Novel Quantitative MRI Techniques for the Assessment of Cardiac Fibrosis without Gadolinium Contrast

无需钆对比即可评估心脏纤维化的新型定量 MRI 技术

• 批准号: 10319011
• 负责人: Mehmet Akcakaya
• 金额: $ 22.72万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10319011
• 关键词: Allergic Reaction; Anatomy; Attention; Brain; Cardiac; Cardiomyopathies; Cicatrix; Clinical; Clinical assessments; Contrast Media; Detection; Electrocardiogram; Exhibits; Fibrosis; Gadolinium; Gold; Heart; Heart Diseases; Histologic; Human; Image; Image Enhancement; Imaging Techniques; Impairment; Kidney; Left; Magnetic Resonance Imaging; Maps; Methods; Modeling; Morphologic artifacts; Motion; Myocardial; Myocardial Infarction; Myocardium; Nephrogenic Systemic Fibrosis; Patients; Phase; Physiologic pulse; Population; Preparation; Recovery; Reference Standards; Relaxation; Reporting; Reproducibility; Techniques; Ventricular; Weight; Work; base; cardiac magnetic resonance imaging; clinical practice; coronary fibrosis; detection sensitivity; human imaging; improved; in vivo; in vivo imaging; interest; magnetic field; millisecond; novel; porcine model; spin-waves

PROJECT SUMMARY/ABSTRACT The clinical gold standard for the assessment of cardiac fibrosis is late gadolinium enhancement (LGE) cardiac MRI (CMR), which is acquired using an inversion-recovery T1-weighted sequence, 10-to-20 minutes after the administration of a gadolinium-based contrast agent (GBCA). Though LGE CMR is widely used in the clinical assessment of myocardial infarction, viability and cardiomyopathies, there are several concerns about GBCA. These include its association with nephrogenic systemic fibrosis (NSF) in patients with renal impairment; allergic reactions to GBCA in some patients; and recently, concerns related to GBCA accumulation in the brain. Thus, strategies for assessing myocardial fibrosis without administering GBCA are highly desirable. Quantitative CMR techniques have received interest as alternatives for identifying myocardial fibrosis without GBCA. Native T1 mapping has received attention, with studies indicating its utility in various cardiomyopathies. Its main drawback has been its limited sensitivity, where the reported changes in T1 values from fibrosis has been in a small range. Magnetization transfer (MT) imaging is another technique that has been investigated through the MT ratio (MTR), which is a non-quantitative metric that depends on acquisition parameters. Nonetheless, it has shown promising correlation with LGE, even when implemented through a simple ratio of two images acquired with different balanced SSFP sequence parameters. T1ρ relaxation mapping, which is based on rotating frame relaxations, maps motional regimes in the micro-to-millisecond scale and has also shown promise, with histological confirmation in a swine model, as well as correlation with LGE in vivo. However, its use in the heart has been limited to continuous-wave spin-lock preparation, making it susceptible to magnetic field inhomogeneities, and limiting the range of macromolecular motion that it can assess. In this proposal, we seek to develop novel quantitative CMR techniques to unleash the full potential of MT imaging and rotating frame relaxation in assessing myocardial fibrosis. For MT contrast, we will extend beyond MTR and quantify MT parameters, improving sensitivity and reproducibility. For rotating frame relaxations, we will develop improved quantification techniques using adiabatic T1p, and higher order relaxations based on Relaxation Along a Fictitious Field in the rotating frame of rank n (TRAFFn). These methods will allow probing of a wide range of macromolecular motion regimes. Neither of our ideas on MT or rotating frame relaxation imaging have been explored for imaging the human myocardium, but their potential has been highlighted in other anatomies. Successful completion of this project has the potential to transform the way CMR is performed for the assessment of myocardial fibrosis, eliminating the need for GBCA administration.

项目摘要/摘要 心脏纤维化评估的临床黄金标准是晚期增强（LGE）心脏 MRI（CMR），使用反转恢复T1加权序列获得，后10到20分钟 施用基于Gadolinium的对比剂（GBCA）。尽管LGE CMR广泛用于临床 评估心肌梗塞，生存能力和心肌病，对GBCA有一些担忧。 其中包括其与肾脏障碍患者的肾病全身性纤维化（NSF）的关联； 某些患者对GBCA的过敏反应；最近，与GBCA在大脑中积累有关的关注点。 这是非常需要评估心肌纤维化的策略。 定量CMR技术已获得兴趣作为识别心肌纤维化的替代方案 GBCA。天然T1映射引起了人们的关注，研究表明其在各种心肌病中的效用。 它的主要缺点是其灵敏度有限，其中报告的纤维化T1值变化已有 范围很小。磁化转移（MT）成像是已研究的另一种技术 通过MT比率（MTR），这是一种取决于采集参数的非定量度量。 但是，即使通过简单的比率实现了LGE的承诺相关性 用不同平衡的SSFP序列参数获取的两个图像。 T1ρ放松映射，是 基于旋转框架放松，在微毫秒尺度上映射运动机制，也有 在猪模型中具有组织学确认以及与体内LGE的相关性，显示了希望。 但是，它在心脏中的使用仅限于连续的波旋锁制备，使其容易受到影响 磁场不均匀性，并限制了它可以评估的大分子运动的范围。 在此提案中，我们试图开发新颖的定量CMR技术来释放MT的全部潜力 成像和旋转框架放松在评估心肌纤维化时。对于MT的对比，我们将超越 MTR和量化MT参数，提高灵敏度和可重复性。对于旋转框架放松，我们 将使用绝热T1P开发改进的定量技术，并基于高阶放松 沿着等级n（贩运）旋转框架中的虚拟领域放松。这些方法将允许探测 多种大分子运动状态。我们对MT或旋转框架放松的想法都没有 对成像人体心肌进行成像探索了成像，但它们的潜力已突出显示 其他解剖学。成功完成该项目有可能改变CMR的方式 进行心肌纤维化评估，消除了对GBCA给药的需求。