Improved Detection of Cerebral Metastases using a using a Novel T1 Relaxation-Enhanced Steady-State (T1RESS) MRI Technique

使用新型 T1 弛豫增强稳态 (T1RESS) MRI 技术改进脑转移瘤的检测

• 批准号: 10440636
• 负责人: Robert R. Edelman
• 金额: $ 53.11万
• 依托单位: NORTHSHORE UNIVERSITY HEALTHSYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-12 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10440636
• 关键词: Adult; Anatomy; Appearance; Applications Grants; Biological Products; Blood; Blood - brain barrier anatomy; Blood Vessels; Brain; Brain Neoplasms; Cerebrum; Clinical; Contrast Media; Deposition; Detection; Disease; Dose; Enhancing Lesion; Equation; Fatty acid glycerol esters; Frequencies; Gadolinium; Goals; Image; Imaging Techniques; Institution; Lesion; Magnetic Resonance Imaging; Metastatic malignant neoplasm to brain; Methods; Modeling; Morphologic artifacts; Neck; Neoplasm Metastasis; Nephrogenic Systemic Fibrosis; Noise; Ocular orbit; Patients; Phase; Physiologic pulse; Pilot Projects; Positron-Emission Tomography; Prognosis; Publishing; Radiosurgery; Relaxation; Research; Resolution; Scanning; Science; Sensitivity and Specificity; Signal Transduction; Site; Specificity; Techniques; Time; Tissues; Variant; Water; base; brain magnetic resonance imaging; brain tumor imaging; cancer imaging; contrast enhanced; cost; diagnostic accuracy; dosage; healthy volunteer; improved; neuroimaging; novel; risk minimization; skull base; standard of care; treatment planning; tumor; tumor diagnosis

Contrast-enhanced magnetic resonance imaging (MRI) is the cornerstone for brain tumor diagnosis and treatment planning. While its sensitivity for metastases is superior to that of CT or PET-CT, small lesions (<5- mm) and leptomeningeal spread may still be missed, which can have a major impact on prognosis and planning for stereotactic radiosurgery, as well as on the use of targeted biologics that cross the blood-brain barrier. A method that could further improve the sensitivity and specificity of MRI for brain tumors would be of great clinical benefit. Towards this end, we have developed a new class of pulse sequences, called T1 Relaxation-Enhanced Steady-State (T1RESS), that greatly improves the visibility of tumors in contrast- enhanced MRI. Compared with existing neuroimaging techniques, T1RESS at least doubles the tumor-to- background contrast while significantly improving the tumor-to-background contrast-to-noise ratio. An “unbalanced” version (uT1RESS) renders blood vessel dark and is the focus of our proposal. In a preliminary study of 54 adult patients that was published in Science Advances, uT1RESS provided a remarkable twofold or greater improvement in tumor-to-brain contrast along with a marked improvement in lesion-to-brain contrast-to-noise in comparison to standard-of-care MPRAGE and other pulse sequences that are commonly used to image brain tumors. We found that even small metastatic tumor deposits and leptomeningeal lesions that were difficult to distinguish from small blood vessels with standard imaging techniques could be unambiguously identified. The primary hypothesis of this five-year grant proposal is that T1RESS will significantly improve the sensitivity for small brain metastases compared with existing MRI pulse sequences, while also reducing scan times. A secondary hypothesis is that the twofold improvement in tumor-to-brain contrast obtained with uT1RESS can be used to enable a substantial twofold reduction in gadolinium-based contrast agent (GBCA) dosage. Studies of phantoms, healthy volunteers, and patients with brain tumors along with Bloch equation modeling will be used to guide sequence optimization. These optimization efforts will be followed by a two- institution study to determine the accuracy of the technique. Our specific aims are as follows: 1. To apply uT1RESS in healthy subjects and patients with brain tumors to systematically evaluate the impact of various sequence parameters on image appearance, contrast, SNR, and lesion sharpness, and to optimize the technique to maximize tumor visibility while minimizing scan time and image artifacts. 2. To perform a pilot study to determine whether metrics of tumor visibility using uT1RESS and a twofold reduced GBCA contrast agent dosage are noninferior to MPRAGE with a standard contrast agent dosage. 3. To perform a two-site research trial at 3T to characterize the appearance of brain metastases with uT1RESS, and to determine its accuracy for small brain metastases compared to standard-of-care MPRAGE.

对比增强磁共振成像（MRI）是脑肿瘤诊断和诊断的基础