Twofold Reduction in Gadolinium Dose for Brain MRI Exams using a Novel Unbalanced T1 Relaxation-Enhanced Steady-State (uT1RESS) Technique

使用新型不平衡 T1 弛豫增强稳态 (uT1RESS) 技术将脑 MRI 检查的钆剂量减少两倍

• 批准号: 10507378
• 负责人: Robert R. Edelman
• 金额: $ 22.58万
• 依托单位: NORTHSHORE UNIVERSITY HEALTHSYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10507378
• 关键词: 3-Dimensional; Adult; Applications Grants; Biological Products; Blood; Blood - brain barrier anatomy; Blood Vessels; Brain; Brain Neoplasms; Clinical; Contrast Media; Cost Savings; Deposition; Detection; Disease; Dose; Enhancing Lesion; Equation; European; Evaluation; Foundations; Gadolinium; Health Benefit; Healthcare Systems; Image; Imaging Techniques; Japan; Lesion; Magnetic Resonance Imaging; Medical; Medical Device; Methods; Modeling; Multi-Institutional Clinical Trial; Multiple Sclerosis; Neoplasm Metastasis; Nephrogenic Systemic Fibrosis; Noise; Pathology; Patients; Pharmacologic Substance; Physiologic pulse; Positron-Emission Tomography; Prognosis; Publishing; Radiosurgery; Relaxation; Reporting; Research; Risk; Savings; Scanning; Science; Sensitivity and Specificity; Site; Techniques; Technology; Testing; Time; United States; United States Food and Drug Administration; Water; base; brain magnetic resonance imaging; brain tumor imaging; cancer imaging; contrast enhanced; cost; diagnostic accuracy; follow-up; healthy volunteer; imaging detection; imaging study; improved; magnetic field; nervous system disorder; neuroimaging; novel; reconstruction; standard of care; treatment planning; tumor; tumor diagnosis

Contrast-enhanced magnetic resonance imaging (MRI) is the cornerstone for brain tumor diagnosis and treatment planning. While its sensitivity for metastases is superior to that of CT or PET-CT, small lesions (<5- mm) and leptomeningeal spread may still be missed, which can have a major impact on prognosis and planning for stereotactic radiosurgery, as well as on the use of targeted biologics that cross the blood-brain barrier. A method that could further improve the sensitivity and specificity of MRI for brain tumors would be of great clinical benefit. Towards this end, we have developed a new class of pulse sequences, called T1 Relaxation-Enhanced Steady-State (T1RESS), that greatly improves the visibility of tumors in contrast- enhanced MRI. Compared with existing neuroimaging techniques, T1RESS at least doubles the tumor-to- background contrast while significantly improving the tumor-to-background contrast-to-noise ratio. An “unbalanced” version (uT1RESS) renders blood vessel dark and is the focus of our proposal. In a preliminary study of 54 adult patients that was published in Science Advances, uT1RESS provided a remarkable twofold or greater improvement in tumor-to-brain contrast along with a marked improvement in lesion-to-brain contrast-to-noise in comparison to standard-of-care MPRAGE and other pulse sequences that are commonly used to image brain tumors. We found that even small metastatic tumor deposits and leptomeningeal lesions that were difficult to distinguish from small blood vessels with standard imaging techniques could be unambiguously identified. The primary hypothesis of this two-year grant proposal is that R21 grant proposal is that the twofold or greater improvement in sensitivity to gadolinium enhancement provided by uT1RESS will enable a corresponding twofold reduction in GBCA dose, with non-inferior diagnostic accuracy compared to full dose MRI using standard neuroimaging techniques. Studies of phantoms, healthy volunteers, and patients with brain tumors along with Bloch equation modeling will be used to guide sequence optimization. Our specific aims are as follows: 1. To maximize the sensitivity of uT1RESS to gadolinium enhancement while optimizing image quality and minimizing scan time. 2. To perform a single site research trial at 3 Tesla to determine whether half dose contrast-enhanced MRI using uT1RESS is non-inferior to full dose contrast-enhanced MRI using a standard neuroimaging technique in patients with brain tumors.

对比增强磁共振成像（MRI）是脑肿瘤诊断和治疗的基石 虽然其对转移的敏感性优于 CT 或 PET-CT，但对于小病灶（<5-） mm）和软脑膜扩散仍可能被遗漏，这可能对预后和预后产生重大影响 规划立体定向放射外科手术，以及使用穿过血脑的靶向生物制剂 一种可以进一步提高 MRI 对脑肿瘤的敏感性和特异性的方法。 为此，我们开发了一种新的脉冲序列，称为 T1。 松弛增强稳态 (T1RESS)，大大提高了对比中肿瘤的可见度 与现有的神经影像技术相比，T1RESS 的肿瘤比增强型 MRI 至少增加了一倍。 背景对比度，同时显着提高肿瘤与背景对比度噪声比。 “不平衡”版本（uT1RESS）使血管变暗，是我们提案的重点。 在 Science Advances 上发表的一项针对 54 名成年患者的初步研究中，uT1RESS 提供了 肿瘤与大脑的对比度显着提高两倍或更大，同时 与标准护理 MPRAGE 和其他脉冲序列相比，病变与大脑的对比噪声 通常用于对脑肿瘤进行成像，我们发现即使是小的转移性肿瘤沉积物和 标准成像难以与小血管区分开的软脑膜病变 可以明确地识别技术。 该两年期拨款提案的主要假设是 R21 拨款提案是双重或 uT1RESS 提供的钆增强灵敏度的更大改进将使 GBCA 剂量相应减少两倍，诊断准确性不低于全剂量 使用标准神经影像技术对模型、健康志愿者和患者进行 MRI 研究。 脑肿瘤和布洛赫方程模型将用于指导我们的特定序列优化。 旨在遵循： 1. 最大化 uT1RESS 对钆增强的灵敏度，同时优化图像质量 和扫描时间。 2. 在 3 特斯拉下进行单点研究试验，以确定半剂量对比增强 MRI 是否有效 使用 uT1RESS 并不劣于使用标准神经影像技术的全剂量对比增强 MRI 脑肿瘤患者。