Multivoxel MRS of Human Breast Cancer at 3T.

描述(由申请人提供)： 在最近的一次美国国立卫生研究院共识发展会议上，强调在20世纪90年代的S期间，美国将有150多万女性被诊断为乳腺癌，其中约30%将死于乳腺癌。据估计，每9名妇女中就有1人在有生之年患上乳腺癌。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)为提高组织定性提供了令人兴奋的潜力。这项建议的最初目标是在使用局部磁共振波谱(MRS)对乳腺病变的代谢进行分析的基础上，改善乳腺病变的良性或恶性特征。收集的50多名女性的MRS数据显示出高度的敏感性和特异性。所有被研究的女性都有注射磁共振造影剂后增强的病变。应该指出的是，无强化的病变几乎肯定是良性的。我们还表明，更高的磁场，即3T，以两种截然不同的方式提高了MRS检查的质量；改善了胆碱检测的信噪比，胆碱是一种似乎是恶性肿瘤标志的代谢物，以及更小的采样量。在过去的一年里，我们开发并验证了一种用于3T乳腺MRS的多体素、多层、MRS序列，该序列可以在大约10分钟内以大约6 mm的平面分辨率覆盖整个乳房。这一序列可以产生乳房的胆碱图，这些图可以很容易地覆盖在解剖MR图像、增强的MR图像或动态对比研究的逐个像素分析的结果上。我们的中心假设是，从MRS单独获得的诊断信息，或者结合MRI标准，可以用来提高整个MR检查的特异性。我们将在一组有强化病变的女性中检验这一假设，作为这项研究的一部分，这些女性都将接受活检。组织病理学将是诊断的金标准。MRS在特异性方面的改进将通过潜在地减少阴性活检的次数而产生有益的效果。我们将确定MRS在乳腺癌整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.