Advancing Virtual Colonoscopy for Early Cancer Screening

推进虚拟结肠镜检查以进行早期癌症筛查

• 批准号: 9753978
• 负责人: JEROME Z LIANG
• 金额: $ 42.64万
• 依托单位: STATE UNIVERSITY NEW YORK STONY BROOK
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-03 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9753978
• 关键词: Adenocarcinoma; Advocate; Age; Blood; Cause of Death; Classification; Clinic; Clinical; Colon; Colonoscopy; Colorectal Polyp; Computed Tomographic Colonography; DNA; Data; Decision Making; Detection; Development; Diagnosis; Dose; Excision; Family; Family member; Feces; Goals; Gold; Growth; Health; Hospitals; Hyperplasia; Hyperplastic Polyp; Image; Image Enhancement; Incidence; Intervention; Large Intestine Carcinoma; Malignant - descriptor; Malignant Neoplasms; Medicare; Methods; Microscopy; Modality; Modeling; Mucous Membrane; Names; Nature; Noise; Operative Surgical Procedures; Optics; Pathologic; Patients; Performance; Polyps; Population; Prediction of Response to Therapy; Procedures; Radiation; Recommendation; Resources; Risk; Roentgen Rays; Screening for cancer; Sedation procedure; Series; Societies; Stroke; Structure; Symptoms; Testing; Texture; Time; Tissues; Translating; United States; Variant; Woman; X-Ray Computed Tomography; adenoma; base; cancer diagnosis; cancer prevention; colon cancer prevention; colorectal cancer prevention; compliance behavior; computer aided detection; cost; cost effective; expectation; high risk; image processing; image reconstruction; imaging biomarker; imaging potential; innovation; insight; low-dose spiral CT; man; minimally invasive; mortality; outcome prediction; personalized health care; personalized management; prototype; radiation risk; screening; screening program; wasting

Colorectal carcinoma (CRC) remains the third most commonly diagnosed cancer and the second leading cause of death from cancer for both man and women in the United States. Often it is diagnosed at an advanced stage, after the patient has developed symptoms, explaining its high mortality rate. Fortunately, most CRC are preventable because they arise from colorectal polyps over a 5 to 15 year period of malignant transformation and, therefore, screening programs to detect and remove the polyps (or precursor) during the transformation period have been advocated for cancer prevention. Unfortunately many people (at present time, more than 35% of the population, a very high rate for the high CRC incidence) do not follow the recommendation and, on the other hand, many of the screened people are either under- or over-diagnosed for several reasons related to the limitations of currently available screening methods. The health relatedness of this project is to advance a convenient, nearly risk-free screening method, called computed tomography (CT)-based virtual colonoscopy (VC) or CT colonography (CTC), to overcome the limitations. Optical colonoscopy (OC) is currently the gold standard for detection and removal of the polyps. Because OC is somehow too invasive, compliance to recommendation with OC screening would remain a concern. Furthermore, OC would demand a great resource to screen the large population as recommended with age over 50 and, therefore, would not be an optimal primary screening test. On the other hand, stool-based tests (e.g. fecal blood or DNA tests) are easy to perform but have a very low detectability. We have been the pioneers in developing CTC as a minimal-invasive cost-effective method to relieve the burden of OC for the screening purpose and have shown its comparable performance to OC on detection of polyps with size 8mm and larger. We understand very well on the two major concerns on the current CT radiation level and the current CTC inconsistency in detecting small polyps (<10mm), which were discussed by the expert panel if CTC is ready as massive screening for Medicare coverage. We have deep insight on CTC potential beyond the detection task for characterizing Hyperplastic (no-risk) vs. Adenoma (risk) polyps for personalized optimal polyp treatment. This proposal intends to relieve the concerns and bring the current CTC detection-only paradigm up to a new level of not only detecting polyps, but also characterizing the detected polyps at the screening stage via the following two specific aims: (1). To develop and evaluate adaptive image reconstruction methods to retain adequate image quality (particularly to enhance image textures) for polyp detection and characterization with as low as achievable CT radiation. (2). To explore and evaluate image texture features as imaging biomarkers to detect polyps and characterize polyp subtypes. We hypothesize that the above specific aims will advance CTC to be a cost-effective screening test and to supplement OC for a streamlined procedure to increase patient compliance and reduce CRC incident rate.

结直肠癌 (CRC) 仍然是第三大最常诊断的癌症和第二大原因 美国男性和女性死于癌症的比例。通常确诊时已是晚期， 患者出现症状后，解释了其高死亡率。幸运的是，大多数 CRC 都是 可以预防，因为它们是由结直肠息肉经过 5 至 15 年的恶变产生的 因此，在转化过程中进行筛选程序来检测和去除息肉（或前体） 期间一直提倡预防癌症。不幸的是，很多人（目前，超过 35% 的人口（CRC 高发病率）不遵循建议，并且 另一方面，许多接受筛查的人由于以下几个原因要么被诊断不足，要么被过度诊断。 目前可用的筛查方法的局限性。该项目与健康的相关性是为了促进 方便、几乎无风险的筛查方法，称为基于计算机断层扫描 (CT) 的虚拟结肠镜检查 （VC）或CT结肠成像（CTC），克服了局限性。 光学结肠镜检查（OC）目前是检测和切除息肉的金标准。因为 OC 在某种程度上具有太大的侵入性，遵守 OC 筛查的建议仍然是一个问题。 此外，OC 将需要大量资源来按照建议对年龄超过 10 岁以上的人群进行筛查 50，因此，这不是最佳的初步筛选测试。另一方面，基于粪便的测试（例如 粪便血液或 DNA 测试）很容易进行，但可检测性非常低。我们一直是这方面的先驱 开发CTC作为一种微创且具有成本效益的方法，以减轻OC的筛查负担 其在检测 8 毫米及以上息肉方面表现出与 OC 相当的性能。 我们非常了解当前CT辐射水平和当前CTC这两个主要问题 检测小息肉（<10mm）的不一致，专家小组讨论了 CTC 是否准备好 大规模筛查医疗保险覆盖范围。我们对检测任务之外的 CTC 潜力有深入的了解 用于表征增生性（无风险）与腺瘤（风险）息肉的特征，以进行个性化最佳息肉治疗。 该提案旨在缓解人们的担忧，并将当前的仅 CTC 检测范式提升到一个新的水平 不仅可以检测息肉，还可以在筛查阶段通过 以下两个具体目标： (1)．开发和评估自适应图像重建方法以保留 足够的图像质量（特别是增强图像纹理），用于息肉检测和表征 CT 辐射尽可能低。 （2）。探索和评估图像纹理特征作为成像生物标志物 检测息肉并表征息肉亚型。 我们假设上述具体目标将使 CTC 成为一种具有成本效益的筛查测试，并 补充 OC 以简化程序，以提高患者依从性并降低 CRC 发生率。