Combined Imaging Modalities for Breast Cancer

Institution: University of California, Irvine
Investigator(s): Gultekin Gulsen, Ph.D. -
Award Cycle: 2006 (Cycle 12) Grant #: 12IB-0095 Award: $149,162
Award Type: IDEA
Research Priorities
Detection, Prognosis and Treatment>Imaging, Biomarkers, and Molecular Pathology: improving detection and diagnosis



Initial Award Abstract (2006)
Although mammography is very sensitive in detecting early breast cancer, it does not work well in women who have dense breast tissues, breast implants, or scar tissues due to previous treatment. It has been proven that dynamic contrast enhanced (DCE) MRI detects malignant cancers which are occult on mammogram and ultrasound, and as such it has becoming the most popular imaging modality for screening young women. DCE-MRI is also considered as the most sensitive detection modality in women who have breast implants, or scar tissues. However, despite its high sensitivity, DCE-MRI also detects many benign lesions. The low specificity may lead to great anxiety to patients, and unnecessary biopsy or over-treatment. There is a great need to develop another imaging modality that can provide supplemental information to improve the specificity of DCE-MRI, particularly for young women.

In this study, we propose to develop a novel breast-imaging platform to provide co-registered tri-modality imaging capability: Optical Imaging (OI), DCE-MRI and MR spectroscopy (MRS). As an adjunct to another imaging modality, the OI systems can provide valuable complementary information, particularly in patients whom the conventional imaging is less optimal, such as young women with dense breasts. Moreover, MRS can provide the choline levels in the lesions, which is elevated in malignant lesions compared to benign lesions. We believe that the combination of OI and MRS with DCE-MRI will allow a better characterization of breast lesions, thus an improved specificity, due to enhanced information gathered by this multi-modality system.

Our first aim is to develop a combined Ol, MRI, and MRS human breast cancer imager. Our second aim is to test and evaluate the tri-modality system with phantom studies. Once the combined system is optimized with ex-vivo studies, the performance of the system will be evaluated with human studies. At the end of the study, the performance of DCE-MRI, DCE-MRI + MRS and the tri-modality system in distinguishing benign and malignant breast cancer tumors will be assessed.


Final Report (2008)
It has been proven that dynamic contrast enhanced (DCE) MRI detects malignant cancers which are occult using either mammography or ultrasound. Thus, it is becoming the most popular imaging modality for screening young women with a high risk of developing breast cancer. However, despite its high sensitivity, DCE-MRI also detects many benign lesions. This low specificity may lead to great anxiety to patients, and unnecessary biopsies or over-treatment. This project aims to develop a novel platform to provide co-registered, tri-modality imaging capability with high specificity: Optical Imaging (0I), DCE-MRI and MR spectroscopy (MRS). Combined 0I and MRS will provide additional information to DCE-MRI and, hence, will allow a better characterization of breast lesions and an improved specificity.

In the first year of the project, we have developed the 0I system, integrated it with MRI, and tested with phantom (anatomical, artificial breast-like materials) studies. This was a major step in the proposed study and accomplished successfully. After that, the platform (i.e. the physical structure to be placed on the breast for imaging) has been tested with a couple of volunteers. Although the imaging system worked fine, this first version of the fiber optic interface and breast rf-coil design were not comfortable. More recently, we have modified the fiber optic interface a number of times to find the most optimum version that is not only comfortable, but also provides the best optical & MRI image quality. This was a time consuming process due to the custom production of the hard plastic platforms and some other special pieces such as customized flexible optical fiber bundles. For this reason we couldn't start the clinical studies. However, we received additional extramural funding to continue to the clinical studies that will continue the preliminary results that we obtained with the support of this CBCRP grant.

The final version of the interface is expected to be ready soon. We believe it will be the optimum one that will provide the best image quality together with the highest patient comfort, which is the pivotal point for the translation of a new technology into clinical settings.


Symposium Abstract (2007)
Motivation: Although mammography is very sensitive in detecting early breast cancer, it does not work well in women who have dense breast tissues, breast implants, or scar tissues due to previous treatment. It has been proven that dynamic contrast enhanced (DCE)-MRI detects malignant cancers which are occult on mammogram and ultrasound, and as such it has becoming the most popular imaging modality for screening young women. DCE-MRI is also considered as the most sensitive detection modality in women who have breast implants, or scar tissues. However, despite its high sensitivity, DCE-MRI also detects many benign lesions. The low specificity may lead to great anxiety to patients, and unnecessary biopsy or over-treatment. There is a great need to develop another imaging modality that can provide supplemental information to improve the specificity of DCE-MRI, particularly for young women.

Methods: We are developing a novel breast-imaging platform to provide co-registered tri-modality imaging capability: Optical Imaging (OI), DCE-MRI and MR spectroscopy (MRS). As an adjunct to another imaging modality, the OI systems can provide valuable complementary information, particularly in patients whom the conventional imaging is less optimal, such as young women with dense breasts. Moreover, MRS can provide the choline levels in the lesions, which is elevated in malignant lesions compared to benign lesions. The combination of OI and MRS with DCE-MRI will allow a better characterization of breast lesions, thus an improved specificity, due to enhanced information gathered by this multi-modality system.

Progress: We have already developed the prototype optical breast cancer imager and integrated with the 4T MRI system. The performance of the optical imaging system was tested inside the MRI using phantoms that simulated the breast tissue. Furthermore, the combined system was tested using a couple of volunteers. Although the measurements were successful, the optical interface integrated into the MRI breast coil was found to be uncomfortable by the volunteers. Besides, the thickness of the interface did not enable us to reach close to the chest wall. Consequently, a new, more comfortable, and thinner interface was designed. Once the construction of the new interface is completed and tested, the performance of DCE-MRI, DCE-MRI & MRS and the tri-modality system in distinguishing benign and malignant breast cancer tumors will be assessed with a small clinical study.

A simulation study of the variability of indocyanine green kinetics and using structural a priori information in dynamic contrast enhanced diffuse optical tomography (DCE-DOT).
Periodical:Physics in Medicine and Biology
Index Medicus: Phys Med Biol
Authors: Unlu MB, Birgul O, Gulsen G
Yr: 2008 Vol: 53 Nbr: 12 Abs: Pg:3189-200