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Investigation of the Diagnostic Value of Diffusion Tensor MRI of the Breast
Detection, Diagnosis and Prognosis
Background Breast MRI typically involves a contrast-enhanced scan that demonstrates tissue vascularity, which is very sensitive for cancer detection but also results in many false positives. Diffusion tensor MRI (DTI) is a different type of scan that characterizes the 3D mobility of water in tissue and allows us to indirectly assess tissue microstructure. DTI anisotropy measures have been used extensively in the brain to characterize white matter organization and abnormalities, and we plan to extend this technology to the breast. DTI is sensitive to tissue characteristics often disrupted in malignant breast tissues (cell organization and density), which may help to better distinguish between different types of breast lesions. Objective/Hypothesis To develop a DTI technique optimized for breast imaging and evaluate the potential improvement to MRI breast tissue characterization provided by DTI information. We hypothesize that alterations in the microstructural characteristics of breast carcinomas will be reflected by parameters measured with DTI, including fractional anisotropy (FA) as well as the apparent diffusion coefficient (ADC), which will lead to new indices for discriminating benign and malignant lesions and improve the diagnostic specificity of breast MRI. Specific Aims 1) Optimize DTI protocol and image processing. 2) Characterize normal values and variability in healthy volunteers. 3) Apply DTI in a group of patients with suspicious breast lesions and assess the differences in DTI parameters between benign and malignant lesions. Study Design We will develop a DTI protocol using a high sensitivity breast coil and parallel imaging to optimize image quality. Six directions will be probed to model the full diffusion tensor and assess diffusion anisotropy. Three diffusion weightings will be used to assess different tissue characteristics (microcirculation and microstructure), reflected by ADC. Normative values will be obtained in a group of 12 volunteers. The DTI acquisition will be added to clinical breast MRI exams in 100 patients with suspicious lesions identified by conventional MRI. We will assess the difference between DTI parameters (FA and ADC) of different lesion types (benign, DCIS, invasive) as determined by histologic assessment from biopsy. Outcomes/Benefits This DTI technique could easily be incorporated into standard clinical breast MRI exams to improve breast MRI specificity and reduce the number of unnecessary biopsies.
Background Magnetic resonance imaging (MRI) is a valuable tool for clinical breast diagnosis, with demonstrated advantages over x-ray mammography for imaging dense and postoperative breasts, screening high risk women, and accurately depicting extent of disease in the breast. Typical breast MRI exams involve a contrast-enhanced scan that highlights tissue with irregular vasculature, which is very sensitive for cancer detection but also results in many false positives. Diffusion tensor imaging (DTI) is a different type of MRI scan that measures the mobility of water in tissue and allows us to indirectly assess tissue microstructure. DTI has been used primarily for neurologic applications to elucidate brain structure and abnormalities, and has only recently begun to be investigated for imaging other areas of the body. Objective We plan to extend this technology to the breast and explore the value of DTI parameters for improving discrimination of breast lesions. We hypothesize that alterations in the microstructural characteristics of breast carcinomas (cell density, cell organization) will be reflected by DTI measures of anisotropy and mean diffusivity, and may help to improve the diagnostic specificity of breast MRI and reduce the number of unnecessary biopsies. Aims 1) Optimize DTI protocol, 2) Characterize normal DTI values in a group of healthy volunteers, and 3) Assess the diagnostic value provided by DTI measures for discriminating benign and malignant lesions in patients. Study design We will adapt and optimize existing DTI acquisition and image analysis tools, and scan a group of healthy volunteers to characterize normal values and variability. We will also add the DTI sequence to clinical breast MRI exams. In a group of 100 patients with suspicious lesions identified on conventional MRI who undergo biopsy, we will compare DTI measures of different lesion types (benign, DCIS, and invasive carcinoma) as determined by histology. Outcomes/Benefits Outcomes of the proposed study include the development of a DTI acquisition and analysis technique optimized for breast imaging, with assessment of normative values, as well as initial characterization of DTI measures in breast lesions. DTI may lead to new indices for differentiating breast lesions, which would have valuable implications for breast cancer management including earlier detection, improved diagnostics, and earlier evaluation of treatment efficacy.