University of Minnesota cancer researchers have gained international recognition for their work on figuring out how to meld two sophisticated technologies—magnetic resonance imaging and magnetic resonance spectroscopy (MRI/MRS)—to achieve more accurate diagnoses and better treatment for breast cancer. Their research over the past eight years has culminated in a recently opened national clinical trial involving women with breast cancer. If the outcomes of the clinical trial are as anticipated, in about five years the MRI/MRS combination could become a standard part of treatment for breast cancer in larger hospitals and clinics throughout the United States and world.

Mammography, a form of x-ray, is currently the best method available to screen for breast cancer. Unfortunately, mammography misses about 25 percent of cancers in premenopausal women.

So, for women at higher risk for breast cancer, the newest recommendation is that they receive mammography plus magnetic resonance imaging (MRI), which shows the changes that occur in anatomy and blood vessels as a result of cancer. However, MRI is so sensitive that it picks up all growths and abnormalities, including those that are not cancer. This can lead to a woman needing to undergo an invasive and unnecessary biopsy to determine whether the growth is malignant or benign.

Researchers find a solution

A University of Minnesota research team, led by Michael Garwood, Ph.D., has found a solution to this problem. Garwood and his colleagues incorporated MRI with magnetic resonance spectroscopy (MRS)—which uses a combination of magnetic fields and radio waves to create a chemical profile of a tumor, called a spectrum. This MRI/MRS technology is used to measure the concentration of the choline molecules present in cancerous tumors. Their studies have shown that being able to measure choline levels allows physicians to differentiate between benign and malignant tumors. (Malignant tumors contain higher levels of choline than benign growths.)

"While this diagnostic capability is exciting, even more exciting is this technology's potential for monitoring the response to cancer treatment," says Garwood, associate director of the University's Center for Magnetic Resonance Research and a member of the Masonic Cancer Center's Breast Cancer Research Program.

For example, he says, with traditional methods of breast cancer treatment, doctors remove the tumor surgically and then follow with radiation or chemotherapy. With a newer method, called primary systemic therapy, doctors first prescribe chemotherapy treatments to try to shrink the tumor. Using MRI/MRS, doctors can find out in as little as 24 hours whether the chemotherapy is working on the tumor. If not, they can rapidly change or adjust the treatment as needed. And if they can see that the treatment has killed the tumor, then they also know that the treatment has likely killed other breast cancer cells that may have spread from the original site of the tumor.

Able to see functions of body

Cancer Center Director Douglas Yee, M.D., who also leads the Breast Cancer Research Program and works with Garwood on the MRI/MRS research project, summarizes the significance of this research this way: "Imaging technology traditionally has been used to see the structures in the body. Mike Garwood's research team is developing ways to see functions of the body."

Yee says that their work has advanced the field of imaging and cancer therapy nationally and internationally. "Our functional capabilities help us attract more clinical trials to the University and Cancer Center."

The National Cancer Institute in Washington, D.C., rates Garwood as one of the leaders in MRI/MRS research in the United States. The University's MRI/MRS research is also receiving international recognition. Last March, Garwood and research colleague Michael Nelson, M.D., University of Minnesota radiologist and Cancer Center member, led workshops on MRI/MRS and breast cancer at the Karolinska Institute in Stockholm, Sweden. They then traveled to Vienna, Austria where Garwood addressed the European Congress of Radiology. Most recently, Garwood received the 2007 gold medal at the Joint Annual Meeting of the International Society for Magnetic Resonance in Medicine (ISMRM) and the European Society for Magnetic Resonance in Medicine and Biology in Berlin, Germany.

National clinical trial begins

But the greatest gratification for Garwood and his team is that the MRI/MRS technology will now be tested clinically in women with breast cancer. A national clinical trial was recently approved. Patrick Bolan, Ph.D., who was mentored as a postdoctoral student by Garwood, is a co-leader of the multi-center clinical trial, which will be conducted at 11 medical centers across the country including the University of Minnesota Medical Center. Nelson and Yee will work together to identify and enroll a limited number of local women with breast cancer in this clinical trial. Additionally, Bolan's team at the University's Center for Magnetic Resonance Research will be a core analysis laboratory for the trial, performing analysis of the MRS data gathered from all of the women participating in the clinical trial.

The clinical trial will take about two years to conduct. Then the data will need to be scrutinized meticulously before the findings can be released and recommendations made. However, Garwood and Bolan are optimistic that, if the outcomes of the clinical trial are as they anticipate, within about five years the MRI/MRS technology that the University of Minnesota developed will be benefiting women across the country.

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This story was originally published in News from your Cancer Center, Fall 2007.