Establishing the clinical utility of a consensus DSC-MRI Protocol

摘要 这项多中心研究旨在建立最佳实践建议和临床价值的新共识 动态磁敏感对比（DSC）MRI方案。DSC-MRI是最广泛使用的生理检查之一， 神经肿瘤学中的成像技术，据报道，在所有研究中心的所有常规脑肿瘤扫描中， 美国和欧洲。DSC-MRI测量相对脑血容量（rCBV）可鉴别胶质瘤 分级，识别非增强胶质瘤中的肿瘤成分，区分肿瘤复发与治疗后 影响（包括假性进展和放射性坏死），并预测治疗反应和患者生存期 在靶向治疗后。尽管这证明了价值，翻译一致的临床DSC-MRI指南 由于采集和后处理协议的可变性，在多个机构之间进行数据交换仍然具有挑战性。 为了提高DSC-MRI的准确性、可重复性和多中心一致性， 该提案确定并验证了DSC-MRI协议，该协议已成为共识建议， 神经胶质瘤患者。因此，我们完全有能力解决这一领域的关键差距，这些差距一旦得到解决， 将加速共识协议的广泛采用，并指导其在临床实践中的使用。我们首先 旨在为DSC-MRI的预处理和后处理方法建立最佳实践。然后我们会利用 我们在图像定位活检和匹配图像-组织相关性方面的专业知识， 解释用共识协议生成的rCBV图，特别适用于低- 从高级别胶质瘤，和进展的高级别胶质瘤从治疗后的影响。最后，我们的目标是 建立共识DSC-MRI方案对影响脑肿瘤患者的临床附加值 管理这些研究将解决关键的实际和临床未满足的需求，这将直接促进 DSC-MRI在神经胶质瘤患者中的未来应用，从而促进共识DSC-MRI的广泛采用 议定书

Abstract This multi-site study aims to establish best practice recommendations and clinical value of a new consensus protocol for dynamic susceptibility contrast (DSC) MRI. DSC-MRI is one of the most widely used physiologic imaging techniques in neuro-oncology, with a reported use in 85% of all routine brain tumor scans at sites across the US and Europe. DSC-MRI measures of relative cerebral blood volume (rCBV) can differentiate glioma grades, identify tumor components in non-enhancing glioma, distinguish tumor recurrence from post-treatment effects (including pseudoprogression and radiation necrosis) and predict treatment response and patient survival after targeted therapy. Despite this demonstrated value, translation of consistent clinical DSC-MRI guidelines across multiple institutions remains challenging owing to variability in acquisition and post-processing protocols. To improve the accuracy, repeatability, and multi-site consistency of DSC-MRI, the team of investigators on this proposal identified and validated a DSC-MRI protocol that has since become a consensus recommendation for patients with glioma. Accordingly, we are well positioned to address critical gaps in this field that, once solved, will accelerate the widespread adoption of the consensus protocol and direct its use in clinical practice. We first aim to establish best practices for the pre- and post-processing methods for DSC-MRI. We will then leverage our expertise with image-localized biopsies and matched image-tissue correlations to establish guidelines for interpreting rCBV maps generated with the consensus protocol, specifically applied to the differentiation of low- from high-grade glioma, and progression of high-grade glioma from post-treatment effects. Finally, we aim to establish the clinical value added of the consensus DSC-MRI protocol for impacting brain tumor patient management. These studies will address key practical and clinical unmet needs that will directly facilitate the future use of DSC-MRI in glioma patients, thereby promoting widespread adoption of the consensus DSC-MRI protocol.