Breast Cancer Screening with Quantitative Ultra-Fast DCEMRI and Clinical Risk Assessment

使用定量超快速 DCEMRI 进行乳腺癌筛查和临床风险评估

• 批准号: 9370492
• 负责人: Gregory S. Karczmar
• 金额: $ 57.82万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-06-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9370492
• 关键词: Address; American College of Radiology Imaging Network; Anatomy; Biological; Blood Vessels; Blood capillaries; Breast; Breast Cancer Detection; Capillary Permeability; Carcinoma in Situ; Clinical Trials; Contrast Media; Data; Data Set; Detection; Diagnostic; Drug Kinetics; Eastern Cooperative Oncology Group; Eligibility Determination; Enhancing Lesion; Evaluation; General Population; Goals; High Risk Woman; Image; Injection of therapeutic agent; Kinetics; Lesion; Lesion by Morphology; Letters; MRI Scans; Magnetic Resonance Imaging; Malignant Neoplasms; Mammography; Measurement; Measures; Methods; Morbidity - disease rate; Patients; Physiological; Physiology; Protocols documentation; ROC Curve; Reader; Research; Research Personnel; Resolution; Risk; Risk Assessment; Roentgen Rays; Scanning; Sensitivity and Specificity; Specificity; Stress; Testing; Texture; Time; Training; Woman; base; blood flow measurement; breast density; cancer invasiveness; clinical risk; clinically significant; cost; design; diagnostic accuracy; high risk; improved; malignant breast neoplasm; mortality; neovasculature; novel; screening; temporal measurement; tumor; uptake

Abstract MRI has potential to significantly improve breast cancer screening, particularly for women with dense breasts and women who are at higher than average risk for breast cancer. However, improvements in diagnostic accuracy are needed before MRI can be used to screen large numbers of women. The abbreviated MRI scan (AB-MRI) designed by Kuhl and colleagues is a very promising approach to MRI- screening, but relies on a single T1-weighted scan post contrast injection to evaluate enhancement. The lack of information regarding contrast media uptake kinetics may reduce diagnostic accuracy. The research proposed here will test the hypothesis that addition of ultrafast MRI to AB-MRI improves diagnostic accuracy. We propose that AB-MRI combined with ultrafast DCE-MRI can provide effective screening with at a reasonable cost, and with minimal inconvenience for patients. This would result in reliable detection of clinically significant breast cancer years earlier than current screening methods, and thus significantly reduce morbidity and mortality due to breast cancer. A national ECOG-ACRIN clinical trial of AB-MRI screening will begin in late 2016. The basic protocol for this trial is a 10 minute scan with a single post-contrast T1-weighted scan. However, based on results from this lab, the leaders of the ECOG ACRIN trial strongly support inclusion of quantitative ultrafast DCE-MRI in AB-MRI at UChicago (please see the letter of support from the Chair). We propose to: 1. Optimize ultrafast DCE-MRI integrated into AB-MRI with total duration of less than 10 minutes. The ultrafast DCE-MRI scan will have time resolution of less than 3 seconds per image. 2. Develop quantitative analysis of ultrafast data to measure time of initial enhancement (TIE), quantitative Ktrans measurements based on a simplified computational approach, lesion transfer function (LTF) and lesion transit Time(LTT). In addition, we will measure the initial kinetics of lesion enhancement texture. 3. Evaluate the diagnostic accuracy of pharmacokinetic parameters from DCE-MRI. Data will be analyzed in two stages. First, we will use data that is currently being acquired at UChicago to identify the most promising parameters from ultrafast DCE-MRI for further evaluation. Second, we will evaluate the most promising parameters in a ‘testing group’. ROC analysis will be used to determine whether parameters from ultrafast imaging can increase the diagnostic accuracy of MRI screening. 4. Compare the diagnostic accuracy of AB-MRI with and without ultrafast DCE-MRI, using both a Reader study and quantitative analysis. New ultrafast DCE-MRI, integrated into AB-MRI scans will significantly reduce morbidity and mortality due to breast cancer, while significantly reducing costs and increasing efficiency.

抽象的 MRI有可能显着改善乳腺癌筛查，尤其是针对密集的女性 乳腺癌风险高于平均风险的乳房和女性。但是，改进 在使用MRI筛查大量女性之前，需要诊断精度。这 由Kuhl及其同事设计的缩写MRI扫描（AB-MRI）是MRI-的一种非常有前途的方法 筛选，但依赖于单个T1加权后对比度注入来评估增强功能。这 缺乏有关对比媒体吸收动力学的信息可能会降低诊断准确性。研究 此处提出的将测试以下假设：在AB-MRI中添加超快MRI可改善诊断 准确性。我们建议AB-MRI与Ultrafast DCE-MRI相结合可以提供有效的筛选 以合理的成本，对患者带来的不便。这将导致可靠的检测 临床上显着的乳腺癌比当前的筛查方法早于 降低由于乳腺癌引起的发病率和死亡率。 AB-MRI筛查的国家ECOG-ACRIN临床试验将于2016年底开始。 该试验是10分钟的扫描，并进行一次对比后T1加权扫描。但是，根据 该实验室，ECOG ACRIN试验的领导者强烈支持将定量超快DCE-MRI纳入其中 在乌奇加哥的AB-MRI（请参阅主席的支持信）。我们建议： 1。优化整合到AB-MRI中的超快DCE-MRI，总持续时间少于10分钟。这 Ultrafast DCE-MRI扫描的时间分辨率为每图像少于3秒。 2。对超快数据进行定量分析，以测量初始增强的时间（TIE）， 基于简化的计算方法，病变转移函数的定量ktrans测量 （LTF）和病变转运时间（LTT）。此外，我们将测量病变的初始动力学 增强纹理。 3。评估来自DCE-MRI的药代动力学参数的诊断准确性。数据将进行分析 在两个阶段。首先，我们将使用目前正在乌奇加哥获取的数据来识别最多的数据 超快DCE-MRI的有希望的参数用于进一步评估。其次，我们将评估最多 “测试组”中有希望的参数。 ROC分析将用于确定是否来自 超快成像可以提高MRI筛选的诊断准确性。 4。使用读者，将AB-MRI的诊断精度与超级dce-MRI进行比较 研究和定量分析。 集成到AB-MRI扫描中的新超快DCE-MRI将显着降低发病率和死亡率 乳腺癌，同时显着降低成本和提高效率。