Neil Rofsky, M.D.
Neil Rofsky, M.D., Chair of the Department of Radiology, concentrates his research on translating innovations in magnetic resonance imaging and spectroscopy into clinical practice. His current studies emphasize developing MRI techniques to improve detection and evaluation of prostate cancer and to better guide treatment. As chair of Radiology, he also leads efforts to bring the benefits of new technologies developed at the AIRC rapidly into clinical practice in the hospital.
Because the prostate cannot be clearly imaged with current radiological techniques, assessing such cancers depends on inference from such measures as prostate specific antigen (PSA) levels and microscopic examination of tissue samples. Thus, clinicians have only limited measures of the aggressiveness of an individual's cancer and whether it will spread beyond the prostate. Furthermore, they have limited information to guide treatment, whose options range from watchful waiting to surgical removal of the prostate. Such surgery often severely affects a patient's quality of life, with effects including impotence and incontinence.
In his research, Dr. Rofsky seeks to apply such MRI techniques as arterial spin labeling (ASL) to measure blood flow in prostate and renal cell carcinomas. Since blood flow can reflect the viability of a tumor, such measurements can offer valuable insights into the potential aggressiveness of tumors and the effectiveness of treatments. In particular, such MRI analysis can assess the efficacy of antiangiogenic drugs that aim to inhibit growth of blood vessels that feed tumors. ASL can also greatly aid testing of new antiangiogenic drugs, since it enables rapid and quantitative early determination of the efficacy of drug candidates.
ASL involves using a specialized series of RF pulses and magnetic field gradients to generate a pulse sequence that labels the incoming blood flow in a specific organ such as the prostate or kidney. This magnetic label consists of inverting the spin of hydrogen atoms in water molecules in the blood. Researchers can use this labeling to determine the extent of blood flow into a region by detecting whether the signal from this labeled blood appears in the region. Thus, ASL does not require injection of chemical contrast agents, and MRI does not involve the use of ionizing radiation, as do techniques such as computerized tomography (CT) scans.
Also, Dr. Rofsky and his colleagues have explored the effectiveness of MRI contrast agents, combined with other MR imaging techniques, in assessing prostate cancers. Contrast agents are chemicals that influence MRI-relevant properties of water in tissues, to create higher contrast between the tissue and the surrounding water.
He was also involved in establishing the effectiveness of MRI in evaluating acute appendicitis in pregnancy. Precise diagnosis of appendicitis is not possible with ultrasound, and CT scans are not desirable in pregnant women because they involve exposing the mother and fetus to ionizing radiation.
Dr. Rofsky and his colleagues have also pioneered the use of rapid contrast-agent-enhanced three-dimensional diagnostic imaging of the abdomen. Such rapid imaging is important because it enables clinicians to obtain high-resolution 3D images during the brief time that a patient can hold a single breath, reducing the artifacts from respiratory and other motions. Three-dimensional images offer the physician a better view of a patient's abdomen and can detect small lesions that may be missed by 2D imaging. Such 3D imaging is superior to 2D imaging techniques that require the acquisition of a series of 2D sections and combining them to create a three-dimensional image.
Dr. Rofsky also plans studies, in collaboration with Dean Sherry, Ph.D., and his colleagues using the AIRC's 7 Tesla MRI machine and hyperpolarized 13C-containing molecules such as pyruvate to analyze the metabolism of prostate cancers. Such metabolic analysis could be applied to assess the aggressiveness of prostate cancers and their response to treatment.
For publication information please view Dr. Rofsky's faculty profile.