Development of a clinically applicable matching tool between MRI and close-up X-ray mammograms for the purpose of MRI-matching guided stereotactic breast biopsy

该D-A-CH提案的目的是建立一种新的方法，用于匹配磁共振成像（MRI）和近距离立体定位活检X射线乳腺X线摄影，该方法基于对女性乳房生物力学的准确模拟，可以将MRI检测到的乳腺病变的检查成本效益提高50%。我们的目标是将仅在MRI中可见的病变信息转移到具有足够配准精度的乳腺X线摄影特写投影视图上，以适应基于乳腺X线摄影的病变检查，从而减少对昂贵且耗时的MRI活检的需求。这样的配准的挑战是对经受乳房摄影压缩的乳房的实质非线性变形进行建模，以科普由于个体定位引起的压缩过程的患者特异性变化，以及将MRI信息与在立体定位活检期间执行的特写乳房摄影视图（其不覆盖整个乳房）进行匹配。为了在临床环境中准确预测这些视图中的病变位置，必须识别克服非线性变形的生物力学模型的所需复杂性，同时在配准精度和计算时间方面满足临床需求。此外，重要的是要识别和考虑影响匹配精度的因素，如解剖，临床或生物力学特征。在这个拟议的项目中，我们将通过患者特定的生物力学模型来模拟接受乳房X光摄影乳房压迫的乳房变形来解决这些研究问题。该项目将研究X线引导活检的临床可行性，该计划仅通过开发必要的软件和工作流程，同时考虑匹配精度和工作流程速度的临床相关性，基于MRI结果进行规划。该项目将提供一个最终的方法，可以直接实施到临床实践中。我们在KIT和MUW的研究团队在乳腺图像配准的技术方面以及诊断性乳腺成像和干预的临床需求方面提供了综合经验。该提案中的研究将为生物力学驱动的乳腺图像配准的临床应用提供新的见解，使成本降低高达50%，解决执行MRI引导干预的设施短缺问题，从而大大促进和加快MRI检测到乳腺病变的患者的检查。

The aim of this D-A-CH proposal is to establish a novel method for matching magnetic resonance imaging (MRI) and close-up stereotactic biopsy X-ray mammograms based on accurate simulation of the biomechanics of the female breast, which could improve the cost-effectiveness of the work-up of MRI-detected breast lesions up to 50%. We aim to transfer information of lesions only visible in MRI onto mammographic close-up projection views with sufficient registration accuracy to fit a mammogram-based lesion workup and thereby reduce the need for costly and time-consuming MRI biopsies. The challenges of such a registration are to model the substantial non-linear deformations of the breast undergoing mammographic compression, to cope with patient-specific variabilities of the compression process due to individual positioning and to match the MRI information to close-up mammography views performed during stereotactical biopsy, which do not cover the complete breast. For accurate prediction of a lesion position in these views in a clinical setting, it is essential to identify the required complexity of a biomechanical model overcoming the non-linear deformation while at the same time serving clinical needs in both registration accuracy and computation time. Moreover, it is important to identify and consider factors influencing matching accuracy like anatomical, clinical or biomechanical features. In this proposed project we will address these research questions by means of patient specific biomechanical models to simulate the deformation of the breast undergoing mammographic breast compression. The project will investigate the clinical feasibility of X-ray guided biopsy, which is planned based on MRI findings only by developing the necessary software and workflow while considering the clinical relevance of matching accuracies and workflow speed. The project will provide a final method which can directly be implemented into clinical practice. Our research team at KIT and MUW provides combined experience with respect to technical aspects of breast image registration and clinical needs of diagnostic breast imaging and intervention. The research in this proposal will provide new insights in the clinical application of biomechanically driven breast image registration, enable a cost reduction of up to 50%, address the shortage of facilities performing MRI-guided interventions and thus considerably facilitate and fasten work-up of patients with MRI-detected breast lesions.