DCE MRI: Standards in the Works

Dynamic contrast agent enhanced MRI (DCE MRI) is a fairly well-established technique that was first introduced in the early 1990s. Used in the pharmaceutical and clinical research environments, the post-processing algorithm evaluates dynamic images to measure contrast agent uptake in target tissue. Although DCE MRI is not a new tool, it has not yet been universally accepted by the pharmaceutical and regulatory communities primarily because the application has been plagued by a major drawback. That is, each group using DCE MRI has developed its own post-processing implementation, which can lead to inconsistencies among results.

“Variability among interpreters is not normally such an issue in radiology,” notes A. Gregory Sorensen, MD, co-director at Massachusetts General Hospital Martinos Center for Biomedical Imaging in Boston. Typically, radiology expects and accepts a certain level of variability among interpreters. But DCE MRI is often held to a different standard as companies use the technique to help assess the effect of new treatment agents such as anti-angiogenic drugs. The stakeholders in this arena, pharmaceutical companies and regulatory agencies, are accustomed to, and often require, quantitative measurements such as those provided by laboratory tests like plasma glucose value or blood counts.

DCE MRI can provide quantitative results; however, it has been nearly impossible for one researcher to replicate another’s results. The lack of standard, replicable and comparable results has prevented more widespread acceptance of DCE MRI.

Siemens Medical Solutions aims to bring a higher level of utility to the application with a new task card that standardizes the DCE MRI post-processing approach. “This brings an opportunity to better standardize DCE MRI because a single protocol would be widely used by a significant portion of the research community,” says Sorensen, who is one of a handful of researchers evaluating the Siemens prototype. It provides an implementation of a commonly-used algorithmic approach with the clinically-oriented user interface typical of such task cards.

The new development could spur significant changes in the acceptance of DCE MRI. For starters, researchers could work from a common and easily available tool; which, in turn, increases the odds that one group could achieve consistent results when studying the impact of a new anti-angiogenic agent or other intervention.

A leg up for therapeutic agent research

In addition to providing a universal framework, the prototype task card could lead to other improvements in the therapeutic agent research process. “Standardizations such as the Siemens task card could deliver tremendous value by helping researchers focus on the biology and mechanism of interventional therapies rather than differences among post-processing mechanisms,” continues Sorensen. “A number of groups are working to develop these sorts of standards, which are sorely needed in this field.”

Sorensen predicts DCE MRI will play a key and valuable role in assessment of new therapies, but stresses that it is not a standalone solution.  “DCE MRI should not be used as a sole assessment measure; it should be used as part of a toolbox in the assessment and evaluation process.” That is, researchers should use DCE MRI in conjunction with other imaging approaches and more typical metrics, including survival rates and tumor volume, to develop a more comprehensive evaluation of new agents.

While the pharmaceutical and regulatory communities await the standardization of DCE MRI, the application also may hold clinical relevance. Given recent results showing utility of MRI in breast cancer imaging, Sorensen foresees a resurgence of interest in DCE MRI for characterization of breast lesions. “A standard tool like the task card could well help push research results into clinical practice,” states Sorensen.