Shutter-Speed DCE-MRI Discrimination of Benign and Malignant Breast Disease

描述（由申请人提供）：本项目的总体目标是使用一种新的分析药代动力学方法-快门-速度模型（SSM）来提高动态对比增强（DCE） MRI对乳腺良恶性疾病的鉴别能力。乳腺癌是妇女癌症死亡的第二大原因。尽管MRI在乳腺癌检测方面比乳房x光检查和超声检查具有更高的灵敏度，但这三种成像方式都有有限的特异性。这可能导致不必要的（良性）活组织检查，以及不希望出现的并发症和患者护理后果。DCE MRI信号时程分析有三种基本方法：定性主观评价、经验定量和分析建模。最后一种是最理想的，因为提取的药代动力学参数应该独立于数据采集细节、对比剂（CR）剂量和注射速度、个人技能等。传统的分析——标准模型（SM）——忽略了CR丸通过病变时的平衡经细胞乳水交换效应，这可能导致药代动力学参数的严重低估，以及CR剂量和注射速率的依赖性，因此特异性较低。对22例患者的DCE MRI数据进行初步SSM分析（考虑水交换效应），消除了CR给药依赖性，显示出完美的敏感性和特异性。具体目标是：1)在统计上有显著意义的人群中，评估SSM分析DCE MRI数据将显著提高乳腺良恶性疾病鉴别（与SM方法相比）的假设。2)。在不牺牲敏感性的情况下，确定区分乳腺良恶性病变的SSM药代动力学参数阈值。3)。评估不同时间分辨率和动脉输入功能测定对1.)和2.)的影响。临床可疑病变患者的t1加权梯度回声DCE MRI数据将在其预定的MRI引导下的术前针头定位或活检过程中收集，并将SM和SSM进行分析。药代动力学参数将与病理结果相关联进行统计分析。如果成功，这种SSM方法可能会被纳入临床乳腺MRI方案，以减少可能不必要的（良性）活检，并可能在监测癌症治疗方面有价值。

DESCRIPTION (provided by applicant): The general aim of this project is to improve dynamic contrast enhanced (DCE) MRI capability for benign and malignant breast disease discrimination, using a new analytical pharmacokinetic approach - the Shutter- Speed Model (SSM). Breast cancer is the second leading cause of cancer death in women. Though MRI has higher sensitivity than mammography and ultrasound for breast cancer detection, all three imaging modalities have limited specificities. This leads to possibly unnecessary (benign) biopsies, as well as undesirable complications and patient care consequences. There are three basic approaches for analyzing DCE MRI signal time-courses: qualitative subjective assessment, empirical quantitation, and analytical modeling. The last is most desirable, since the pharmacokinetic parameters extracted should be independent of data acquisition details, contrast reagent (CR) dose and injection rate, personal skill, etc. The conventional analysis - the Standard Model (SM) - ignores equilibrium transcytolemmal water exchange effects during CR bolus passage through the lesion, which can lead to significant underestimation, and CR dose- and injection rate-dependence, of the pharmacokinetic parameters, and thus low specificity. Preliminary SSM analyses (accounting for water exchange effects) of DCE MRI data from 22 patients eliminate the CR administration dependencies, and show perfect sensitivity and specificity. The specific aims are: 1.) Evaluate the hypothesis that SSM analyses of DCE MRI data will significantly improve benign and malignant breast disease discrimination (compared to the SM approach) in a statistically significant population. 2.) Determine the SSM pharmacokinetic parameter thresholds that separate benign and malignant breast lesions with highest positive predictive value without sacrificing sensitivity. 3.) Evaluate the effects of varying temporal resolution and arterial input function determination on 1.) and 2.). T1-weighted gradient echo DCE MRI data from patients with clinically suspicious lesions will be collected during their scheduled MRI-guided preoperative needle localization or biopsy procedures, and will be analyzed with both SM and SSM. The pharmacokinetic parameters will be correlated with pathology results for statistical analyses. If successful, this SSM method may potentially be incorporated into clinical breast MRI protocols to reduce possibly unnecessary (benign) biopsies, and may be valuable in monitoring cancer treatment.