Diffusion-Weighted Magnetic Resonance Imaging as a Cancer Biomarker: Consensus and Recommendations
Diffusion-Weighted Magnetic Resonance Imaging as a Cancer Biomarker: Consensus and Recommendations
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2008年5月3日，在2008年国际医学磁共振学会会议期间，国家癌症研究所（NCI）在加拿大安大略的多伦多举办了一次公开共识会议。大约100名专家和利益相关者总结了目前对弥散加权磁共振成像（DW-MRI）的理解，并就DW-MRI作为癌症成像生物标志物的使用达成了共识。DW-MRI应在明确定义的临床试验中作为成像生物标志物进行测试，将DW-MRI添加到现有的NCI申办的试验中，特别是那些具有组织采样或生存指标的试验。如果可能，应将DW-MRI测量结果与组织学指标（包括细胞构成和组织反应）进行比较。需要组织等效扩散系数体模，同时应使用简单的液体填充体模。表观扩散系数值的单指数评估应使用两个B值（> 100和500 - 1000 mm（2）/sec，取决于应用）。自由呼吸多次采集上级复杂的门控技术。基线患者再现性研究应是研究设计的一部分。应获得感兴趣区域和表观扩散系数测量的直方图分析。需要用于测量、分析和显示的标准。验证研究的注释数据（沿着结果测量）应公开提供。磁共振成像供应商应参与这一进程。NCI应该建立一个专家工作组（物理学家、放射学家和肿瘤学家）来计划、组织技术方面的工作，并进行试点试验。美国放射学会成像网络基础设施可能适合这些目的。DW-MRI有一个非凡的机会发展成为一种具有临床价值的成像工具，对药物开发具有潜在的重要意义。
On May 3, 2008, a National Cancer Institute (NCI)-sponsored open consensus conference was held in Toronto, Ontario, Canada, during the 2008 International Society for Magnetic Resonance in Medicine Meeting. Approximately 100 experts and stakeholders summarized the current understanding of diffusion-weighted magnetic resonance imaging (DW-MRI) and reached consensus on the use of DW-MRI as a cancer imaging biomarker. DW-MRI should be tested as an imaging biomarker in the context of well-defined clinical trials, by adding DW-MRI to existing NCI-sponsored trials, particularly those with tissue sampling or survival indicators. Where possible, DW-MRI measurements should be compared with histologic indices including cellularity and tissue response. There is a need for tissue equivalent diffusivity phantoms; meanwhile, simple fluid-filled phantoms should be used. Mono-exponential assessments of apparent diffusion coefficient values should use two b values (> 100 and between 500 and 1000 mm(2)/sec depending on the application). Free breathing with multiple acquisitions is superior to complex gating techniques. Baseline patient reproducibility studies should be part of study designs. Both region of interest and histogram analysis of apparent diffusion coefficient measurements should be obtained. Standards for measurement, analysis, and display are needed. Annotated data from validation studies (along with outcome measures) should be made publicly available. Magnetic resonance imaging vendors should be engaged in this process. The NCI should establish a task force of experts (physicists, radiologists, and oncologists) to plan, organize technical aspects, and conduct pilot trials. The American College of Radiology Imaging Network infrastructure may be suitable for these purposes. There is an extraordinary opportunity for DW-MRI to evolve into a clinically valuable imaging tool, potentially important for drug development.