Fast algorithms for biophysically-constrained inverse problems in medical imaging

We present algorithms and software for parameter estimation for forward and inverse tumor growth problems and diffeomorphic image registration. Our methods target the following scenarios: automatic image registration of healthy images to tumor bearing medical images and parameter estimation/calibration of tumor models. This thesis focuses on robust and scalable algorithms for these problems. Although the proposed framework applies to many problems in oncology, we focus on primary brain tumors and in particular low and high-grade gliomas. For the tumor model, the main quantity of interest is the extent of tumor infiltration into the brain, beyond what is visible in imaging. The inverse tumor problem assumes that we have patient images at two (or more) well-separated times so that we can observe the tumor growth. Also, the inverse problem requires that the two images are segmented. But in a clinical setting such information is usually not available. In a typical case, we just have multimodal magnetic resonance images with no segmentation. We address this lack of information by solving a coupled inverse registration and tumor problem. The role of image registration is to find a plausible mapping between the patient's tumor-bearing image and a normal brain (atlas), with known segmentation. Solving this coupled inverse problem has a prohibitive computational cost, especially in 3D. To address this challenge we have developed novel schemes, scaled up to 200K cores. Our main contributions is the design and implementation of fast solvers for these problems. We also study the performance for the tumor parameter estimation and registration solvers and their algorithmic scalability. In particular, we introduce the following novel algorithms: An adjoint formulation for tumor-growth problems with/without mass-effect; The first parallel 3D Newton-Krylov method for large diffeomorphic image registration; A novel parallel semi-Lagrangian algorithm for solving advection equations in image registration and its parallel implementation on shared and distributed memory architectures; and Accelerated FFT (AccFFT), an open-source parallel FFT library for CPU and GPUs scaled up to 131,000 cores with optimized kernels for computing spectral operators. The scientific outcomes of this thesis, has appeared in the proceedings of three ACM/IEEE SCxy conferences (two best student paper finalist, and one ACM SRC gold medal), two journal papers, two papers in review, four papers in preparation (coupling, mass effect, segmentation, and multi-species tumor model), and seven conference presentations.Computational Science, Engineering, and Mathematic

INTEGRATION OF BIOMEDICAL IMAGING AND TRANSLATIONAL APPROACHES FOR MANAGEMENT OF HEAD AND NECK CANCER

The aim of the clinical component of this work was to determine whether the currently available clinical imaging tools can be integrated with radiotherapy (RT) platforms for monitoring and adaptation of radiation dose, prediction of tumor response and disease outcomes, and characterization of patterns of failure and normal tissue toxicity in head and neck cancer (HNC) patients with potentially curable tumors. In Aim 1, we showed that the currently available clinical imaging modalities can be successfully used to adapt RT dose based-on dynamic tumor response, predict oncologic disease outcomes, characterize RT-induced toxicity, and identify the patterns of disease failure. We used anatomical MRIs for the RT dose adaptation purpose. Our findings showed that after proper standardization of the immobilization and image acquisition techniques, we can achieve high geometric accuracy. These images can then be used to monitor the shrinkage of tumors during RT and optimize the clinical target volumes accordingly. Our results also showed that this MR-guided dose adaptation technique has a dosimetric advantage over the standard of care and was associated with a reduction in normal tissue doses that translated into a reduction of the odds of long-term RT-induced toxicity. In the second aim, we used quantitative MRIs to determine its benefit for prediction of oncologic outcomes and characterization of RT-induced normal tissue toxicity. Our findings showed that delta changes of apparent diffusion coefficient parameters derived from diffusion-weighted images at mid-RT can be used to predict local recurrence and recurrence free-survival. We also showed that Ktrans and Ve vascular parameters derived from dynamic contrast-enhanced MRIs can characterize the mandibular areas of osteoradionecrosis. In the final clinical aim, we used CT images of recurrence and baseline CT planning images to develop a methodology and workflow that involves the application of deformable image registration software as a tool to standardize image co-registration in addition to granular combined geometric- and dosimetric-based failure characterization to correctly attribute sites and causes of locoregional failure. We then successfully applied this methodology to identify the patterns of failure following postoperative and definitive IMRT in HNC patients. Using this methodology, we showed that most recurrences occurred in the central high dose regions for patients treated with definitive IMRT compared with mainly non-central high dose recurrences after postoperative IMRT. We also correlated recurrences with pretreatment FDG-PET and identified that most of the central high dose recurrences originated in an area that would be covered by a 10-mm margin on the volume of 50% of the maximum FDG uptake. In the translational component of this work, we integrated radiomic features derived from pre-RT CT images with whole-genome measurements using TCGA and TCIA data. Our results demonstrated a statistically significant associations between radiomic features characterizing different tumor phenotypes and different genomic features. These findings represent a promising potential towards non-invasively tract genomic changes in the tumor during treatment and use this information to adapt treatment accordingly. In the final project of this dissertation, we developed a high-throughput approach to identify effective systemic agents against aggressive head and neck tumors with poor prognosis like anaplastic thyroid cancer. We successfully identified three candidate drugs and performed extensive in vitro and in vivo validation using orthotopic and PDX models. Among these drugs, HDAC inhibitor and LBH-589 showed the most effective tumor growth inhibition that can be used in future clinical trials

A neuronal network of mitochondrial dynamics regulates metastasis.

The role of mitochondria in cancer is controversial. Using a genome-wide shRNA screen, we now show that tumours reprogram a network of mitochondrial dynamics operative in neurons, including syntaphilin (SNPH), kinesin KIF5B and GTPase Miro1/2 to localize mitochondria to the cortical cytoskeleton and power the membrane machinery of cell movements. When expressed in tumours, SNPH inhibits the speed and distance travelled by individual mitochondria, suppresses organelle dynamics, and blocks chemotaxis and metastasis, in vivo. Tumour progression in humans is associated with downregulation or loss of SNPH, which correlates with shortened patient survival, increased mitochondrial trafficking to the cortical cytoskeleton, greater membrane dynamics and heightened cell invasion. Therefore, a SNPH network regulates metastatic competence and may provide a therapeutic target in cancer