Diffusion Histology Imaging: A Clinical Tool to Non-Invasively Diagnose and Manage Prostate Cancer

项目总结 目前前列腺癌(PCA)的诊断方法有明显的局限性。大约一半的人 接受经直肠前列腺活检的男性-这是一种非常不舒服的侵入性手术， 包括脓毒症在内的重大风险--未发现有前列腺癌。对于那些患有前列腺癌的人来说，许多人都有懒惰 通过主动监测(AS)管理最好的癌症，由于 缺乏准确的非侵入性工具。生物标记物和前列腺磁共振成像(MRI)已经被 越来越多地被用来试图解决这个问题。然而，目前可用的工具并不准确 足以让你放弃活组织检查。 我们已经开发了一种新的磁共振序列(扩散基谱成像)和一种分析这些序列的方法 成像指标--扩散组织成像(DHI)--可克服常规MRI的局限性 释义。初步数据显示DHI预测前列腺活检结果的准确性很高 (癌症的存在和癌症的级别(如果存在))。我们的目标是在两个不同的临床中将DHI应用于患者 设置：AIM 1，用于PSA筛查的初始活检，以及AIM 2，对已知的惰性前列腺癌进行重复活检 使用AS。我们还计划目标3根据在这些目标中获得的数据更新我们的DHI模型，然后 招募并在接受PSA筛查的独立患者组中测试更新后的DHI模型。我们 假设DHI将允许准确和非侵入性地诊断PCA，从而减少不必要的 活组织检查。 在我们提出的研究中，这些男性将接受生物标记物测试，然后接受临床前列腺核磁共振检查 (常规序列)，在活检前添加DBSI成像协议。DBSI映像将 通过我们的DHI模型在收购后进行分析。请注意，DBSI协议只会增加几分钟 临床MRI的总持续时间，不会对患者或临床影像工作流程产生重大影响。在……里面 除了常规的MRI解释和每个临床护理的活检，我们的团队将对 核磁共振图像。通过将DHI与生物标志物和常规MRI与组织病理学金进行比较 标准(活检)，我们将确定DHI是否可以用于非侵入性诊断和 监测PCA；因此，支持DHI的临床翻译作为侵入性的替代方案 活组织检查。

PROJECT SUMMARY There are clear limitations to the current approach to prostate cancer (PCa) diagnosis. Approximately half of the men who undergo a transrectal prostate biopsy—an extremely uncomfortable, invasive procedure with significant risk including sepsis—are not found to have PCa. For those who have PCa, many have indolent cancers that are best managed with active surveillance (AS), which requires annual repeat biopsies due to a lack of accurate noninvasive tools. Biomarkers and prostate magnetic resonance imaging (MRI) have been increasingly used to attempt to address this problem. However, the currently available tools are not accurate enough alone or in combination to forgo biopsy. We have developed a new MRI sequence (diffusion basis spectrum imaging) and a method of analyzing these imaging metrics—diffusion histology imaging (DHI)—that may overcome the limitations of conventional MRI interpretation. Preliminary data demonstrates high accuracy of DHI to predict prostate biopsy results (presence of cancer and grade of cancer when present). We aim to apply DHI to patients in two distinct clinical settings: Aim 1, initial biopsy for PSA screening, and Aim 2, repeat biopsy for known indolent PCa managed with AS. We also plan for Aim 3 to update our DHI model based on the data obtained in these aims, then recruit and test the updated DHI model in an independent group of patients undergoing PSA screening. We hypothesize that DHI will allow for accurate and non-invasive diagnosis of PCa, and thus reduce unnecessary biopsies. In our proposed studies, the men will have had biomarker testing, then receive a clinical prostate MRI (conventional sequences) with the DBSI imaging protocol added onto it prior to biopsy. The DBSI imaging will be analyzed post-acquisition by our DHI model. Note that the DBSI protocol will add just a few minutes to the total duration of the clinical MRI and will not significantly impact the patient or the clinical imaging workflow. In parallel to conventional MRI interpretation and biopsy per clinical care, our team will perform DHI analysis on the MRI images. By comparing DHI to biomarkers and conventional MRI against the histopathologic gold standard (biopsy) in a prospective manner, we will determine if DHI can be used to noninvasively diagnose and monitor PCa; therefore, supporting the clinical translation of DHI to be used as an alternative to invasive biopsies.