Breast Cancer Screening with Quantitative Ultra-Fast DCEMRI and Clinical Risk Assessment

摘要 MRI有可能显着改善乳腺癌筛查，特别是对于致密型乳腺癌的女性。 女性患乳腺癌的风险高于平均水平。然而， 在MRI用于筛查大量妇女之前，需要诊断的准确性。的 Kuhl及其同事设计的简化MRI扫描（AB-MRI）是一种非常有前途的MRI方法， 筛查，但依赖于一个单一的T1加权扫描后造影剂注射，以评估增强。的 缺乏关于造影剂摄取动力学的信息可能降低诊断准确性。研究 这里提出的将测试的假设，超快MRI的AB-MRI增加提高诊断 精度我们建议AB-MRI结合超快DCE-MRI可以提供有效的筛查， 以合理的成本，并且对患者的不便最小化。这将导致可靠的检测， 具有临床意义的乳腺癌比目前的筛查方法早几年， 降低乳腺癌的发病率和死亡率。 AB-MRI筛查的全国ECOG-ACRIN临床试验将于2016年底开始。的基本协议， 该试验是10分钟的扫描，具有单次造影后T1加权扫描。然而，根据结果， 在这个实验室中，ECOG ACRIN试验的领导者强烈支持将定量超快DCE-MRI纳入 芝加哥大学的AB-MRI（请参见主席的支持信）。我们建议： 1.优化集成到AB-MRI中的超快DCE-MRI，总持续时间小于10分钟。的 超快DCE-MRI扫描将具有每张图像小于3秒的时间分辨率。 2.开发超快数据的定量分析，以测量初始增强时间（TIE）， 基于简化计算方法的定量Ktranss测量，损伤传递函数 (LTF)和病变通过时间（LTT）。此外，我们将测量病变的初始动力学 增强纹理。 3.评价DCE-MRI药代动力学参数的诊断准确性。将对数据进行分析 分两个阶段首先，我们将使用芝加哥大学目前获得的数据来确定最重要的 从超快DCE-MRI中获得有希望的参数以进行进一步评估。第二，我们将评估最 在“测试组”中有希望的参数。ROC分析将用于确定是否来自 超快成像可以提高MRI筛查的诊断准确性。 4.比较AB-MRI与和不与超快DCE-MRI的诊断准确性，使用读取器 研究和定量分析。 新的超快DCE-MRI，集成到AB-MRI扫描将显着降低发病率和死亡率， 乳腺癌，同时显着降低成本，提高效率。

Abstract MRI has potential to significantly improve breast cancer screening, particularly for women with dense breasts and women who are at higher than average risk for breast cancer. However, improvements in diagnostic accuracy are needed before MRI can be used to screen large numbers of women. The abbreviated MRI scan (AB-MRI) designed by Kuhl and colleagues is a very promising approach to MRI- screening, but relies on a single T1-weighted scan post contrast injection to evaluate enhancement. The lack of information regarding contrast media uptake kinetics may reduce diagnostic accuracy. The research proposed here will test the hypothesis that addition of ultrafast MRI to AB-MRI improves diagnostic accuracy. We propose that AB-MRI combined with ultrafast DCE-MRI can provide effective screening with at a reasonable cost, and with minimal inconvenience for patients. This would result in reliable detection of clinically significant breast cancer years earlier than current screening methods, and thus significantly reduce morbidity and mortality due to breast cancer. A national ECOG-ACRIN clinical trial of AB-MRI screening will begin in late 2016. The basic protocol for this trial is a 10 minute scan with a single post-contrast T1-weighted scan. However, based on results from this lab, the leaders of the ECOG ACRIN trial strongly support inclusion of quantitative ultrafast DCE-MRI in AB-MRI at UChicago (please see the letter of support from the Chair). We propose to: 1. Optimize ultrafast DCE-MRI integrated into AB-MRI with total duration of less than 10 minutes. The ultrafast DCE-MRI scan will have time resolution of less than 3 seconds per image. 2. Develop quantitative analysis of ultrafast data to measure time of initial enhancement (TIE), quantitative Ktrans measurements based on a simplified computational approach, lesion transfer function (LTF) and lesion transit Time(LTT). In addition, we will measure the initial kinetics of lesion enhancement texture. 3. Evaluate the diagnostic accuracy of pharmacokinetic parameters from DCE-MRI. Data will be analyzed in two stages. First, we will use data that is currently being acquired at UChicago to identify the most promising parameters from ultrafast DCE-MRI for further evaluation. Second, we will evaluate the most promising parameters in a ‘testing group’. ROC analysis will be used to determine whether parameters from ultrafast imaging can increase the diagnostic accuracy of MRI screening. 4. Compare the diagnostic accuracy of AB-MRI with and without ultrafast DCE-MRI, using both a Reader study and quantitative analysis. New ultrafast DCE-MRI, integrated into AB-MRI scans will significantly reduce morbidity and mortality due to breast cancer, while significantly reducing costs and increasing efficiency.