Longitudinal and quantitative MR plaque imaging for prediction of response to medical management in symptomatic intracranial atherosclerosis

纵向和定量 MR 斑块成像用于预测症状性颅内动脉粥样硬化药物治疗的反应

• 批准号: 10331648
• 负责人: Zhaoyang Fan
• 金额: $ 44.65万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-01 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10331648
• 关键词: 3-Dimensional; Acceleration; Activities of Daily Living; Acute; Alternative Therapies; Arterial Fatty Streak; Arteries; Atherosclerosis; Blood; Brain; Cerebrospinal Fluid; Clinical; Clinical Research; Clinical Trials; Clinical assessments; Computational algorithm; Consumption; Cross-Sectional Studies; Data Set; Diagnosis; Ensure; Evaluation; Failure; Financial compensation; Fostering; Future; Goals; Human; Image; Imaging Device; Imaging Techniques; Individual; Intracranial Atherosclerotic Disease; Ischemic Stroke; Lesion; Longitudinal Studies; Magnetic Resonance; Medical; Methods; Morphology; Motion; Movement; Patients; Pharmacodynamics; Population; Prediction of Response to Therapy; Recurrence; Reproducibility; Research; Resolution; Risk Factors; Role; Rupture; Scanning; Severities; Signal Transduction; Site; Stenosis; Stroke; Stroke prevention; Techniques; Testing; Three-Dimensional Imaging; Time; Treatment outcome; Validation; Work; base; burden of illness; clinical practice; clinical risk; deep learning; follow-up; high resolution imaging; high risk; imaging approach; imaging modality; improved; morphometry; non-invasive imaging; novel therapeutics; personalized management; predicting response; preservation; prevent; segmentation algorithm; standard of care; tool; validation studies

ABSTRACT Intracranial atherosclerotic disease (ICAD) is one of the most common causes of ischemic stroke worldwide. Despite intensive medical management, the current standard of care for secondary stroke prevention, the rate of recurrent stroke is 13% in the first year and as high as 35% in certain populations by 2 years. Currently, the initial and follow-up evaluations of these patients rely exclusively on assessments of clinical risk factors and, in some circumstances, the degree of luminal stenosis on imaging. However, this strategy may overlook subtle non-luminal changes within ICAD lesions. A tool that can directly probe atherosclerotic plaques and accurately quantify longitudinal changes of plaque features may help early identify non-responsive patients in whom an alternative therapy can be initiated. Magnetic resonance (MR) vessel wall imaging (VWI) has the potential to fulfill this role because of its compacity to directly visualize the vessel wall and characterize plaque features. However, there are several technical challenges associated with intracranial VWI: small size, tortuous course, and deep sitting warrant a high-resolution and 3D imaging approach; multiple lesion sites require a large imaging view; signals arising from neighboring blood and cerebrospinal fluid (CSF) need to be adequately suppressed; relatively long imaging time and potential image corruption by patient motion; and lack of dedicated plaque analysis tools particularly for 3D dataset. In this proposal, we will develop a reliable 3D VWI- based MR plaque imaging (MRPI) strategy for prediction of response to medical management in symptomatic ICAD. Specifically, we will first develop a whole-brain 3D VWI sequence with intracranial vessel-dedicated motion compensation and motion-adaptive imaging acceleration (Aim1-Task1) and develop an automated intracranial vessel wall (IVA) tool integrating 3D vessel wall segmentation and computational algorithms for deriving quantitative plaque features (Aim1-Task2) followed by a validation study (Aim1-Task3). The validated techniques will then be used in a cross-sectional study to determine the MRPI-derived quantitative plaque features that are associated with ICAD lesions within the infarcted territory in patients with acute symptomatic ICAD (Aim 2). We will finally conduct a longitudinal study to determine the capacity of longitudinal and quantitative MRPI to predict response to medical management in symptomatic ICAD patients (Aim 3). Successful completion of the project will validate the compacity of VWI-based MRPI to quantitatively characterize ICAD and predict response to medical management in symptomatic ICAD patients. This will open the door to future clinical trials investigating the role of MRPI in developing personalized management paradigms and assessing new therapies.

抽象的 颅内动脉粥样硬化疾病（ICAD）是全球缺血性中风的最常见原因之一。 尽管进行了密集的医疗管理，这是预防次级中风的当前护理标准 第一年的复发性中风为13％，在某些人群中高达35％。目前， 这些患者的初始和随访评估仅依赖于临床风险因素的评估，以及 在某些情况下，影像学上的腔狭窄程度。但是，该策略可能会忽略微妙的 ICAD病变内的非灯泡变化。可以直接探测动脉粥样硬化斑块并准确探测的工具 量化牙菌斑特征的纵向变化可能有助于早期识别非反应性患者 可以启动替代疗法。磁共振（MR）容器壁成像（VWI）具有潜力 履行此角色是因为它坚定地直接可视化容器壁并表征斑块特征。 但是，与颅内VWI相关的技术挑战：小尺寸，曲折的过程， 深坐着需要高分辨率和3D成像方法；多个病变部位需要大的 成像视图；需要足够的信号由相邻的血液和脑脊液（CSF）产生 被压制；相对较长的成像时间和潜在的图像损坏因患者运动而损坏；并且缺乏 专用的斑块分析工具，尤其是3D数据集。在此提案中，我们将开发一个可靠的3D VWI- 基于有症状的医疗管理反应预测对医疗管理的反应的基于MR斑块成像（MRPI）策略 ICAD。具体而言，我们将首先使用颅内容器划分的全脑3D VWI序列 运动补偿和运动自适应成像加速度（AIM1-TASK1）并开发自动化 颅内容器壁（IVA）工具整合了3D容器墙分割和计算算法 得出定量斑块特征（AIM1-TASK2），然后进行验证研究（AIM1-TASK3）。已验证 然后，技术将在横截面研究中使用以确定MRPI衍生的定量斑块 与急性症状患者相关的ICAD病变与ICAD病变相关的功能 ICAD（目标2）。我们最终将进行纵向研究，以确定纵向和 定量MRPI预测有症状的ICAD患者对医疗管理的反应（AIM 3）。 成功完成该项目将验证基于VWI的MRPI的一致性 特征ICAD并预测有症状的ICAD患者对医疗管理的反应。这将打开 未来临床试验的大门调查了MRPI在发展个性化管理中的作用 范式和评估新疗法。