Future Of Mrs In Oncology

Past trends suggest an increased use of MRS for the purpose of addressing clinical management problems in cancer patients, and also to further our understanding of the unique biochemistry and physiology of cancer. Two attributes of MRS provide compelling support for this assertion. First, MRS clearly provides information beyond that provided by other forms of MRI. MRI provides a vivid anatomic depiction as well as some physiological information (e.g., perfusion or oxygenation), while MRS provides complementary biochemical information. The ease with which MRS can be incorporated into an MRI study protocol therefore guarantees it an increased use even though the biochemical information provided by MRS is not fully understood in many cases. Many relevant studies have emphasized that MRS augments MRI and that the two techniques should be used in concert. Second, MRS provides one of the few means of assessing aspects of tissue biochemistry without exposure to radioisotopes or to ionizing radiation. Therefore, MRS can be performed in an individual patient at a frequency that is only limited by finances and logistics. This suggests that MRS may become a diagnostic tool of considerable significance for long-term management of cancer patients, because an individual patient can undergo almost unlimited MRS surveillance during different treatments.

A major factor that limits the increased acceptance of MRS is the problem of interpretation. There simply is not sufficient knowledge of relationships between the relevant metabolism and key clinical features, such as grade of disease or therapeutic response. Future studies will therefore need to address two specific areas. First, there is need for detailed studies of the biochemistry and metabolism of specific cancers. Ultimately, such studies must be related to genetic control of specific metabolic pathways in specific cancers. Most of this work may not even use MRS as an assessment tool, and the techniques of modern molecular biology are likely to significantly augment this discovery process. Second, even if a detailed understanding of relevant biochemisty is lacking, there is a need for large-scale clinical studies that support the role of MRS in addressing specific problems associated with cancer management. Existing studies typically come from a single center and rarely include more than 50 subjects. While such studies are unquestionably useful for defining the appropriate directions for future study, they cannot adequately define the attributes and pitfalls of routine assessment of cancer by MRS.

Finally, it is most important to emphasize that MRS is a "moving technology." There has been sustained technological progress in its implementation during the past ten years. It is clear that this technological progress will continue for at least another decade and will cause a further acceleration in the use of MRS for the clinical assessment of the cancer patient.

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