Multivoxel MRS of Human Breast Cancer at 3T.

描述（由申请人提供）： 在最近的国立卫生研究院共识发展会议上，强调在20世纪90年代，美国将有超过150万妇女被诊断患有乳腺癌，其中约30%将死于这种疾病。据估计，每9名妇女中就有1人在其一生中会患上乳腺癌。一般来说，发现时病变越小，预后越好。与其他成像方式相比，磁共振成像（MRI）在增加组织表征方面具有令人兴奋的潜力。该提案的最初目标是基于使用局部磁共振波谱（MRS）分析其代谢来改善乳腺病变的良性或恶性特征。收集的50多名妇女的MRS数据显示出高灵敏度和特异性。所有研究的妇女都有病变，这些病变在注射MR造影剂后增强。应该注意的是，无强化病变几乎肯定是良性的。我们还表明，更高的字段，即3 T提高MRS检查的质量在两个明显不同的方式;提高信噪比的检测胆碱，代谢物似乎是恶性肿瘤的标志物，和更小的采样体积。在过去的一年中，我们已经开发并验证了一种用于3 T乳腺MRS的多体素、多切片、MRS序列，该序列可以在约10分钟内以约6 mm的平面分辨率覆盖整个乳腺。该序列可以产生乳房的胆碱图，其可以容易地覆盖在解剖MR图像、对比增强MR图像或动态对比研究的逐像素分析的结果上。我们的中心假设是，从MRS单独或结合MRI标准得出的诊断信息，可以用来提高整体MR检查的特异性。我们将在一组病变增强的妇女中检验这一假设，作为本研究的一部分，她们都将接受活检。组织学将成为诊断的金标准。MRS衍生的特异性改善将通过潜在地减少进行的阴性活检的数量而具有有益效果。我们将确定MRS在乳腺癌总体检查中的成本效益。

DESCRIPTION (provided by applicant): In a recent National Institutes of Health consensus development conference, it was emphasized that during the 1990's, more than 1.5 million women in the U.S. will be diagnosed with breast cancer and that approximately 30% of them will die of the disease. It is estimated that 1 out of every 9 women will develop breast cancer during her lifetime. In general, the smaller the lesion is at the time of detection, the better the prognosis. Magnetic Resonance Imaging (MRI) offers exciting potential for increased tissue characterization compared to other imaging modalities. The initial goal of this proposal was to improve the characterization of lesions in the breast as either benign or malignant based on an analysis of their metabolism using localized magnetic resonance spectroscopy (MRS). The MRS data collected on more than 50 women show high sensitivity and specificity. All of the women studied had lesions which enhanced with the injection of MR contrast agent. It should be noted that non-enhancing lesions are almost certainly benign. We have also showed that higher fields, i.e. 3 T improve the quality of the MRS examination in two distinctly different ways; improved signal-to-noise in the detection of choline, the metabolite which appears to be a marker for malignancy, and smaller sampling volumes. Over the past year we have developed and validated a multivoxel, multi-slice, MRS sequence for breast MRS at 3T that can provide coverage of the whole breast with about 6 mm in plane resolution in about 10 minutes. This sequence can produce choline maps of the breast that can be readily overlaid on both the anatomical MR images, contrast enhanced MR images or the results of pixel-by-pixel analyses of dynamic contrast studies. Our central hypothesis is that the diagnostic information derived from MRS alone, or in combination with MRI criteria, can be employed to improve the specificity of the overall MR examination. We will test this hypothesis in a cohort of women with enhancing lesions who will all be biopsied as part of this study. Histopathology will be the gold standard for diagnosis. MRS derived improvements in specificity will have a beneficial effect by potentially reducing the number of negative biopsies performed. We will determine the cost-effectiveness of MRS in the overall work-up of breast cancer.