RESUMO
High magnetic fields expand our capability to use sodium MRI for biomedical applications. The central goal of this review is devoted to the unique features of sodium MRI in tumor animal models, mainly in glioma, performed at 9.4 and 21.1 T. The ability of sodium MRI to monitor tumor response to therapy was evaluated. It is noteworthy that sodium MRI can detect glioma response to chemotherapy earlier than diffusion MRI. Especially attractive is the ability of sodium MRI to predict tumor therapeutic resistance before therapy. The non-invasive prediction of tumor chemo-resistance by sodium MRI presents a potential to individualize strategies for cancer treatment. Specifics of sodium MRI and technical aspects of imaging are also presented.
Assuntos
Neoplasias Encefálicas/diagnóstico , Glioma/diagnóstico , Campos Magnéticos , Imageamento por Ressonância Magnética/métodos , Sódio/metabolismo , Animais , Neoplasias Encefálicas/tratamento farmacológico , Modelos Animais de Doenças , Glioma/tratamento farmacológico , HumanosRESUMO
At ultrahigh magnetic field strengths (B0 ≥ 7.0 T), potassium ((39) K) MRI might evolve into an interesting tool for biomedical research. However, (39) K MRI is still challenging because of the low NMR sensitivity and short relaxation times. In this work, we demonstrated the feasibility of (39) K MRI at 21.1 T, determined in vivo relaxation times of the rat head at 21.1 T, and compared (39) K and sodium ((23) Na) relaxation times of model solutions containing different agarose gel concentrations at 7.0 and 21.1 T. (39) K relaxation times were markedly shorter than those of (23) Na. Compared with the lower field strength, (39) K relaxation times were up to 1.9- (T1 ), 1.4- (T2S ) and 1.9-fold (T2L ) longer at 21.1 T. The increase in the (23) Na relaxation times was less pronounced (up to 1.2-fold). Mono-exponential fits of the (39) K longitudinal relaxation time at 21.1 T revealed T1 = 14.2 ± 0.1 ms for the healthy rat head. The (39) K transverse relaxation times were 1.8 ± 0.2 ms and 14.3 ± 0.3 ms for the short (T2S ) and long (T2L ) components, respectively. (23) Na relaxation times were markedly longer (T1 = 41.6 ± 0.4 ms; T2S = 4.9 ± 0.2 ms; T2L = 33.2 ± 0.2 ms). (39) K MRI of the healthy rat head could be performed with a nominal spatial resolution of 1 × 1 × 1 mm(3) within an acquisition time of 75 min. The increase in the relaxation times with magnetic field strength is beneficial for (23) Na and (39) K MRI at ultrahigh magnetic field strength. Our results demonstrate that (39) K MRI at 21.1 T enables acceptable image quality for preclinical research. Copyright © 2016 John Wiley & Sons, Ltd.
Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Imageamento por Ressonância Magnética/métodos , Imagem Molecular/métodos , Potássio/farmacocinética , Isótopos de Sódio/farmacocinética , Animais , Estudos de Viabilidade , Compostos Radiofarmacêuticos/farmacocinética , Ratos , Ratos Endogâmicos F344 , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Distribuição TecidualRESUMO
An initiative to design and build magnetic resonance imaging (MRI) and spectroscopy (MRS) instruments at 14 T and beyond to 20 T has been underway since 2012. This initiative has been supported by 22 interested participants from the USA and Europe, of which 15 are authors of this review. Advances in high temperature superconductor materials, advances in cryocooling engineering, prospects for non-persistent mode stable magnets, and experiences gained from large-bore, high-field magnet engineering for the nuclear fusion endeavors support the feasibility of a human brain MRI and MRS system with 1 ppm homogeneity over at least a 16-cm diameter volume and a bore size of 68 cm. Twelve neuroscience opportunities are presented as well as an analysis of the biophysical and physiological effects to be investigated before exposing human subjects to the high fields of 14 T and beyond.
Assuntos
Encéfalo/diagnóstico por imagem , Imageamento por Ressonância Magnética , Anisotropia , Axônios/patologia , Encéfalo/patologia , Mapeamento Encefálico/métodos , Simulação por Computador , Metabolismo Energético , Glucose/análise , Temperatura Alta , Humanos , Movimento (Física) , Neurônios/patologia , Permeabilidade , Reprodutibilidade dos Testes , ATPase Trocadora de Sódio-Potássio/química , Espectrofotometria , Imagem Corporal TotalRESUMO
OBJECT: MR imaging of low-gamma nuclei at the ultrahigh magnetic field of 21.1 T provides a new opportunity for understanding a variety of biological processes. Among these, chlorine and sodium are attracting attention for their involvement in brain function and cancer development. MATERIALS AND METHODS: MRI of (35)Cl and (23)Na were performed and relaxation times were measured in vivo in normal rat (n = 3) and in rat with glioma (n = 3) at 21.1 T. The concentrations of both nuclei were evaluated using the center-out back-projection method. RESULTS: T 1 relaxation curve of chlorine in normal rat head was fitted by bi-exponential function (T 1a = 4.8 ms (0.7) T 1b = 24.4 ± 7 ms (0.3) and compared with sodium (T 1 = 41.4 ms). Free induction decays (FID) of chlorine and sodium in vivo were bi-exponential with similar rapidly decaying components of [Formula: see text] ms and [Formula: see text] ms, respectively. Effects of small acquisition matrix and bi-exponential FIDs were assessed for quantification of chlorine (33.2 mM) and sodium (44.4 mM) in rat brain. CONCLUSION: The study modeled a dramatic effect of the bi-exponential decay on MRI results. The revealed increased chlorine concentration in glioma (~1.5 times) relative to a normal brain correlates with the hypothesis asserting the importance of chlorine for tumor progression.
Assuntos
Neoplasias Encefálicas/patologia , Cloro/química , Glioma/patologia , Imageamento por Ressonância Magnética/métodos , Sódio/química , Animais , Progressão da Doença , Desenho de Equipamento , Imageamento Tridimensional , RatosRESUMO
Sodium and diffusion magnetic resonance imaging (MRI) in intracranial rat 9L gliomas were evaluated over 6-8 days using the advanced sensitivity of sodium MRI at 21.1 T. Glioma doubling time was 2.4-2.6 days. Glioma sodium signal was detected using the ultra-short echo time of 0.15 ms. The high resolution 3D sodium MRI with pixels of 0.125 µL allowed for minimizing a partial volume effect often relevant to the MRI of low intensity signals. Tumor sodium and diffusion MRI were evaluated for two separate subclones of 9L cells with different resistance to 1,3-bis(2-chloroethyl)-1-nitrosurea detected by pre-surgery assays. In vivo, after implantation, resistant 9L cells created tumors with significantly reduced sodium concentrations (57 ± 3 mM) compared with nonresistant 9L cells (78 ± 3 mM). The corresponding differences in diffusion were less, but also statistically significant. During tumor progression, an increase of glioma sodium concentration was observed in both cell types with a rate of 2.4-5.8 %/day relative to normal brain. Tumor diffusion was not significantly changed at this time, indicative of no alterations in glioma cellularity. Thus, changes in sodium during tumor progression reflect increasing intracellular sodium concentration and mounting metabolic stress. These experiments also demonstrate an enhanced sensitivity of sodium MRI to reflect tumor cell resistance.
Assuntos
Neoplasias Encefálicas/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Glioma/patologia , Animais , Neoplasias Encefálicas/metabolismo , Progressão da Doença , Glioma/metabolismo , Ratos , Sensibilidade e Especificidade , Sódio , Células Tumorais CultivadasRESUMO
Multiple quantum NMR signals that appear in the presence of weak quadrupole interactions were formulated using statistical tensors (Fano, 1957). The approach aimed to present a concise and a computer-based tool for a detailed analysis and modification of the MQ pulse sequences. The calculation avoids a lengthy procedure of utilizing exponential operators and, moreover, the same formulae are applicable for any interval in the TQ pulse sequence, as well as any spin value. The quantum operator algebra was implemented using "Mathematica" software (Wolfram Inc.). The results of tensor's evolutions in the TQ pulse sequence were graphically illustrated using corresponding spherical harmonics. The visualization takes into consideration the parity properties of irreducible tensors and the corresponding spherical harmonics.
Assuntos
Espectroscopia de Ressonância Magnética/métodos , Software , Interpretação Estatística de Dados , Teoria QuânticaRESUMO
Gliomas are the most common form of central nervous system tumor. The most prevalent form, glioblastoma multiforme, is also the most deadly with mean survival times that are less than 15 months. Therapies are severely limited by the ability of these tumors to develop resistance to both radiation and chemotherapy. Thus, new tools are needed to identify and monitor chemoresistance before and after the initiation of therapy and to maximize the initial treatment plan by identifying patterns of chemoresistance prior to the start of therapy. Here we show how magnetic resonance imaging, particularly sodium imaging, metabolomics, and genomics have all emerged as potential approaches toward the identification of biomarkers of chemoresistance. This work also illustrates how use of these tools together represents a particularly promising approach to understanding mechanisms of chemoresistance and the development individualized treatment strategies for patients.
RESUMO
BACKGROUND: Controlled cortical impact (CCI) has emerged as one of the most flexible and clinically applicable approaches for the induction of traumatic brain injury (TBI) in rodents and other species. Although this approach has been shown to model cognitive and functional outcomes associated with TBI in humans, recent work has shown that CCI is limited by excessive variability in lesion size despite attempts to control velocity, impact depth, and dwell time. NEW METHOD: Thus, this work used high-speed imaging to evaluate the delivery of cortical impact and permit the identification of specific parameters associated with technical variability in the CCI model. RESULTS: Variability is introduced by vertical oscillations that result in multiple impacts of varying depths, lateral movements after impact, and changes in velocity, particularly at the prescribed impact depth. CONCLUSIONS: Together these data can inform future work to design modifications to commonly used CCI devices that produce TBI with less variability in severity and lesion size.
Assuntos
Lesões Encefálicas Traumáticas/patologia , Encéfalo/patologia , Modelos Animais de Doenças , Processamento de Imagem Assistida por Computador/métodos , Animais , Encéfalo/diagnóstico por imagem , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Masculino , Ratos Sprague-Dawley , Reprodutibilidade dos TestesRESUMO
Potassium and sodium specific binding in vivo were explored at 21.1T by triple quantum (TQ) magnetic resonance (MR) signals without filtration to achieve high sensitivities and precise quantifications. The pulse sequence used time proportional phase increments (TPPI). During simultaneous phase-time increments, it provided total single quantum (SQ) and TQ MR signals in the second dimension at single and triple quantum frequencies, respectively. The detection of both TQ and SQ signals was performed at identical experimental conditions and the resulting TQ signal equals 60±3% of the SQ signal when all ions experience sufficient time for binding. In a rat head in vivo the TQ percentage relative to SQ for potassium is 41.5±3% and for sodium is 16.1±1%. These percentages were compared to the matching values in an agarose tissue model with MR relaxation times similar to those of mammalian brain tissue. The sodium TQ signal in agarose samples decreased in the presence of potassium, suggesting a competitive binding of potassium relative to sodium ions for the same binding sites. The TQTPPI signals correspond to almost two times more effective binding of potassium than sodium. In vivo, up to â¼69% of total potassium and â¼27% of total sodium can be regarded as bound or experiencing an association time in the range of several milliseconds. Experimental data analyses show that more than half of the in vivo total sodium TQ signal could be from extracellular space, which is an important factor for quantification of intracellular MR signals.
Assuntos
Espectroscopia de Ressonância Magnética/métodos , Potássio/química , Sefarose/química , Sódio/química , Animais , Sítios de Ligação , Química Encefálica , Cabeça/diagnóstico por imagem , Imagens de Fantasmas , RatosRESUMO
The aim of this study was to observe the effects of strophanthin induced inhibition of the Na-/K-ATPase in liver cells using a magnetic resonance (MR) compatible bioreactor. A microcavity array with a high density three-dimensional cell culture served as a functional magnetic resonance imaging (MRI) phantom for sodium multi quantum (MQ) spectroscopy. Direct contrast enhanced (DCE) MRI revealed the homogenous distribution of biochemical substances inside the bioreactor. NMR experiments using advanced bioreactors have advantages with respect to having full control over a variety of physiological parameters such as temperature, gas composition and fluid flow. Simultaneous detection of single quantum (SQ) and triple quantum (TQ) MR signals improves accuracy and was achieved by application of a pulse sequence with a time proportional phase increment (TQTPPI). The time course of the Na-/K-ATPase inhibition in the cell culture was demonstrated by the corresponding alterations of sodium TQ/SQ MR signals.
Assuntos
Fígado/metabolismo , Espectroscopia de Ressonância Magnética/métodos , ATPase Trocadora de Sódio-Potássio/metabolismo , Técnicas de Cultura de Tecidos , Inibidores Enzimáticos/administração & dosagem , Células Hep G2 , Humanos , Imageamento Tridimensional , Fígado/efeitos dos fármacos , Imagens de Fantasmas , Estrofantinas/administração & dosagemRESUMO
The ability to quantitate early effects of tumor therapeutic response using noninvasive imaging would have a major impact in clinical oncology. One area of active research interest is the ability to use MR techniques to detect subtle changes in tumor cellular density. In this study, sodium and proton diffusion MRI were compared for their ability to detect early cellular changes in tumors treated with a cytotoxic chemotherapy. Subcutaneous 9L gliosarcomas were treated with a single dose of 1,3-bis(2-chloroethyl)-1-nitrosourea. Both sodium and diffusion imaging modalities were able to detect changes in tumor cellularity as early as 2 days after treatment, which continued to evolve as increased signal intensities reached a maximum approximately 8 days posttreatment. Early changes in tumor sodium and apparent diffusion coefficient values were predictive of subsequent tumor shrinkage, which occurred approximately 10 days later. Overall, therapeutical induced changes in sodium and diffusion values were found to have similar dynamic and spatial changes. These findings suggest that these imaging modalities detected similar early cellular changes after treatment. The results of this study support the continued clinical testing of diffusion MRI for evaluation of early tumor treatment response and demonstrate the complementary insights of sodium MRI for oncology applications.
Assuntos
Antineoplásicos Alquilantes/farmacologia , Neoplasias Encefálicas/tratamento farmacológico , Carmustina/farmacologia , Imagem de Difusão por Ressonância Magnética/métodos , Gliossarcoma/tratamento farmacológico , Animais , Biomarcadores Tumorais , Neoplasias Encefálicas/química , Gliossarcoma/química , Imageamento Tridimensional , Masculino , Transplante de Neoplasias , Prótons , Ratos , Ratos Endogâmicos F344 , SódioRESUMO
Functional changes of sodium 3D MRI signals were converted into millimolar concentration changes using an open-source fully automated MATLAB toolbox. These concentration changes are visualized via 3D sodium concentration maps, and they are overlaid over conventional 3D proton images to provide high-resolution co-registration for easy correlation of functional changes to anatomical regions. Nearly 5000/h concentration maps were generated on a personal computer (ca. 2012) using 21.1T 3D sodium MRI brain images of live rats with spatial resolution of 0.8×0.8×0.8 mm(3) and imaging matrices of 60×60×60. The produced concentration maps allowed for non-invasive quantitative measurement of in vivo sodium concentration in the normal rat brain as a functional response to migraine-like conditions. The presented work can also be applied to sodium-associated changes in migraine, cancer, and other metabolic abnormalities that can be sensed by molecular imaging. The MATLAB toolbox allows for automated image analysis of the 3D images acquired on the Bruker platform and can be extended to other imaging platforms. The resulting images are presented in a form of series of 2D slices in all three dimensions in native MATLAB and PDF formats. The following is provided: (a) MATLAB source code for image processing, (b) the detailed processing procedures, (c) description of the code and all sub-routines, (d) example data sets of initial and processed data. The toolbox can be downloaded at: http://www.vuiis.vanderbilt.edu/~truongm/COMA3D/.
Assuntos
Imageamento por Ressonância Magnética/métodos , Prótons , Isótopos de Sódio/análise , Sódio/análise , Algoritmos , Animais , Encéfalo/patologia , Química Encefálica , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patologia , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Transtornos de Enxaqueca/metabolismo , Transtornos de Enxaqueca/patologia , Ratos , Ratos Sprague-Dawley , Sódio/metabolismo , SoftwareRESUMO
The first in vivo sodium and proton magnetic resonance (MR) images and localized spectra of rodents were attained using the wide bore (105 mm) high resolution 21.1-T magnet, built and operated at the National High Magnetic Field Laboratory (Tallahassee, FL, USA). Head images of normal mice (C57BL/6J) and Fisher rats (approximately 250 g) were acquired with custom designed radiofrequency probes at frequencies of 237/900 MHz for sodium and proton, respectively. Sodium MR imaging resolutions of approximately 0.125 microl for mouse and rat heads were achieved by using a 3D back-projection pulse sequence. A gain in SNR of approximately 3 for sodium and approximately 2 times for proton were found relative to corresponding MR images acquired at 9.4 T. 3D Fast Low Angle Shot (FLASH) proton mouse images (50x50x50 microm(3)) were acquired in 90 min and corresponding rat images (100x100x100 microm(3)) within a total time of 120 min. Both in vivo large rodent MR imaging and localized spectroscopy at the extremely high field of 21.1 T are feasible and demonstrate improved resolution and sensitivity valuable for structural and functional brain analysis.
Assuntos
Química Encefálica , Encéfalo/anatomia & histologia , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Sódio/análise , Animais , Camundongos , Camundongos Endogâmicos C57BL , Prótons , Ratos , Ratos Endogâmicos F344 , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
The ultimate goal of any cancer therapy is to target the elimination of neoplastic cells. Although newer therapeutic strategies are in constant development, therapeutic assessment has been hampered by the inability to assess, rapidly and quantitatively, efficacy in vivo. Diffusion imaging and, more recently, sodium MRI have demonstrated their distinct abilities to detect therapy-induced alterations in tumor cellularity, which has been demonstrated to be indicative of therapeutic efficacy. More importantly, both imaging modalities detect tumor response much earlier than traditional methodologies that rely on macroscopic volumetric changes. In this study, the correlation between tumor sodium and diffusion was further tested to demonstrate the sensitivity of sodium imaging to gauge tumor response to therapy by using a 9L rat gliosarcoma treated with varying doses of BCNU [1,3-bis(2-chloroethyl)-1-nitrosourea]. This orthotopic model has been demonstrated to display variability in response to BCNU therapy where initial insult has been shown to lead to drug-resistance. In brief, a single 26.6 mg/kg BCNU dose yielded dramatic responses in both diffusion and sodium MRI. However, a second equivalent BCNU dose yielded a much smaller change in diffusion and sodium, suggesting a drop in tumor sensitivity to BCNU. The MRI responses of animals treated with 13.3 mg/kg BCNU were much lower and similar responses were observed after the initial and secondary applications of BCNU. Furthermore, these results were further validated using volumetric measurements of the tumor and also ex vivo determination of tumor sensitivity to BCNU. Overall, these experiments demonstrate the sensitivity and applicability of sodium and diffusion MRI as tools for dynamic assessment of tumor response to therapy.
Assuntos
Neoplasias Encefálicas/tratamento farmacológico , Carmustina/uso terapêutico , Resistencia a Medicamentos Antineoplásicos/fisiologia , Gliossarcoma/tratamento farmacológico , Imageamento por Ressonância Magnética/métodos , Animais , Antineoplásicos , Neoplasias Encefálicas/patologia , Linhagem Celular Tumoral , Difusão , Gliossarcoma/patologia , Masculino , Prótons , Ratos , Ratos Endogâmicos F344 , SódioRESUMO
This study investigates the comparative changes in the sodium MRI signal and proton diffusion following treatment using a 9L rat glioma model to develop markers of earliest response to cancer therapy. Sodium MRI and proton diffusion mapping were performed on untreated (n = 5) and chemotherapy 1,3-bis(2-chloroethyl)-1-nitrosourea-treated rats (n = 5). Animals were scanned serially at 2- to 3-day intervals for up to 30 days following therapy. The time course of Na concentration in a tumor showed a dramatic increase in the treated brain tumor compared to the untreated tumor, which correlates in time with an increase in tumor water diffusion. The largest posttreatment increase in sodium signal occurred 7-9 days following treatment and correlated to the period of the greatest chemotherapy-induced cellular necrosis based on diffusion and histopathology. Both Na MRI and proton ADC mapping revealed early changes in tumor sodium content and cellularity. This study demonstrates the possibility of Na MRI to function as a biomarker for monitoring early tumor treatment and validates the use of monitoring changes in diffusion MRI values for assessing tumor cellularity.
Assuntos
Neoplasias Encefálicas/tratamento farmacológico , Gliossarcoma/tratamento farmacológico , Imageamento por Ressonância Magnética , Animais , Antineoplásicos Alquilantes/uso terapêutico , Biomarcadores Tumorais , Neoplasias Encefálicas/química , Carmustina/uso terapêutico , Gliossarcoma/química , Imageamento Tridimensional , Imageamento por Ressonância Magnética/métodos , Masculino , Transplante de Neoplasias , Prótons , Ratos , Ratos Endogâmicos F344 , SódioRESUMO
T cell immunotherapy is a potential strategy for the treatment of brain tumors because it offers a high degree of specificity, the ability to extravasate into solid tumors, and the potential for eliciting a long-term protective immune response. Various approaches have been developed to overcome T cell immune tolerance to cancer, including the use of cytokines and bispecific antibodies. T cell stimulation with the proinflammatory cytokine IL-12 can elicit antitumor immunity. T cell activation can be increased using bispecific antibodies against activating molecules on the surface of T cells and a tumor antigen. We studied the effects of systemic IL-12 administration in combination with a conjugate of an anti-CD28 antibody and a ligand for the folate receptor. The high affinity folate receptor is expressed on endogenously arising choroid plexus tumors of SV11 mice, which are transgenic for large T antigen under the control of the SV40 promoter. SV11 mice are immunocompetent, yet immunologically tolerant to large T antigen expressed by choroid plexus tumors. MRI analysis showed that the administration of IL-12 and anti-CD28 Fab/folate significantly slowed tumor growth. Proliferating CD8(+) T cells were found in choroid plexus tumors of treated animals. Treatment of animals with IL-12 + anti-CD28 Fab/folate prolonged survival compared to IL-12 alone. Cytokine treatment combined with tumor-targeted costimulation may be a useful adjunct treatment.
Assuntos
Soro Antilinfocitário/metabolismo , Antineoplásicos/metabolismo , Antineoplásicos/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Sistemas de Liberação de Medicamentos/métodos , Linfócitos T/imunologia , Animais , Neoplasias Encefálicas/imunologia , Linhagem Celular Tumoral , Humanos , Ligantes , Camundongos , Camundongos TransgênicosRESUMO
To evaluate noninvasive measures of gene expression and tumor response in a gene-dependent enzyme prodrug therapy (GDEPT), a bifunctional fusion gene between Saccharomyces cerevisiae cytosine deaminase (CD) and Haemophilus influenzae uracil phosphoribosyltransferase (UPRT) was constructed. CD deaminates 5-fluorocytosine (5FC) to 5-fluorouracil (5FU), and UPRT subsequently converts 5FU to fluorouridine monophosphate, and both of these reactions can be monitored noninvasively in vitro and in vivo using 19F magnetic resonance spectroscopy (MRS). Following transient transfection the CD-UPRT fusion protein exhibited both UPRT and CD enzymatic activities as documented by 19F MRS. In addition, an increase in CD activity and thermal stability was witnessed for the fusion protein compared to native CD. Stable expression of CD-UPRT in 9L glioma cells increased both 5FC and 5FU sensitivity in vitro compared to CD-expressing and wild-type 9L cells. Noninvasive 19F MRS of both CD and UPRT gene function in vivo demonstrated that in animals bearing CD-expressing tumors there was limited conversion of 5FC to 5FU with no measurable accumulation of cytotoxic fluorinated nucleotides (F-nucs). In contrast, CD-UPRT-expressing tumors had increased CD gene activity with a threefold higher intratumoral accumulation of 5FU and significant generation of F-nucs. Finally, CD-UPRT yielded increased efficacy in an orthotopic animal model of high-grade glioma. More importantly, early changes in cellular water mobility, which are felt to reflect cellular death, as measured by diffusion-weighted MRI, were predictive of both durable response and increased animal survival. These results demonstrate the increased efficacy of the CD-UPRT GDEPT compared to CD alone both biochemically and in a preclinical model and validate both 19F MRS and diffusion-weighted MRI as tools to assess gene function and therapeutic efficacy.