A Major Breakthrough in the Diagnosis of Acute Leukemia - MRI Evaluation of Angiogenesis in Patient with Acute Leukemia Greatly Enhanced the Forecasting and Treatment Assessment

On January 14th, 2009, NTU held a press conference to announce the achievements of Professor Tiffany Ting-Fang Shih and Professor Hwei-Fang Tien's research teams, whose members have found a way to assess accurately the effectiveness of treatment and the survival of acute myeloid leukemia patients by integrating regular MRI with an innovative analytical method. Their finding is a fast, non-invasive and reproducible method which allows for repeated measurements of the neovascularity of leukemia patients, and the results of their research has been published in the top hematology journal "Blood."

For many years Professor Tiffany Shih's research team has been exploring the blood perfusion in bone marrows. They used non-invasive dynamic magnetic resonance scanning, coupled with the development of precision image data analysis and imaging software, and accomplished an innovative and effective diagnostic measurement mode: patients need only take a small amount (about 10-20 ml) of contrast agent injection and less than five minutes' image scanning, and the radiologists are able to obtain the comprehensive parameters of the change of blood flows in the large areas of the bone marrows of their patients. By using this method, the patients do not need to bear the pain of bone marrow aspiration/biopsy, and the radiologists are able to detect the amount of abnormal blood vessels and the functional changes as well as the micro-moment volume of the permeability of the blood. Furthermore, the blood perfusion changes that occur in the blood vessels surrounding the cancer cells both before, during, and after treatment can be clearly detected by this method. Thus, Dr. Shih's new imaging method is an effective biological indicator of the angiogenesis of acute myeloid leukemia patients.

After spending five years on research, Professor Shih's team has successfully measured the blood perfusion in human's bone marrows. The team members found out that there was an enormous difference between men and women in terms of the amount of blood perfusion in their bone marrows. In addition, the team members discovered that the amount of blood flow reached its peak when a human being is between 20 and 40 years of age. After the age of 40, the blood flow in the bone marrows drops year by year, and there is a linear correlation between the amount of blood flow and a person's age. This discovery was published in the top journal of radiology field. In the mean time, the research team discovered that vasculogenesis of acute leukemia patients is five times that of people of the same age and gender. The leukemia patients not only develop more blood vessels, they also have a larger amount of blood perfusion, and incur drastic changes in the permeability functions of their blood. NTU's new technology allows the physicians to observe these changes on a real time basis, and by obtaining the relevant indicators the physicians are able to accurately prescribe treatment for acute myeloid leukemia patients. Moreover, during the treatment process, this new technology can monitor the efficacy of the drugs, providing references for the physicians for them to decide whether to continue treatment or to change the prescription of medication. Even for patients with normal chromosomes whose risk of having leukemia remains uncertain, NTU's new technology can provide further analysis and assessment.

Professor Shih further explained that, there is an inseparable relationship between the formation of leukemia and vasculogenesis, which is comparable to the importance of the soil to the seeds. In leukemia related research, there has been a boom in bone marrow vasculogenesis studies in recent years. However, as the bone marrows are confined in densely enclosed space, surrounded by bones and trabeculation, it is highly difficult to measure their blood flow. One of the advantages of this new technology is that it overcome the difficult by using imaging technology and can be used for prognostic purposes. It may be used to evaluate the new born blood vessels and to detect a patient's abnormal bone marrow conditions with any possible potential to evolve into leukemia.

Professor Shih emphasized that the diagnosis of leukemia still had to depend on bone marrow aspiration or biopsy. Patients who receive treatment must undergo bone marrow aspiration or biopsy from time to time in order to evaluate the effect of their treatments. As the procedures are quite painful for the patients, doctors can not perform them repeatedly within a short period of time. Therefore, this new diagnostic imaging technology provides early and abundant information for clinical physicians in their treatment of leukemia patients.

Professor Shih indicated that this innovative method could be widely applied to the detection and treatment of other types of cancer, such as liver cancer. Starting from the early days after the patient receives treatment; this method can assess the changes of angiogenesis of the patient in a non-invasive and real time manner. By detecting the volume of new blood flow in the vessel or the changes in permeability of the blood vessel walls, physicians will be able to achieve at an early prediction of the efficiency of anti-cancer treatment and use that as an indicator for follow up tracking or change of therapy. For oriental people who have a high incidence of liver cancer, this is a very important breakthrough.

Professor Shih stressed that the technology devised by her team provided a highly personalized therapy. Ordinary personalized treatment of cancer depends heavily upon gene and protein biomarkers to assess therapeutic effects and to prognosticate survivability. However, gene research often demands the use of extremely expensive equipments and sophisticated analysis of genetic variations. Using magnetic resonance image analysis as functional blood flow map, Dr. Shih's research team offers personalized health care for cancer patients.