Imaging-based biomechanical assessment of abdominal aortic aneurysms for improved progression risk prediction

基于成像的腹主动脉瘤生物力学评估，以改善进展风险预测

• 批准号: 10481360
• 负责人: Joseph Leach
• 金额: --
• 依托单位: VETERANS AFFAIRS MED CTR SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2022-09-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10481360
• 关键词: Abdominal Aortic Aneurysm; Address; Aging; Anatomic Models; Anatomy; Aneurysm; Angiography; Atherosclerosis; Award; Benchmarking; Biochemical; Biological; Biomechanics; Blood Vessels; Blood flow; Calculi; Caliber; Cardiac; Cardiovascular Surgical Procedures; Cardiovascular system; Caring; Characteristics; Clinical; Clinical Management; Clinical Research; Clinical/Radiologic; Communities; Computer Analysis; Computers; Counseling; Data; Development; Development Plans; Diagnosis; Disease; Educational workshop; Equilibrium; Evaluation; Familiarity; Finite Element Analysis; Future; Generations; Geometry; Goals; Healthcare Systems; Histologic; Hypertension; Image; Image Analysis; Imaging technology; Inflammation; Inflammatory; Intervention; Investigation; Knowledge; Leadership; Magnetic Resonance Imaging; Measures; Medical Imaging; Mentors; Methods; Modeling; Morphology; Motivation; Multiparametric Analysis; Operative Surgical Procedures; Outcome; Parents; Patient Care; Patients; Periodicity; Personal Satisfaction; Physicians; Physiological; Physiology; Positioning Attribute; Process; Protocols documentation; Radiology Specialty; Reference Standards; Reporting; Research; Research Personnel; Research Training; Resolution; Risk; Risk Assessment; Role; Rupture; Scientific Advances and Accomplishments; Scientist; Smoking; Specificity; Stress; Structure; Surgeon; Technical Expertise; Testing; Tissues; Training; Vascular Diseases; Veterans; Work; X-Ray Computed Tomography; base; biomechanical test; career; career development; cost; design; experience; image processing; imaging Segmentation; imaging modality; improved; individual patient; medical specialties; men; military veteran; prevent; programs; prospective; radiologist; recruit; repaired; research and development; risk prediction; risk stratification; screening; skills; success; surveillance imaging; ultrasound

Dr Leach is an early career physician-scientist with specialty training in radiology and computational biomechanics, who seeks to continue developing his career within the VA health care system. Dr Leach’s long-term career goal is to use all of his clinical and research knowledge and expertise to comprehensively help patients and clinicians maximize wellbeing and prevent and alleviate suffering through improved understanding, diagnosis, and risk stratification of vascular diseases. To achieve this, Dr Leach seeks additional mentored training to further develop his knowledge and expertise in two key ways: 1) advancement of his scientific skills in imaging-based analysis of vascular disease that steps beyond anatomic characterization, to include compositional analysis, biomechanics, and biological features extracted from advanced imaging, and 2) leadership in clinical radiology and the vascular imaging research community. Improving management of abdominal aortic aneurysms (AAA) at both the patient and health care system levels necessitates new capabilities to distinguish aneurysms that will remain stable and clinically quiescent from those that will rapidly progressively enlarge and possibly rupture. To do this, we must step beyond the present paradigm of AAA surveillance, which involves no more than measuring the aneurysm size, and find ways to assess other AAA features that predispose to rapid progression. Dr Leach is perfectly positioned to pursue development of powerful new methods of AAA assessment, owing to his advanced scientific training and intimate familiarity with the complexity of AAA disease, its clinical management, and the simultaneous shortcomings of current imaging evaluation and impressive possibilities for future development. In this application, Dr Leach aims to combine his clinical expertise in vascular radiology and technical expertise in imaging-based biomechanical analysis of blood vessels to perform the necessary developments that will permit increasingly patient-specific geometric and biomechanical AAA analysis (Aims 1 and 2), multiparametric and multi-timepoint evaluation of AAA, and will culminate in a hypothesis-driven investigation of AAA features and their associations with aneurysm progression (Aim 3). [[Central to this work is careful testing and benchmarking of advanced MRI-based methods against the de facto standard CT-based methods of AAA assessment, to determine the appropriate balance between sophistication and precision and wide availability and cost.]] Dr Leach’s pursuit of these advancements necessitates close interaction with the community of radiologists and imaging researchers, vascular surgeons, and computer scientists at the VA, and provides a natural opportunity for Dr Leach to expand his leadership within that community. The proposed research and career development plan is expected to meaningfully advance our ability to comprehensively assess the progression risk of AAAs on a patient-specific basis and prepare Dr Leach for leadership roles in the vascular imaging and vascular research domains. To facilitate success in the scientific and training aspects of the proposal, Dr Leach has assembled an exceptional team of mentors and advisors who are themselves respected leaders in vascular imaging (Hope, Saloner), image processing and computational analysis (Mitsouras), [[and cardiovascular surgery (Gasper, Tseng)]]. Dr Leach’s training plan consists of directly mentored experiences, formal coursework and workshops, and structured counseling from advisors. The research and training components of this proposal will collectively equip and establish Dr Leach as a capable independent investigator well-positioned to submit a Merit Review application in the later years of the CDA period. [[Dr Leach is committed to advancing the care of veterans and others with vascular disease, and through the proposed research and training, he will build a research program at the VA toward this goal.]]

Leach 博士是一位早期职业医师兼科学家，接受过放射学和计算方面的专业培训 生物力学，他寻求在 VA 医疗保健系统中继续发展自己的职业生涯。 长期职业目标是利用他所有的临床和研究知识和专业知识 全面帮助患者和信徒最大限度地福祉并预防和减轻痛苦 通过提高对血管疾病的理解、诊断和风险分层。 为此，利奇博士寻求额外的指导培训，以进一步发展他在两个关键领域的知识和专业知识 方法：1）提高他在基于成像的血管疾病分析方面的科学技能，超越了 解剖特征，包括成分分析、生物力学和提取的生物特征 来自先进成像，2) 临床放射学和血管成像研究界的领导地位。 改善患者和医疗机构对腹主动脉瘤 (AAA) 的管理 系统级别需要新的能力来区分动脉瘤，从而保持稳定并在临床上 为了做到这一点，我们必须采取行动。 超越目前的 AAA 监测模式，仅涉及测量动脉瘤大小， 并找到评估其他容易导致快速进展的 AAA 特征的方法，这是利奇博士的完美选择。 凭借其先进的技术，他致力于开发强大的 AAA 评估新方法 科学培训并熟悉 AAA 疾病的复杂性、临床管理和治疗 当前成像评估的同时存在的缺点和未来发展的令人印象深刻的可能性。 在此应用中，Leach 博士旨在将他在血管放射学和技术方面的临床专业知识结合起来。 基于成像的血管生物力学分析的专业知识，以进行必要的开发 这将允许越来越多的患者特定几何和生物力学 AAA 分析（目标 1 和 2）， 对 AAA 进行多参数和多时间点评估，最终将进行假设驱动的调查 AAA 特征及其与动脉瘤进展的关联（目标 3）[[这项工作的核心是谨慎。 根据事实上的标准 CT 方法对基于 MRI 的先进方法进行测试和基准测试 AAA 评估，以确定复杂性、精确性和宽度之间的适当平衡 可用性和成本。]] Leach 博士对这些进步的追求需要与 VA 的放射科医生和影像研究人员、血管外科医生和计算机科学家社区，以及 为利奇博士提供了一个自然的机会来扩大他在该社区内的领导力。 拟议的研究和职业发展计划预计将有意义地提高我们的能力 根据患者具体情况全面评估 AAA 的进展风险，并为 Leach 博士做好准备 在血管成像和血管研究领域发挥领导作用，促进科学的成功。 以及该提案的培训方面，利奇博士组建了一支由导师和顾问组成的出色团队 他们本身就是血管成像（Hope、Saloner）、图像处理和 计算分析（Mitsouras），[[和心血管外科（Gasper，Tseng）]] Leach 博士的培训计划。 包括直接指导的经验、正式的课程和研讨会以及结构化咨询 该提案的研究和培训部分将共同装备和建立利奇博士。 作为一名有能力的独立调查员，有能力在接下来的几年里提交绩效审查申请 CDA 期间 [[Leach 博士致力于促进退伍军人和其他患有血管疾病的人的护理， 通过拟议的研究和培训，他将在 VA 建立一个研究计划以实现这一目标。]]