Towards Improved Detection of BRain Metastatses in Breast Cancer Patients: a Pilot Study of Magnetic Resonance Imaging (MRI) in Detecting Vascular Permeable and Non-Permeable Brain Metastases
Women diagnosed with metastatic HER-2 positive breast cancer are usually treated with trastuzumab (a HER-2 monoclonal antibody). This therapy is effective against extra-cranial metastases and extends survival. However, these women have up to a 40% risk of developing and succumbing to brain metastases, because antibodies are too large to cross the blood brain barrier. Pre-clinical work by Drs. Foster and Chambers suggests that current MRI diagnostic imaging techniques for these patients, which rely on permeability of brain metastases to gadolinium contrast agent, may underestimate metastatic burden. Balanced steady-state free precession (bSSFP) is an option on clinical MRI units, typically used to image the heart or individual nerves due to its speed and high spatial resolution; this sequence has not been used to image human brain tumours. Our work in a mouse model showed that bSSFP detects more brain metastases than standard contrast enhanced MRI. The purpose of this study is to determine if these findings translate to the human setting. If this is the case, our work may lead to improved detection of brain metastases and a more accurate description of true metastatic burden in these patients, a way to diagnose brain metastases earlier, enabling earlier interventions to improve outcomes.
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