Combining MRI With Near-Infrared Spectral Tomography Increases Specificity in Breast Imaging
By combining two modalities of imaging, investigators from Norris Cotton Cancer Center at Dartmouth, led by Keith Paulsen, PhD, and collaborators from Xijing Hospital in Xian, China, demonstrated that a dual breast exam using magnetic resonance imaging (MRI) and near-infrared spectral tomography is feasible and more accurate than MRI alone. Their findings were published by Mastanduno et al in Clinical Cancer Research.
“The research is exciting because it shows for the first time, in the largest clinical study to date of the combined [MRI/near-infrared spectral tomography] imaging approach, that improvement in the specificity of breast MRI is possible by adding [near-infrared spectral tomography] to the imaging procedure,” explained Dr. Paulsen, Professor of Radiology and Surgery at Dartmouth's Geisel School of Medicine, and of Biomedical Engineering at Dartmouth's Thayer School of Engineering. He is also Director of the Dartmouth Advanced Imaging Center, and is Scientific Director of the Center for Surgical Innovation at Dartmouth-Hitchcock Medical Center.
“Other reports suggested that such improvement was possible, but they included small numbers of clinical exams that were not sufficiently large enough to show a statistically significant improvement,” he added.
Study Details
Breast MRI is the most sensitive imaging technique for cancer surveillance, and is recommended for screening in women with elevated risk of breast cancer. Unfortunately, breast MRI generates many false-positive findings. Better imaging could provide additional information for clinicians and potentially reduce the need for MRI-guided biopsies.
Dr. Paulsen's study investigated whether the addition of molecular imaging (near-infrared spectral tomography) at the time of MRI would improve the diagnostic accuracy of breast MRI alone, by contributing functional information about regions of suspicion in the breast identified by the MRI and helping to categorize the regions as malignant or benign. The study showed that data from the combined imaging procedure improved specificity of the exam from 67% for MRI alone to 89% when a tissue optical index measurement from near-infrared spectral tomography imaging was added. The sensitivity did not decrease, remaining high at 95%, and the area under the curve increased to 0.95 from 0.86 for MRI alone.
“Working with our colleagues at Xijing Hospital, we found that a combined [MRI/near-infrared spectral tomography] breast exam is feasible as a clinical breast imaging procedure, and that the data from the combined imaging modalities is diagnostically more accurate,” said Dr. Paulsen. “In particular, this combination improves on what is reported by breast MRI alone. With additional technical improvements related to exam setup and delivery, the approach is ready for evaluation in larger clinical studies, including multicenter trials.”
Looking forward, Dr. Paulsen plans to refine the technology to improve its clinical acceptance, making it easier to use and seamless in the standard clinical workflow of breast MRI.
Funding for this work was provided by the National Institutes of Health.
Dr. Paulsen is the corresponding author for the Clinical Cancer Research article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
