Establishing the Validity of Brain Tumor Perfusion Imaging

摘要 这一竞争性更新的主要目标是建立临床脑肿瘤灌注成像方案。 高精确度、生理敏感度和临床适用性的战略性设计。动态磁化率 对比(DSC)磁共振成像是神经肿瘤学中应用最广泛的先进成像技术之一，具有 据报道，在美国和欧洲的所有常规脑瘤扫描中，有85%的人使用了这一技术。在上一次 在资金周期内，该项目的唯一目标是确定最准确的DSC-MRI采集方案(S) 通过开发、验证和应用基于群体的数字参考对象(DRO)，然后验证 这些方案适用于脑瘤患者。这一努力中最重要的发现是识别和 精确的单次造影剂剂量和单次回声DSC-MRI方案的临床验证，现已 已被脑肿瘤成像界采纳为共识建议。另一个关键结果是 该项目是使用DRO和一项预期的患者研究，对单剂量、双回波DSC进行验证。 MRI序列，一种能够同时评估DSC和动态增强的方法 (DCE)-MRI数据作为具有最高准确性的协议，即使在不同的脉冲序列参数和 组织属性。在这项先前工作取得成功的基础上，我们现在的目标是克服仍然限制我们的两个障碍 DSC-MRI的临床实用性、准确性和多点一致性：i)基于回声平面成像(EPI)的依赖 脉冲序列破坏了灌注图像和解剖图像的几何保真度、可靠的共定位 以及ii)缺乏对脑肿瘤DSC/DCE的验证和基准。 MRI后处理算法和软件，用于单回波和双回波采集。这些限制 是迫切需要解决的关键和临床相关挑战。为了解决这些问题， 我们建议：1)建立一个用于验证脑肿瘤DSC DCE-MRI分析的拟人化基准 工具和2)开发用于同时进行DSC/DCE MRI的三维、双回波脉冲序列。在这 我们将为神经肿瘤学社区提供经过验证的图像采集和分析方法 脑肿瘤患者准确、生理敏感、临床适用的DSC/DCE-MRI定位方法。 我们将提供第一个DSC/DCE-MRI拟人基准，可用于验证现有和 未来的算法和软件，从而提高多站点和临床试验的一致性。最终，经过验证 DSC-MRI技术将提高其在包括肿瘤在内的一系列临床情景中的可靠性和相关性 定位，治疗反应评估，手术和活检指导，以及多点临床试验 常规的和有针对性的脑肿瘤治疗。

ABSTRACT The principal goal of this competitive renewal is to establish clinical brain tumor perfusion imaging protocols strategically designed for high accuracy, physiologic sensitivity and clinical applicability. Dynamic susceptibility contrast (DSC) MRI is one of the most widely used advanced imaging techniques in neuro-oncology, with a reported use of 85% in all routine brain tumor scans at sites across the US and Europe. During the previous funding cycle, the singular aim of the project was to identify the most accurate DSC-MRI acquisition protocol(s) by developing, validating and applying a population-based digital reference object (DRO) and then verifying these protocols in patients with brain tumors. The most significant finding of this effort was the identification and clinical validation of an accurate single contrast agent dose and single-echo DSC-MRI protocol, which has now been adopted as the consensus recommendation by the brain tumor imaging community. Another key result of this project was the validation, using the DRO and a prospective patient study, of a single-dose, dual-echo DSC- MRI sequence, an approach that enables simultaneous assessment of DSC and dynamic contrast enhanced (DCE)-MRI data, as the protocol with highest accuracy, even across variable pulse sequence parameters and tissue properties. Building on the success of this prior work, we now aim to overcome two obstacles that still limit DSC-MRI’s clinical utility, accuracy, and multi-site consistency: i) a reliance on echo planar imaging (EPI) based pulse sequences that undermine the geometric fidelity, reliable colocalization of perfusion and anatomic images and accuracy of derived DCE-MRI data, and ii) lack of validation of, and a benchmark for, brain tumor DSC/DCE- MRI post-processing algorithms and software, for both single- and dual-echo acquisitions. These limitations represent critical and clinically relevant challenges that urgently need to be addressed. To address these issues, we propose to: 1) establish an anthropomorphic benchmark for validating brain tumor DSC DCE-MRI analysis tools and 2) develop a three-dimensional, dual-echo pulse sequence for simultaneous DSC/DCE MRI. In this project we will provide the neuro-oncology community with validated image acquisition and analysis methods for accurate, physiologic sensitive and clinically applicable DSC/DCE-MRI mapping methods in brain tumor patients. We will provide the first DSC/DCE-MRI anthropomorphic benchmark that can be used to validate existing and future algorithms and software, thereby improving multi-site and clinical trial consistency. Ultimately, validated DSC-MRI techniques will improve its reliability and relevancy 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.