Establishing the validity of brain tumor perfusion imaging

摘要 该提案的中心目标是建立脑肿瘤灌注成像的准确性。动态 磁敏感对比（DSC）MRI是神经系统中最广泛使用的先进成像技术之一， 肿瘤学多项研究表明，DSC-MRI测量的相对脑血容量（rCBV）可以 鉴别胶质瘤分级、肿瘤类型及鉴别肿瘤成分在非强化胶质瘤中的区分 从治疗后的肿瘤复发效果，并预测靶向治疗后的肿瘤反应和患者生存率 疗法尽管DSC-MRI对临床护理具有潜在的影响，但其大规模集成一直缓慢， 很大程度上是由于缺乏关于方法学和如何防止潜在的rCBV不准确的共识。 尽管DSC依赖于钆基造影剂（GBCA）保留在 血管腔，这种情况经常在体内被侵犯。如果未纠正，造影剂泄漏会影响电极导线 rCBV不准确，误诊和潜在的误治。虽然许多泄漏校正策略 存在，一个根本的限制，阻止了标准化和广泛采用的DSC-MRI 方法：迄今为止，没有研究证实泄漏校正的rCBV测量在患者中的准确性。 缺乏验证影响了DSC-MRI标准化工作、临床rCBV阈值的建立 使用、多中心比较和临床试验。鉴于rCBV准确性的重要性，我们建议解决 这是通过两个高度集中的研究。首先，我们的目标是通过与 高级别胶质瘤患者的血管内参考标准。多种采集和分析技术将 追究其次，使用一种新的计算机数字体模，我们的目标是系统地定义 DSC-MRI方案保持一致的rCBV测量。对医疗保健的影响：我们的主要 可交付成果是为神经肿瘤学社区提供经验证的图像采集和分析方法 用于脑肿瘤患者的精确rCBV标测。经验证的DSC-MRI技术将改善其临床 可靠性，并证明其在一系列临床场景中的使用，包括肿瘤定位，治疗反应 评估、手术和活检指导，以及常规和靶向脑的多中心临床试验 肿瘤治疗 !

ABSTRACT The central goal of this proposal is to establish the accuracy of brain tumor perfusion imaging. Dynamic susceptibility contrast (DSC) MRI is one of the most widely used advanced imaging techniques in neuro- oncology. Multiple studies have shown how DSC-MRI measures of relative cerebral blood volume (rCBV) can differentiate glioma grades, tumor types and identify tumor components in non-enhancing glioma distinguish tumor recurrence from post-treatment effects, and predict tumoral response and patient survival after targeted therapy. Despite DSC-MRI's potential impact on clinical care, its broad scale integration has been slow, in large part from a lack of consensus about methodology and how to prevent potential rCBV inaccuracies. Although DSC relies on the assumption that gadolinium-based contrast agents (GBCA) remain within the vascular lumen, this condition is often violated in vivo. If not corrected for, contrast agent leakage effects lead to rCBV inaccuracy, misdiagnosis, and potentially mistreatment. While numerous leakage correction strategies exist, a fundamental limitation has prevented the standardization and wide-spread adoption of DSC-MRI methodology: To date, no study has validated the accuracy of leakage corrected rCBV measures in patients. The lack of validation impacts DSC-MRI standardization efforts, the establishment of rCBV thresholds for clinic use, multi-site comparisons and clinical trials. Given the importance of rCBV accuracy we propose to address this through two highly focused studies. First, we aim to validate rCBV accuracy by comparison to an intravascular reference standard in high-grade glioma patients. Multiple acquisition and analysis techniques will be investigated. Second, using a novel in silico digital phantom we aim to systematically define the range of DSC-MRI protocols that maintain consistent rCBV measurements. Impact on Healthcare: Our primary deliverable is to provide the neuro-oncology community with validated image acquisition and analysis methods for accurate rCBV mapping in brain tumor patients. Validated DSC-MRI techniques will improve its clinical reliability and justify its use across a range of clinical scenarios, including tumor localization, therapy response assessment, surgical and biopsy guidance, and multi-site clinical trials of conventional and targeted brain tumor therapies. !