Twofold Reduction in Gadolinium Dose for Brain MRI Exams using a Novel Unbalanced T1 Relaxation-Enhanced Steady-State (uT1RESS) Technique

使用新型不平衡 T1 弛豫增强稳态 (uT1RESS) 技术将脑 MRI 检查的钆剂量减少两倍

• 批准号: 10507378
• 负责人: Robert R. Edelman
• 金额: $ 22.58万
• 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: 2022-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10507378
• 关键词: 3-Dimensional; Adult; Applications Grants; Biological Products; Blood; Blood - brain barrier anatomy; Blood Vessels; Brain; Brain Neoplasms; Clinical; Contrast Media; Cost Savings; Deposition; Detection; Disease; Dose; Enhancing Lesion; Equation; European; Evaluation; Foundations; Gadolinium; Health Benefit; Healthcare Systems; Image; Imaging Techniques; Japan; Lesion; Magnetic Resonance Imaging; Medical; Medical Device; Methods; Modeling; Multi-Institutional Clinical Trial; Multiple Sclerosis; Neoplasm Metastasis; Nephrogenic Systemic Fibrosis; Noise; Pathology; Patients; Pharmacologic Substance; Physiologic pulse; Positron-Emission Tomography; Prognosis; Publishing; Radiosurgery; Relaxation; Reporting; Research; Risk; Savings; Scanning; Science; Sensitivity and Specificity; Site; Techniques; Technology; Testing; Time; United States; United States Food and Drug Administration; Water; base; brain magnetic resonance imaging; brain tumor imaging; cancer imaging; contrast enhanced; cost; diagnostic accuracy; follow-up; healthy volunteer; imaging detection; imaging study; improved; magnetic field; nervous system disorder; neuroimaging; novel; reconstruction; 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 two-year grant proposal is that R21 grant proposal is that the twofold or greater improvement in sensitivity to gadolinium enhancement provided by uT1RESS will enable a corresponding twofold reduction in GBCA dose, with non-inferior diagnostic accuracy compared to full dose MRI using standard neuroimaging techniques. Studies of phantoms, healthy volunteers, and patients with brain tumors along with Bloch equation modeling will be used to guide sequence optimization. Our specific aims are as follows: 1. To maximize the sensitivity of uT1RESS to gadolinium enhancement while optimizing image quality and minimizing scan time. 2. To perform a single site research trial at 3 Tesla to determine whether half dose contrast-enhanced MRI using uT1RESS is non-inferior to full dose contrast-enhanced MRI using a standard neuroimaging technique in patients with brain tumors.

增强磁共振成像(MRI)是脑肿瘤诊断和治疗的基石 治疗计划。虽然它对转移的敏感性优于CT或PET-CT，但小病变(&lt；5- Mm)和软脑膜扩散仍有可能被错过，这可能对预后和 规划立体定向放射外科，以及跨血脑的靶向生物制剂的使用 障碍。可以进一步提高MRI对脑肿瘤的敏感性和特异性的方法是 极大的临床益处。为此，我们开发了一类新的脉冲序列，称为T1 松弛增强稳态(T1RESS)，与之相比，它大大提高了肿瘤的可见度- 增强的核磁共振成像。与现有的神经成像技术相比，T1RESS至少使肿瘤与肿瘤的比率翻了一番 背景对比度，同时显著提高了肿瘤与背景的对比度噪声比。一个 “不平衡”版本(UT1RESS)使血管变暗，这是我们建议的重点。 在发表在《科学进展》上的一项对54名成年患者的初步研究中，uT1RESS提供了 肿瘤对脑的对比度显著提高两倍或更多，同时 与标准护理MPRAGE和其他脉冲序列进行比较的病变-脑对比噪声比 通常用于对脑瘤进行成像。我们发现，即使是微小的转移性肿瘤沉积和 标准影像难以与小血管区分的软脑膜病变 技术可以毫不含糊地识别出来。 这项为期两年的拨款提案的主要假设是，R21拨款提案是两倍或两倍 由uT1RESS提供的对Gd增强的敏感度的更大改进将使 GBCA剂量相应减少两倍，与全量相比，诊断准确率并不逊色 使用标准神经成像技术的核磁共振成像。对幻影、健康志愿者和患有抑郁症的患者的研究 脑肿瘤和Bloch方程模型将用于指导序列优化。我们的特定 目标如下： 1.在优化图像质量的同时，最大化uT1RESS对Gd增强的敏感度 并最大限度地减少扫描时间。 2.在3特斯拉下进行单部位研究试验，以确定一半剂量的对比增强MRI 使用uT1RESS不逊于使用标准神经成像技术的全剂量对比增强MRI 脑瘤患者。