Role of 3D Tomography in Breast Cancer

描述（由申请人提供）：本修订后的申请响应PAR-08-147 （PAR-06-293的再版），“成像和图像引导干预的快速试验：探索性资助（R21）”。该研究是一项针对特定器官的可行性研究，旨在确定专用乳腺计算机断层扫描系统（此处称为乳腺CT系统）可视化病变的能力。乳房x光检查中乳房结构的叠加可能会由于“掩蔽”效应而导致漏诊，或者可能会模拟病变的存在，从而导致额外的成像或活检。计算机断层扫描（CT）乳房成像可以克服这种叠加问题，并提供更好的对比度，从而提高可检测性。此外，乳房的CT成像可以在没有物理压迫乳房的情况下进行，减轻了患者的不适。它可以提供三维病变形态，可以作为诊断指标，更好地定量评估乳腺腺体含量，这可能是乳腺癌的危险因素。本研究旨在证明，使用具有各向同性体素大小的三维（3-D）乳房成像系统，采用先进的图像处理方法可以改善病变的可视化，并提供更好的边缘描绘，从而提高图像质量。改善病变及其边缘的可视化将提高确定恶性肿瘤的信心，并可能潜在地提高检测。确定病变边缘和病变体积对于手术计划、准确监测和早期确定治疗药物和方法的有效性也是必要的。研究计划包括确定专用临床原型乳腺CT系统可视化病变的能力；确定所述三维形态是否提供改进的恶性肿瘤的确定；确定定量CT数字是否能提高确定恶性肿瘤的可信度；并获得乳腺密度的体积估计，这是乳腺癌的一个可能的风险因素。这项研究的结果将使我们能够更好地定义专用的3-D锥束平板CT系统在乳腺癌中的作用，并使我们能够确定图像处理方法的有效性，以提高临床图像质量。精心设计的专用乳腺CT系统，采用先进的图像处理技术，可作为筛查诊断成像、植入成像、三维术前规划、术前治疗监测和微创手术指导的平台技术。公共卫生相关性：使用专用乳腺CT系统的体积三维成像有可能成为监测治疗性治疗的有效工具，并且可以克服乳房x光检查中的组织重叠问题，该问题会导致遗漏癌症和不必要地召回患者进行额外的成像。在本研究中，我们建议使用原型乳腺CT系统进行临床可行性研究，并开发和评估提高对比的方法，从而提高乳腺癌的检测，诊断和管理。

DESCRIPTION (provided by applicant):This revised application is responsive to PAR-08-147 (reissue of PAR-06-293), "Quick-Trials for Imaging and Image-Guided Interventions: Exploratory Grants (R21)". The proposed research is a feasibility study that is organ specific and is aimed at determining the ability of a dedicated breast computed tomography system (herein referred to as breast CT system) to visualize lesions. Superposition of breast structures in mammography may result in missed cancers due to 'masking' effect, or may mimic the presence of a lesion resulting in additional imaging or biopsy. Computed Tomographic (CT) Imaging of the breast can overcome this superposition problem, and provide much improved contrast, thus improving detectability. Further, CT imaging of the breast can be performed with no physical compression of the breast, alleviating patient discomfort. It can provide for 3-D lesion morphology, which could serve as a diagnostic indicator, and for better quantitative assessment of breast glandular content, a likely risk factor for breast cancer. This research is to demonstrate that image quality improvements achieved with advanced image processing approaches could improve lesion visualization and provide for better delineation of its margins, using a three-dimensional (3-D) breast imaging system with isotropic voxel size. Improved visualization of lesions and its margins would improve the confidence to determine malignancy and could potentially improve detection. Determination of lesion margins and lesion volume are also necessary for surgical planning and for accurate monitoring and early determination of the effectiveness of therapeutic agents and methods. The research plan includes studies to determine the ability of the dedicated clinical prototype breast CT system to visualize lesions; to determine if the 3-D morphology provides for improved determination of malignancy; to determine if quantitative CT numbers can provide for improved confidence to determine malignancy; and to obtain volumetric estimates of breast density, a likely risk factor for breast cancer. The results from this study will allow us to better define the role of a dedicated 3-D cone-beam flat-panel CT system in breast cancer and will allow us to determine the effectiveness of image processing approaches for improved clinical image quality. A well- designed dedicated breast CT system with advanced image processing techniques can serve as a platform technology for screening and diagnostic imaging, implant imaging, 3-D presurgical planning, monitoring preoperative treatment, and guidance in minimally invasive surgery. PUBLIC HEALTH RELEVANCE: Volumetric 3-D imaging with a dedicated breast CT system has the potential to be an effective tool for monitoring therapeutic treatments and can overcome the tissue superposition problem in mammography, which results in missed cancers and unnecessary recall of the patient for additional imaging. In this research, we propose to conduct a clinical feasibility study with a prototype breast CT system and develop and evaluate methods to improve contrast that could result in improved detection, diagnosis, and management of breast cancer.