MR Diffusion Tensor Imaging for Detection and Characterization of Breast Lesions

描述（由申请人提供）：乳腺癌极为常见，每8名美国女性中就有1名患有乳腺癌，是美国女性癌症死亡的第二大原因，通过筛查早期发现是提高生存率的根本途径。乳腺动态对比增强MRI （DCE-MRI）对乳腺癌的检测具有很高的敏感性，是筛查高危女性和对侧或多灶性病变的最敏感技术。然而，乳腺良性和恶性病变在dce上的重叠表现会产生许多假阳性。特别是考虑到最近美国癌症协会的指南建议对高风险女性进行年度MRI筛查，估计在美国有180万女性受到影响，有一个明确的和快速增长的需求来提高乳房MRI的特异性，以限制由于扩大使用这种高度敏感的筛查工具而导致的不必要的活检次数。此外，基于钆的造影剂的高成本和安全性问题限制了许多女性进行乳腺MRI筛查的可及性，因此寻找一种非造影剂替代DCE-MRI检测乳腺癌将具有很强的临床影响。弥散张量成像（DTI）是一种很有前途的辅助MRI技术，它可以间接评估组织微观结构，并为DCE-MRI的病变特征提供补充信息。我们的研究小组和其他人已经证明了良性和恶性病变之间表观扩散系数（ADC）值的显著差异。此外，我们有很好的初步数据表明，表观扩散系数（ADC）测量可以增加常规乳腺MRI评估的阳性预测值，DTI分数各向异性（FA）为区分恶性肿瘤的ADC测量提供了补充信息。我们还观察到，许多乳腺x线摄影和临床隐匿性癌症在弥散加权图像上可见，无需使用造影剂即可在MRI上检测到。这项工作的目的是：(1)验证DTI作为一种有价值的辅助手段来改善乳腺MRI的病变特征，并确定将DTI测量纳入临床乳腺MRI评估的最佳方法；(2)更好地了解肿瘤组织学对DTI测量的影响；(3)评估DTI作为一种替代的非对比乳腺筛查技术的潜在作用。这项研究的结果具有潜在的重要意义，因为DTI可以提供一种快速可翻译的解决方案，以提高传统乳房MRI的特异性，减少不必要的活检次数，或者，DTI可以提供比DCE-MRI更快、更便宜、更安全的筛查选择。

DESCRIPTION (provided by applicant): Breast cancer is extremely common, striking 1 in 8 American women, and is the second leading cause of cancer death among women in the U.S. Earlier detection through screening is a fundamental way to improve survival. Dynamic contrast enhanced MRI (DCE-MRI) of the breast has a high sensitivity for breast cancer detection and is the most sensitive technique for screening high risk women and detecting contralateral or multifocal disease in patients with recently diagnosed breast cancer. However, overlap in the appearance of benign and malignant breast lesions on DCE-MRI can produce many false positives. Particularly in light of recent American Cancer Society guidelines recommending annual MRI screening for high risk women, estimated to affect up to 1.8 million women in the US, there is a clear and quickly growing need to improve the specificity of breast MRI in order to limit the number of unnecessary biopsies that will result from expanded use of this highly sensitive screening tool. Furthermore, the high costs and safety concerns of gadolinium-based contrast agents limit the accessibility of breast MRI screening for many women, so identifying a non-contrast alternative to DCE-MRI for detecting breast cancer would have strong clinical impact. A promising adjunct MRI technique is Diffusion Tensor Imaging (DTI), which indirectly assesses tissue microstructure and can provide complementary information to DCE-MRI for lesion characterization. Our group and others have demonstrated notable differences in apparent diffusion coefficient (ADC) values between benign and malignant lesions. Moreover, we have promising preliminary data suggesting apparent diffusion coefficient (ADC) measures can increase the positive predictive value of conventional breast MRI assessment, and that DTI fractional anisotropy (FA) adds complementary information to ADC measures in discriminating malignancies. We have also observed that many mammographically and clinically-occult cancers are visible on diffusion-weighted images and can be detected on MRI without using a contrast agent. The aims of this work are: (1) to validate DTI as a valuable adjunct to improve lesion characterization on breast MRI and determine the optimal way to incorporate DTI measures into the clinical breast MRI assessment, (2) to better understand the effects of tumor histology on DTI measures, and (3) to evaluate the potential role of DTI as an alternative non-contrast breast screening technique. The outcomes of this study are potentially significant because DTI could provide a quickly translatable solution to improve the specificity of conventional breast MRI and reduce the number of unnecessary biopsies, and alternatively, DTI could provide a faster, less expensive, and safer screening option than DCE-MRI. PUBLIC HEALTH RELEVANCE: Relevance to Public Health: (1) Improving the characterization of suspicious lesions on conventional breast MRI would significantly reduce the resulting number of unnecessary biopsies performed, and (2) Identifying a non-contrast technique for detecting cancer would reduce costs and toxicity of breast MRI screening and increase accessibility to more women.