Combined MRI and Optical Imaging to Improved Breast Cancer Diagnosis

描述（由申请人提供）：本提案将研究联合mri -光学成像系统在乳腺癌诊断中的性能。漫射光学断层扫描（DOT）成像系统集成4.0 T MRI扫描仪将被使用。假设磁共振光谱（胆碱）和光学成像（氧饱和度和吲哚青绿ICG动力学）测量的附加信息将提高DCE-MRI（动态对比增强MRI）诊断乳腺癌的特异性。该研究是根据项目公告PAR-06-293提交的，重点是研究领域3“临床可行性研究以证明成像技术中有前途的发现的潜在功效”，该提案中的技术是联合MRI-DOT系统。高分辨率解剖MRI和DCE-MRI已发展成为致密乳房患者乳腺病变检测和诊断的既定临床工具。形态外观和增强动力学是两个基本要素。由于其高灵敏度，MRI正迅速成为筛查易患乳腺癌早期发展的年轻女性的最流行的成像方式。术前MRI也已成为检测多灶或多中心疾病的常用程序，以方便手术计划。然而，尽管MRI具有很高的灵敏度，但它也能检测到许多良性病变。特异性较低，可能会给患者带来极大的焦虑，导致许多不必要的活检或过度治疗。迫切需要其他辅助成像方式来提高特异性。磁共振光谱（MRS）和DOT是两种有很大潜力提供互补信息的技术。在这项研究中，我们将评估这两种方式如何提高DCE-MRI在乳腺癌诊断中的表现。有可疑乳房病变的受试者将使用联合MRI-DOT系统进行研究。然后采用人工神经网络和常规回归分析的ROC分析来评估优化后DCE-MRI测量的形态学和动力学参数的敏感性/特异性。然后，使用优化的DCE-MRI参数，加上(1)MRS测量的胆碱，(2)氧饱和度，(3)ICG动力学中的转运率，获得ROC曲线，以评估这些附加信息是否可用于提高诊断特异性。研究完成后，我们将能够验证“MR光谱和光学成像提供的额外信息可以与DCE-MRI测量的形态学和动力学参数结合使用，以提高乳腺癌的诊断”这一假设。此外，我们将能够确定在MRS和DOT测量的附加信息中，哪些参数对于设计优化方案是最重要的。虽然目前的乳房成像方式已经取得了很大的成功，但对于传统成像效果不佳的妇女亚群来说，进一步的改进是非常需要的。我们的目标是开发一种具有优化采集方案的成像技术，以提高乳腺癌的诊断特异性，特别是对年轻女性，使她们不会受到假阳性结果的影响。

DESCRIPTION (provided by applicant): This proposal will investigate the performance of a combined MRI-optical imaging system in diagnosis of breast cancer. A diffuse optical tomography (DOT) imaging system integrated with a 4.0 T MRI scanner will be used. It is hypothesized that the additional information measured by MR spectroscopy (Choline) and optical imaging (oxygen saturation and kinetics of indocyanine green ICG) will improve the specificity of DCE-MRI (dynamic contrast enhanced MRI) in diagnosis of breast cancer. The study is submitted responding to program announcement PAR-06-293, focusing on area-3 of research "clinical feasibility studies to demonstrate potential efficacy of promising discoveries in imaging technology", the technology in this proposal being the combined MRI-DOT system. High resolution anatomic MRI and DCE-MRI has evolved into an established clinical tool for detection and diagnosis of breast lesions in patients with dense breasts. The morphological appearance and enhancement kinetics are two essential elements. Due to its high sensitivity MRI is fast becoming the most popular imaging modality for screening young women who are susceptible to early development of breast cancer. Pre-operative MRI has also become a common procedure for detecting multifocal or multicentric diseases to facilitate surgical planning. However, despite its high sensitivity, MRI also detects many benign lesions. The low specificity may lead to great anxiety to patients, and many unnecessary biopsies or over-treatment. Other adjunct imaging modality to improve specificity is greatly needed. MR spectroscopy (MRS) and DOT are two techniques that have great potential to provide complementary information. In this study we will evaluate how these two modalities can enhance the performance of DCE-MRI in diagnosis of breast cancer. Subjects with suspicious breast lesions will be studied using the combined MRI-DOT system. Then ROC analysis using artificial neural network and conventional regression analyses will be used to assess sensitivity/specificity of the optimized morphological and kinetic parameters measured by DCE-MRI. Then the ROC curves using the optimized DCE-MRI parameters with addition of (1) Choline measured by MRS, (2) oxygen saturation, and (3) transport rates in ICG kinetics will be obtained to evaluate whether these additional information may be used to improve the diagnostic specificity. After the study is completed, we will be able to test the hypothesis that "additional information provided by MR Spectroscopy and optical imaging can be used in conjunction with morphological and kinetics parameters measured by DCE-MRI to improve diagnosis of breast cancer". Furthermore, we will be able to determine among the additional information measured by MRS and DOT, which parameter(s) are the most essential to design an optimized protocol. Although the current breast imaging modalities have achieved a high success, further improvements for a subpopulation of women in whom conventional imaging do not work well are in great need. Our goal is to develop an imaging technology with optimized acquisition protocol to improve diagnostic specificity of breast cancer, particularly for young women, so that they would not be subjected to false positive findings.