Contrast-enhanced magnetic resonance imaging (MRI) detects breast cancer with very high sensitivity. MRI is potentially very attractive as an adjunct screening method for detecting occult tumors in women who are identified with a high risk of breast cancer. The success of screening MRI hinges not only on its high sensitivity, but also on minimizing the complexity and duration of the exam. It must also achieve the highest possible specificity in order to minimize the number of false positive lesions that are detected and must be worked up. The long-term objective of our research is to develop a fast, practical screening MRI method that delivers the highest performance, most accurate imaging method available. The major objective of this proposal is to develop and clinically evaluate an easily prescribed, quick bilateral version of a previously developed unilateral method of obtaining both rapid dynamic and high spatial resolution contrast-enhanced breast MRI data. The first specific aim, technology development, includes new methods for bilateral breast shimming, bilateral water-selective spectral-spatial excitations, and bilateral simultaneous image acquisition. Subsequently, an integrated acquisition will be developed to obtain both high spatial resolution and rapid dynamic images using the same spiral pulse sequence. Finally, a new web-based breast MRI interpretation tool will be developed that uses 3D volume rendering of high spatial resolution images that are colorized with pharmacokinetic measures of tumor angiogenesis to simplify and speed-up breast MR image interpretation by radiologists. The second specific aim, clinical evaluation, will measure the image quality and diagnostic accuracy of the new bilateral technique, compared to the benchmark unilateral method. In addition, a pilot screening trial will be started, with the limited objective of proving that the high performance integrated bilateral 3D spiral method generates fewer false positive lesions than current dynamic-only or high resolution-only screening approaches. When completed, these aims will produce a very powerful screening tool for breast cancer that is simple to perform. Data collected by this proposal will pave the way for future full-scale screening trials that will prove the superior efficacy of the technique. By simplifying the exam and minimizing the risk of false-positive lesions, this technology could potentially benefit a great number of women than current protocols that are targeted only at women at very high risk.
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