3D Ultra-sensitive Ultrasound Microvessel Imaging for Breast Mass Differentiation

项目摘要 乳腺癌是女性癌症死亡的第二大原因，影响着数百万美国人。早期 癌症检测和准确的肿瘤诊断对于良好的临床结果至关重要。超声 (US)是乳腺X线摄影的重要辅助成像方式，因为它是无创的，成本效益高， available.然而，US的低特异性限制了其诊断准确性，即使与 乳房X光检查由此产生的不必要的良性活检大大增加了患者的成本和焦虑。 肿瘤血管生成可以作为一个有价值的生物标志物，以更好的乳腺肿瘤超声分化。然而，在这方面， 传统的多普勒成像具有不足的血管检测灵敏度。 我们最近开发了一种新的二维超灵敏超声微血管成像（2D-UMI） 技术，与传统多普勒相比，该技术显著提高了血管检测灵敏度 方法而不需要使用造影剂。在我们的初步研究中， 与单独使用常规US相比，US与2D-UMI组合提高了15%。然而，2D 由于大多数肿瘤是异质性的，因此肿瘤血管分布评估可能是不全面的。拟议 研究，2D-UMI技术将被推进到3D成像，并进一步增强，以提供一个 全面的肿瘤血管检查可提高乳腺肿瘤分类准确性并减少 不必要的良性活检 鉴于临床需要和我们最近的诊断发展，这项建议有两个具体目标： 具体目标1：开发和增强3D-UMI扫描序列。我们将开发UMI 使用Verasonics Vantage研究扫描仪在3D成像中进行序列扫描。我们将应用多个编码平面 波传输，以确保足够的入射声能和超声穿透。我们还将 开发新的组织杂波滤波器，以消除由强反射体引起的带状旁瓣伪影， 乳房成像然后，我们将使用定制的流动体模来测试和增强技术，并铺设 目的2的临床研究的方法。 具体目标2：对乳腺肿块患者进行3D-UMI的初步临床研究。我们将 研究42例乳腺肿瘤患者，以评估3D-UMI改善乳腺肿瘤的疗效 分类.有经验的放射科医生将评估结果。然后我们会将诊断结果 常规超声与常规超声联合诊断之间的准确性（以病理学为金标准） 3D-UMI与单独使用常规US。 成功完成拟议的研究将导致一种新的超灵敏3D多普勒技术， 有助于以高准确性诊断乳腺肿瘤。

PROJECT SUMMARY Breast cancer, the second-leading cause of cancer deaths among women, affects millions of Americans. Early cancer detection and accurate tumor diagnosis are crucial for favorable clinical outcomes. Ultrasonography (US) is an important imaging modality adjunct to mammography as it is noninvasive, cost-effective, and widely available. However, the low specificity of US limits its diagnosis accuracy, even in combination with mammography. The resultant unnecessary benign biopsies substantially increase patients’ cost and anxiety. Tumor angiogenesis can be used as a valuable biomarker for better breast tumor US differentiation. However, conventional Doppler imaging has insufficient vessel detection sensitivity. We have recently developed a novel 2-dimensional ultra-sensitive ultrasound microvessel imaging (2D-UMI) technology, which demonstrates significantly increased vessel detection sensitivity over conventional Doppler methods without the need of using contrast agents. In our preliminary study, the diagnosis accuracy of combining US with 2D-UMI was improved by 15% compared to using conventional US alone. However, 2D tumor vascularity evaluation may be incomprehensive as most tumors are heterogeneous. In the proposed research, the 2D-UMI technique will be advanced to 3D imaging, and further enhanced to provide a comprehensive tumor vessel investigation to improve breast tumor classification accuracy and reduce unnecessary benign biopsies. In light of clinical need and our recent diagnostic development, this proposal has two specific aims: Specific Aim 1: Develop and enhance the 3D-UMI scanning sequence. We will develop the UMI sequence in 3D imaging using a Verasonics Vantage research scanner. We will apply multiple coded plane wave transmissions to ensure sufficient incident acoustic energy and ultrasound penetration. We will also develop new tissue clutter filters to eliminate the banding side-lobe artifacts caused by strong reflectors in breast imaging. We will then use a custom flow phantom to test and enhance the technology, and pave the way for the clinical study in Aim 2. Specific Aim 2: Conduct a pilot clinical study of 3D-UMI on patients with breast masses. We will study 42 patients with breast tumors to assess the 3D-UMI’s efficacy in improving breast tumor classification. An experienced radiologist will evaluate the results. We will then compare the diagnosis accuracy (using pathology as the gold standard) between the combined diagnosis of conventional US plus 3D-UMI versus use of conventional US alone. Successful completion of the proposed research will lead to a novel ultra-sensitive 3D Doppler technology to facilitate diagnosis of breast tumors with high accuracy.