MR Fingerprinting and Computerized Decision Support for Prostate Cancer

项目总结 前列腺仍然是唯一盲目的非靶向活检的器官，没有预先确定的 疑似肿瘤病灶。有明显异常或前列腺特异性抗原升高的男性必须 忍受经直肠活检带来的相关费用、不适、压力和并发症，因为它不是 不可能客观可靠地确定谁不需要活组织检查。美国有超过50万的男性 由于没有前列腺癌的证据，仍在接受前列腺活检，仅仅是因为PSA，这是一种D级测试 根据USPTF的说法。因此，显然有一种尚未满足的需求，即开发更好的成像 能够改进前列腺的非侵入性表征的技术和图像分析算法 癌症，并区分低级别惰性癌症与更具侵袭性的中至高度级别癌症 变种。这将有助于引导和监测适当的患者，采用不那么激进的治疗方案，如 作为主动监视。 目前，MRI对检测高级别前列腺癌(PCA)是很好的，但对低级别和 中度疾病。明确排除疾病，因此需要对部分患者进行活组织检查 病人，是不可能的。此外，选择主动监测的患者不能仅通过成像和 需要反复定期活检。磁共振指纹识别(MRF)是由我们的 利用MRI同时量化多个组织属性的团队，并已被用于量化T1和 T2比以前更高效、更准确、更精确。广泛的初步数据显示， 将该技术与表观扩散系数(ADC)图相结合用于分离法线 从潜在的癌症周围地带。与此同时，我们的团队一直在开发和验证计算机化 决策支持(CDS)工具，可在外围和 核磁共振上的移行区。我们建议开发一种前列腺癌的MRF检查，它可以 T1、T2和ADC的同时定位用于有效和定量地分离PCa和正常 并将低风险和更具侵袭性的疾病分开。我们还将开发综合CDS 用于从MRF派生地图识别附加图像派生特征(放射组学)的工具 补充MRF测量以更准确地检测和分级外周的PCa 和过渡区。这项联合的MRF CDS考试的准确性将在 250名男性在活检前进行了扫描。

PROJECT SUMMARY The prostate remains the only organ in which blind untargeted biopsies are conducted without a pre-identified suspected focus of neoplasm. Men with palpable abnormalities or elevated prostate specific antigen must endure trans-rectal biopsy with related costs, discomfort, stress, and complications, because it is not impossible to objectively and reliably identify who does not require a biopsy. Well over 500,000 men in the US with no evidence of prostate cancer still undergo prostate biopsies, solely on account of PSA, a grade D test according to the USPTF. Consequently there is clearly an unmet need to develop both better imaging techniques and image analysis algorithms that can enable improved non-invasive characterization of prostate cancer and distinguish low grade indolent cancers from the more aggressive intermediate to high grade variants. This would help channel and monitor appropriate patients in less aggressive treatment protocols such as active surveillance. Currently MRI is excellent for detecting high grade prostate cancer (PCa), but is less accurate for low and intermediate grade disease. Definitive exclusion of disease, and thus the need for biopsy in a subset of patients, is not possible. Also, patients who opt for active surveillance cannot be followed by imaging alone and require repeated periodic biopsy. Magnetic resonance fingerprinting (MRF) is a framework pioneered by our team for simultaneously quantifying multiple tissue properties with MRI, and has been used to quantify T1 and T2 more efficiently, accurately, and precisely than previously possible. Extensive preliminary data show the utility of this technology in combination with apparent diffusion coefficient (ADC) mapping, to separate normal peripheral zone from potential cancer. In parallel our team has been developing and validating computerized decision support (CDS) tools which can diagnose, grade, and characterize PCa both in the peripheral and transitional zones on MRI. We propose to develop an MRF exam for prostate cancer that allows simultaneous mapping of T1, T2, and ADC for efficient and quantitative separation of PCa from normal prostate and to separate low risk and more aggressive disease. We will also develop integrated CDS tools to identify additional image derived features (radiomics) from the MRF derived maps to complement MRF measurements for more accurate detection and grading of PCa both in the peripheral and transitional zones. The accuracy of this combined MRF+CDS exam will be prospectively validated in a cohort of 250 men scanned prior to biopsy.