Conventional magnetic resonance imaging has good sensitivity for detecting very early breast cancers, andmay be a valuable for screening women who are at high risk for breast cancer. However, its specificity isinadequate, particularly given its high sensitivity. As a result there is a concern that MRI scans lead tounnecessary treatment. We propose to significantly increase sensitivity and specificity with improvedspectral, temporal and spatial sampling (MRITSS). MRITSS has two components. High spectral and spatialresolution MRI provides a high resolution water spectrum associated with each image voxel, and the waterspectral lineshape is analyzed to produce improved anatomic and functional MR images. High temporal andspatial resolution imaging during contrast media uptake and washout allows accurate measurement ofperfusion and other physiologic parameters. We will test the hypothesis that the combination of these twoapproaches - MRITSS - improves specificity and sensitivity in the high risk population that would benefitmost from MRI. We will study 'incidental' lesions that are found during clinical MRI screening, since theselesions are most susceptible to incorrect diagnosis. An additional research scan before biopsy will acquiredata from an 'incidental lesion', using MRITSS. Conventional and MRITSS data will be evaluated usingstandard morphologic and functional parameters to arrive at a diagnosis. We will determine whetherMRITSS increases specificity and sensitivity, using the pathologist's diagnosis as the gold standard. Inaddition, we will determine whether MRI parameters are correlated with genetic and biologic markers forcancer risk, including microvessel density, cell proliferation markers, VEGF receptors, and P53, HER2,BRCA1 and BRCA2. The study will include African American women who are at particularly high risk foraggressive early breast cancer. We will compare the MRI parameters for breast lesions in these women withthose for the other women in the study.The research will have a significant impact on clinical managements of breast cancer. If the resultsdemonstrate that MRITSS has high specificity for early breast cancer- this will support increased clinicaluse of MRI for screening high risk women, and integration of improved spectral, spatial, and temporalsampling into clinical MRI. In addition, the research provides an unusual opportunity to correlate MRIparameters with biological markers for malignancy in early breast cancers. This could lead to improveddesign of MRI protocols and interpretation of MR images. The research is an interdisciplinary collaborationbetween Radiologists, Oncologists, Surgeons, Pathologists, Medical Physicists, and Statisticians with strongtrack records in breast imaging and breast cancer treatment.
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