Conventional magnetic resonance imaging has good sensitivity for detecting very early breast cancers, and may be a valuable for screening women who are at high risk for breast cancer. However, its specificity is inadequate, particularly given its high sensitivity. As a result there is a concern that MRI scans lead to unnecessary treatment. We propose to significantly increase sensitivity and specificity with improved spectral, temporal and spatial sampling (MRITSS). MRITSS has two components. High spectral and spatial resolution MRI provides a high resolution water spectrum associated with each image voxel, and the water spectral lineshape is analyzed to produce improved anatomic and functional MR images. High temporal and spatial resolution imaging during contrast media uptake and washout allows accurate measurement of perfusion and other physiologic parameters. We will test the hypothesis that the combination of these two approaches - MRITSS - improves specificity and sensitivity in the high risk population that would benefit most from MRI. We will study 'incidental'lesions that are found during clinical MRI screening, since these lesions are most susceptible to incorrect diagnosis. An additional research scan before biopsy will acquire data from an 'incidental lesion', using MRITSS. Conventional and MRITSS data will be evaluated using standard morphologic and functional parameters to arrive at a diagnosis. We will determine whether MRITSS increases specificity and sensitivity, using the pathologist's diagnosis as the gold standard. In addition, we will determine whether MRI parameters are correlated with genetic and biologic markers for cancer 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 for aggressive early breast cancer. We will compare the MRI parameters for breast lesions in these women with those for the other women in the study. The research will have a significant impact on clinical managements of breast cancer. If the results demonstrate that MRITSS has high specificity for early breast cancer- this will support increased clinical use of MRI for screening high risk women, and integration of improved spectral, spatial, and temporal sampling into clinical MRI. In addition, the research provides an unusual opportunity to correlate MRI parameters with biological markers for malignancy in early breast cancers. This could lead to improved design of MRI protocols and interpretation of MR images. The research is an interdisciplinary collaboration between Radiologists, Oncologists, Surgeons, Pathologists, Medical Physicists, and Statisticians with strong track records in breast imaging and breast cancer treatment.
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