Quantitative DCEMRI of Prostate Cancer Correlation with Gold Standards

描述(申请人提供)：动态增强磁共振成像(DCEMRI)有可能为前列腺癌(PCA)患者提供指导治疗和改善预后的关键信息。然而，灵敏度和特异度还不足以满足常规临床应用。DCEMRI还没有被证明能够可靠地区分高Gleason评分癌症和低Gleason评分癌症。目前尚不清楚诊断准确性差是由于测量误差还是潜在的生物变异性。虽然已经提出了多种方法来改进DCEMRI，但很少有人尝试以金标准来验证这些方法，以确定是否准确测量了对比动力学。为了解决这些问题，我们建议a)开发有可能提高诊断准确性的创新的DCEMRI定量方法。B)对照“黄金标准”测试DCEMRI，以确定准确性和可变性，并指导改进以减少误差。C)确定定量DCEMRI是否可以提高高Gleason分级和低Gleason分级癌症的鉴别能力。我们提出了以下具体目标：1.使用芝加哥大学开发的创新方法，定量测量造影剂浓度、动脉输入功能和生理参数(例如KTRANS)。2.使用金标准测量，包括动态增强CT、直接测量造影剂血药浓度和心输出量，验证造影剂浓度、动脉输入功能、Ktras和Ve的测量。3.评价从DCEMRI数据中提取的参数的变异性。确定可变性的来源-根据黄金标准测量并修改程序以将可变性降至最低。4.Gleason分级与定量DCEMRI结果的相关性。5.建立一个由在体多参数MRI、金标准测量和体外组织学图像组成的精选影像数据库。这包括来自DCEMRI、弥散加权成像(DWI)、CT、校准扫描、定量分析参数和组织学的数据。这将为其他机构的研究人员提供一个宝贵的数据库，可用于测试定量分析方法。建议的研究将提供有效的DCEMRI方法，改善PCa的诊断和分期，并将对DCEMRI的其他应用产生影响。这项研究将为前列腺癌研究界提供重要的资源，国际公认的专家的支持信证明了这一点。此外，与飞利浦医疗系统公司的合作(见支持函)将确保将结果迅速转化为临床实践。

DESCRIPTION (provided by applicant): Dynamic contrast enhanced MRI (DCEMRI) has potential to provide critical information to guide therapy and improve outcomes for prostate cancer (PCa) patients. However, sensitivity and specificity are not yet adequate for routine clinical use. DCEMRI has not been demonstrated to reliably differentiate between high Gleason score cancers and low Gleason score cancers. It is not known whether poor diagnostic accuracy is due to measurement error or to underlying biological variability. While a wide range of methods have been proposed to improve DCEMRI, there have been few attempts to validate these methods against gold standards, to determine whether contrast dynamics are accurately measured. To address these problems, we propose to a) Develop innovative quantitative approaches to DCEMRI that have the potential to increase diagnostic accuracy. b) Test DCEMRI against 'gold standards', to determine accuracy and variability, and guide the development of improvements that reduce error. c) Determine whether quantitative DCEMRI can improve discrimination of high Gleason grade from low Gleason grade cancers. We propose the following specific aims: 1. Quantitatively measure contrast media concentration, arterial input function, and physiological parameters (e.g. Ktrans) using innovative approaches developed at the University of Chicago. 2. Validate measurements of contrast media concentration, the arterial input function, Ktrans, and ve, using gold standard measurements, including dynamic contrast enhanced CT, direct measurements of blood concentration of contrast media, and measurements of cardiac output. 3. Evaluate variability of parameters extracted from DCEMRI data. Identify sources of variability - based on the gold-standard measurements and modify procedures to minimize variability. 4. Correlate Gleason grade with quantitative DCEMRI results. 5. Establish a curated imaging database consisting of registered multiparametric in vivo MRI, gold standard measurements, and in vitro histological images. This includes data from DCEMRI, diffusion- weighted-imaging (DWI), CT, calibration scans, parameters from quantitative analysis, and histology. This will provide researchers at other institutions with a valuable database that can be used to test quantitative analysis methods. The proposed research will provide validated DCEMRI methods that improve diagnosis and staging of Pca, and will also impact other applications of DCEMRI. The research will provide important resources for the prostate cancer research community, as evidenced by letters of support by internationally recognized experts. In addition, the collaboration with Philips Medical Systems (see letter of support) will insure rapid translation of results to clinical practice.