
| WO2022106788A1 (en) | 2020-11-19 | 2022-05-27 | Nh Theraguix | Method for preparing nanoparticles |
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| WO2011135101A2 (en) | 2010-04-30 | 2011-11-03 | Nanoh | Ultrafine nanoparticles comprising a functionalized polyorganosiloxane matrix and including metal complexes; method for obtaining same and uses thereof in medical imaging and/or therapy |
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