Establishing the clinical utility of a consensus DSC-MRI Protocol

摘要 这项多点研究旨在建立最佳实践建议和临床价值的新共识 动态磁化率对比(DSC)磁共振成像方案。DSC-MRI是目前应用最广泛的生理学方法之一 神经肿瘤学中的成像技术，据报道，在所有常规脑肿瘤扫描中，有85%的部位使用了成像技术 美国和欧洲。DSC-MRI测量相对脑血容量对脑胶质瘤的鉴别诊断价值 分级，识别无强化胶质瘤的肿瘤成分，区分肿瘤复发和治疗后 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 在靶向治疗之后。尽管证明了这一价值，但一致的临床DSC-MRI指南的翻译 由于采购和后处理协议的差异，跨多个机构的评估仍然具有挑战性。 为了提高DSC-MRI的准确性、重复性和多点一致性，研究小组对此进行了研究 提案确定并验证了DSC-MRI协议，该协议已成为以下领域的共识建议 患有神经胶质瘤的患者。因此，我们处于有利地位，能够解决这一领域的关键差距，这些差距一旦得到解决， 将加速广泛采用协商一致议定书，并指导其在临床实践中的使用。我们首先 目的建立DSC-MRI前处理和后处理方法的最佳实践。然后我们将利用 我们在图像定位活检和匹配的图像-组织相关性方面的专业知识，以建立指南 解释用协商一致方案生成的rCBV图，特别适用于低血压的鉴别 从高级别胶质瘤发展到高级别胶质瘤，从治疗后效果来看。最后，我们的目标是 建立一致的DSC-MRI方案对脑肿瘤患者的临床增值价值 管理层。这些研究将解决关键的实际和临床上未得到满足的需求，这些需求将直接促进 未来DSC-MRI在胶质瘤患者中的应用，从而促进共识的DSC-MRI的广泛采用 协议。

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.