1. Dave Wyper opened the meeting with an overview of SINAPSE including advice on the role it is playing in connection with Brexit:
SINAPSE works with the Scottish Funding Council to obtain information from the medical imaging community that can be fed back to the Scottish Government. A poll on the immediate effects of the Brexit vote was a recent example of this.
Action: Contact Dave Wyper if you wish to discuss
2. A brief update was provided by Avinash Kanodia on SANON.
3. The Brain Tumour Charity’s strategy and priorities were presented by Erica Moyes.
4. With the new 7 Tesla MRI scanner due to be commissioned at the University of Glasgow next year it was invaluable to have Christopher Hess of the University of California, San Francisco, give the keynote address.
Jozien Goense (Glasgow) first updated the audience on the 7 Tesla MRI project at Glasgow.
Chris then gave an excellent overview of the potential benefits and pitfalls. Chris emphasised the importance of focusing on the strengths of 7 Tesla:
- Increased T1 relaxation times and hence better image resolution
- Shorter T2* relaxation times and so better image contrast
- Better spectral separation and so improved spectroscopic imaging.
Dave Wyper noted that it is perhaps the latter that will be of most benefit in brain tumour imaging and already papers are appearing in the 7 Tesla MRI literature on this. Potentially also, however, the GOLD technique that was developed in Glasgow to enable MRI to image changes in metabolism could be explored in tumour models.
Alison Murray felt that the presentations highlighted that there is so much potential for better diagnosis and prognosis.
5. After coffee is was the turn of a radiologist, neurosurgeon and neuro-oncologist from Dundee to provide their overview of intra- and post-operative assessment of brain tumours.
Avinash Kanodia gave the radiologist’s perspective on pre- intra- and post-operative issues.
James Galea then presented the aims of neuro-oncological surgery, considerations and challenges. He concluded by highlighting:
- The role of a neurosurgery has to be increasingly justified.
- Increasing need to be aware of established and upcoming Rx modalities.
- Ethical dilemmas will always be present – it is a “burden” and a “responsibility” on the surgeon.
- The patient should be at the centre of treatment.
Hannah Lord then provided some of the challenges and opportunities for neuro-oncology. She asked if it might be possible for the updates in pathology eg IDH-1, to be mirrored by advances in radiology. She also raised questions about the respective roles of pathologists and radiologists, suggesting that radiologists might better serve their patients by focussing less on diagnosis and more on the best type of treatment for each patient. She raised the challenge of understanding the balance between the advantages of using chemotherapy and the issues associated with its toxicity, especially the long-term effects of chemotherapy on young patients and the impact on their cognitive ability over time.
Anthony Chalmers indicated that a presentation was coming up looking at using prognosis factors to design care for older patients and that this was trying to address some of the questions raised by Hannah.
Sally Pimlott felt that “…discussion after Hannah’s talk on the challenges that face clinicians was fantastic and it was great to see that actually some of the projects we have ongoing (as a result of the SINAPSE/SANON meetings) are actually already trying to address at least some of these challenges.”
6. After lunch SANON-SINAPSE project updates were provided.
i) First up was Antoine Vallatos (Glasgow) who provided an update on “Optimising small animal MRI to measure invasion and tumour heterogeneity in glioblastoma xenografts”.
Two main questions were raised and answered as follows:
Question 1: Regarding the BBB permeability weighted images, is it possible that another effect is probed related to relaxation changes for example (not related to BBB damage or GBM invasion).
Answer 1: What is probed has to be evaluated with histology, this is the reason we combined Dextran stains to probe the BBB damage with HLA to probe tumour invasion. The first results are promising. The resulting perfusion maps are obtained by a ratio of two images (one with and one without diffusion gradient at the same echo times) acquired with same echo time and TR, so relaxation effects are not really expected to affect the outcome.
Question 2: In order to evaluate BBB permeability weighted images it is possible to use techniques that are known to cause BBB breakdown, for example using ultrasound a technique we have been using in the past.
Answer 2: We were already considering evaluation of the technique using BBB damage techniques as mannitol injection or irradiation. The ultrasound alternative and its advantages have to be discussed.
Action: Antoine to discuss as appropriate with Gerry Thompson (Edinburgh) and Jim Walkden (Aberdeen). [Subsequent to meeting, Gerry suggested discussing potential translational work and impacts building on human imaging work with Alan Jackson in Manchester and a meeting is being organised for later this year.]
ii) This was followed with an update on “Assessment of prognostic factors in older patients with glioblastoma” prepared by Cressida Lorimer (Brighton), Catherine Hanna (Glasgow) and Samantha Mills (Liverpool). This highlighted the approach being taken to research geriatric assessment and WMH scoring of normal hemisphere (so optimising patient selection for radiotherapy).
Hannah Lord indicated that she was very interested in the project’s aims and in playing a part.
Action: Cressida to discuss possible opportunities for Hannah Lord to become involved.
iii) Anthony Chalmers then gave an update on the “Development and application of a radiolabelled PARP inhibitor”
iv) Sally Pimlott (Glasgow) then had an excellent opportunity to update the brain tumour community on the planned PET imaging project “18F-Fluciclovine study in glioblastoma”, getting input and suggestions from people not already involved.
She said “I think this highlights the strength of bringing together the centres across Scotland to design a clinical study that can be successfully funded.”
Dave Wyper added that “it was also encouraging to see that progress is being made on the SINAPSE-SANON projects to develop novel PET tracers and to evaluate commercial tracers in a clinical setting. These studies are world class and demonstrate the strength of Scottish research groups internationally.”
7. Thanks to sponsors and speakers.
Anthony closed the meeting by noting that these meetings are doing what they set out to, i.e., bringing a mix of brain tumour researchers and clinicians together to share understanding and look for opportunities to collaborate on projects. He thanked SINAPSE and the Brain Tumour Charity for their sponsorship of the event and all the speakers for their very valuable input. In particular, he thanked Chris Hess for coming all the way from (sunny!) San Francisco to share his experience of 7 Tesla MRI.
8. Additional feedback
“…it was good to see such good attendance from research teams from the Universities of Glasgow, Strathclyde, Dundee and Aberdeen and from NHS groups around Scotland.”
“…this was a great meeting with good attendance from multiple disciplines relevant to adult brain tumour research”
“…agenda was very busy, but also mostly of very much interest…”
[Many thanks to Irene Clark for preparing the meeting notes and to the presenters for sharing their slides]