Improved Detection of Cerebral Metastases using a using a Novel T1 Relaxation-Enhanced Steady-State (T1RESS) MRI Technique

使用新型 T1 弛豫增强稳态 (T1RESS) MRI 技术改进脑转移瘤的检测

• 批准号: 10609032
• 负责人: Robert R. Edelman
• 金额: $ 49.76万
• 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: 2022-04-12 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10609032
• 关键词: Adult; Anatomy; Appearance; Applications Grants; Biological Products; Blood; Blood Vessels; Brain; Brain Neoplasms; Cerebrum; Clinical; Contrast Media; Darkness; Deposition; Detection; Disease; Dose; Enhancing Lesion; Equation; Fatty acid glycerol esters; Frequencies; Gadolinium; Goals; Image; Imaging Techniques; Institution; Leptomeninges; Lesion; Magnetic Resonance Imaging; Metastatic malignant neoplasm to brain; Methods; Modeling; Morphologic artifacts; Neck; Neoplasm Metastasis; Nephrogenic Systemic Fibrosis; Noise; Ocular orbit; PET/CT scan; Patients; Phase; Physiologic pulse; Pilot Projects; Prognosis; Publishing; Radiosurgery; Relaxation; Research; Resolution; Scanning; Science; Sensitivity and Specificity; Signal Transduction; Site; Specificity; Techniques; Time; Tissues; Variant; Water; blood-brain barrier crossing; brain tumor imaging; cancer imaging; contrast enhanced; cost; diagnostic accuracy; dosage; healthy volunteer; image registration; improved; neuroimaging; novel; risk minimization; skull base; 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 five-year grant proposal is that T1RESS will significantly improve the sensitivity for small brain metastases compared with existing MRI pulse sequences, while also reducing scan times. A secondary hypothesis is that the twofold improvement in tumor-to-brain contrast obtained with uT1RESS can be used to enable a substantial twofold reduction in gadolinium-based contrast agent (GBCA) dosage. Studies of phantoms, healthy volunteers, and patients with brain tumors along with Bloch equation modeling will be used to guide sequence optimization. These optimization efforts will be followed by a two- institution study to determine the accuracy of the technique. Our specific aims are as follows: 1. To apply uT1RESS in healthy subjects and patients with brain tumors to systematically evaluate the impact of various sequence parameters on image appearance, contrast, SNR, and lesion sharpness, and to optimize the technique to maximize tumor visibility while minimizing scan time and image artifacts. 2. To perform a pilot study to determine whether metrics of tumor visibility using uT1RESS and a twofold reduced GBCA contrast agent dosage are noninferior to MPRAGE with a standard contrast agent dosage. 3. To perform a two-site research trial at 3T to characterize the appearance of brain metastases with uT1RESS, and to determine its accuracy for small brain metastases compared to standard-of-care MPRAGE.

对比增强的磁共振成像（MRI）是用于脑肿瘤诊断的基石和 治疗计划。虽然其对转移的敏感性优于CT或PET-CT的敏感性，但小病变（<5-- MM）和瘦脑膨胀可能仍会被遗漏，这可能会对预后和预后产生重大影响 立体定向放射外科手术以及跨越血脑的靶向生物制剂的使用 障碍。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将是 巨大的临床益处。为此，我们开发了一种新的脉冲序列，称为T1 放松增强的稳态（T1RESS），极大地提高了肿瘤的可见性 - 增强的MRI。与现有的神经影像技术相比，T1RESS至少翻了一番 背景对比度，同时显着改善了肿瘤与背景的对比度比率。一个 “不平衡”版本（UT1RESS）使血管变暗，这是我们提议的重点。 在一项针对科学进展中发表的54名成年患者的初步研究中，UT1RESS提供了 肿瘤到脑的对比度有显着改善，并显着改善 与护理标准的mprage和其他脉搏序列相比 通常用于图像脑肿瘤。我们发现，即使是小的转移性肿瘤沉积物和 难以与标准成像的小血管区分开的瘦脑膜病变 可以明确识别技术。 该五年赠款提案的主要假设是T1RESS将显着改善 与现有的MRI脉冲序列相比，对小脑转移的敏感性，同时还原扫描 时代。次要假设是，通过 UT1RESS可用于使基于Gadolinium的造影剂（GBCA）大大降低双重降低 剂量。幻影，健康志愿者和脑肿瘤患者以及Bloch方程的研究 建模将用于指导序列优化。这些优化工作将是两个 机构研究确定技术的准确性。我们的具体目的如下： 1。在健康受试者和脑肿瘤患者中应用UT1RESS系统评估影响 图像外观，对比度，SNR和病变清晰度的各种序列参数，并优化 最大化肿瘤可见性的技术，同时最大程度地减少扫描时间和图像伪影。 2。进行试点研究以确定使用UT1RESS的肿瘤可见度指标和双重 降低的GBCA对比剂剂量不在标准对比剂剂量的MPRAGE。 3。在3T上进行两次研究试验以表征与脑转移的外观 UT1RESS，并确定其与护理标准MPRAGE相比，小脑转移的准确性。