Core--Imaging

核心--影像

• 批准号: 7140956
• 负责人: MELVIN E CLOUSE
• 金额: $ 55.39万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-01 至 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7140956
• 关键词: abdomen; adipose tissue; angiography; atherosclerosis; atherosclerotic plaque; bioimaging /biomedical imaging; biomedical facility; body composition; calcification; cardiovascular imaging /visualization; computed axial tomography; contrast media; fats; imaging /visualization /scanning; inflammation; liver; liver imaging /visualization /scanning; metabolic syndrome

The function of the imaging core will be to optimize the methodology for reproducibly assessing both soft and calcified plaque in coronary arteries, as well as the assessment of abdominal and liver fat deposition using MDCT. This technology is currently being assessed as part of multi-center studies to compare MDCTA coronary arteriography to standard quantitative coronary angiography. These techniques will be applied to the clinical study population who are obese and have established CHD and meet criteria for the metabolic syndrome. The Imaging Core will be responsible for providing the clinical investigators with measurements of soft and calcified plaque and change in character or volume in the coronary tree as assessed by high resolution computed tomography using IV contrast, the amount of visceral fat and liver lipid as assessed by non contrast CT at baseline and after 30 months of treatment. The most important measure will be to assess the degree of vascular and plaque remodeling with this new technology over a 30 month period in the usual care group versus the other treatment groups. The primary endpoint in the clinical projects will be assessment of coronary soft plaque remodeling as determined by MDCTA at baseline and at 30 months. A secondary endpoint will be to assess change in the amount and location of calcification in plaque as it relates to progression, regression or stabilization. This CT modality without contrast material will also be used to assess total body (subcutaneous and visceral) and liver fat reduction or deposition. Estimated coefficients of variation for soft plaque (mean and SD volume 39 and 12 mm3) are 6%. We estimate progression of 5% in the usual care group and regression of up to 5% in the treatment groups, requiring a sample size of at least 202 subjects per intervention to attain a p<0.05. "Metabolic syndrome, inflammation and vascular remodeling", will evaluate the effect of three interventions: 1) life style (diet, exercise, weight loss); 2) HDL raising with niacin and fenofibrate; and 3) disalsid on progression, regression and stabilization of coronary artery plaque and inflammatory markers in patients with CHD and metabolic syndrome. An integral part of this SCCOR proposal is the Imaging Core which will enable the measurement of coronary artery calcified and non-calcified plaque burden, the accumulation or reduction of hepatic and total body fat using established quantifiable imaging techniques by the most advanced computed tomographic scanner . The spatial resolution of the scanner is 0.4mm and therefore creates pixels of 0.4mm2 and isotropic 0.4 mm voxels. The information gained from MDCT imaging could allow us to determine which risk factors are the most important for developing cardiovascular disease and would help direct future intervention strategies for prevention. The data from coronary artery calcium combined with CT coronary arteriographic studies could tell us whether the calcification that has increased in volume represents progression of calcification into new areas of non calcified plaque, indicating progression, or if the calcium increase is in a positively remodeled artery, suggesting that plaque burden is not increasing, therefore atherosclerosis is not progressing. The change in character and volume of non- calcified plaque over time is especially important to evaluate regression or stability, i.e., change from fatty to fibrous plaque or regression of fatty plaque on clinical projects by Shoelson and Welty may indicate the most appropriate dietary interventions and treatments to promote regression and/or stabilization. This type of information can also be obtained from total body and hepatic fat since the subjects will be followed longitudinally with repeat MDCTA scanning for calcified and noncalcified plaque, total body and hepatic fat content at 30 months.

成像核心的功能是优化可重复评估的方法 冠状动脉中的软斑块和钙化斑块，以及腹部和肝脏脂肪的评估 使用 MDCT 进行沉积。该技术目前正在作为多中心研究的一部分进行评估，以 将 MDCTA 冠状动脉造影与标准定量冠状动脉造影进行比较。这些 技术将应用于肥胖且患有先心病的临床研究人群 并符合代谢综合征的标准。成像核心将负责提供 临床研究人员测量软斑和钙化斑以及特征或体积的变化 在使用 IV 造影剂通过高分辨率计算机断层扫描评估的冠状动脉树中， 基线时和 30 个月后通过非对比 CT 评估的内脏脂肪和肝脏脂质量 治疗。最重要的措施是评估血管和斑块重塑的程度 与其他治疗组相比，在常规护理组中使用这项新技术超过 30 个月的时间 组。临床项目的主要终点是冠状动脉软斑块的评估 由 MDCTA 在基线和 30 个月时确定的重塑。次要终点是 评估斑块中钙化数量和位置的变化，因为它与进展有关， 回归或稳定。这种没有造影剂的 CT 模式也将用于评估总体 身体（皮下和内脏）和肝脏脂肪减少或沉积。估计系数 软斑块的变异（平均体积和标准差体积分别为 39 和 12 mm3）为 6%。我们估计进展 常规护理组的下降幅度为 5%，治疗组的下降幅度高达 5%，需要样本量 每次干预至少有 202 名受试者达到 p<0.05。 “代谢综合征、炎症和 血管重塑”，将评估三种干预措施的效果：1）生活方式（饮食、运动、体重） 损失）; 2)用烟酸和非诺贝特提高HDL； 3）拒绝进展、回归和 冠心病和代谢患者冠状动脉斑块和炎症标志物的稳定 综合症。该 SCCOR 提案的一个组成部分是成像核心，它将使得 测量冠状动脉钙化和非钙化斑块负荷、累积或 使用已建立的可量化成像技术减少肝脏和全身脂肪 先进的计算机断层扫描仪。扫描仪的空间分辨率为 0.4 毫米，因此可创建 0.4 毫米 2 的像素和 0.4 毫米各向同性的体素。从 MDCT 成像中获得的信息可以让我们确定哪种风险 因素对于发生心血管疾病最重要，并将有助于指导未来 预防干预策略。冠状动脉钙化结合CT数据 冠状动脉造影研究可以告诉我们钙化体积是否增加 代表钙化进展到非钙化斑块的新区域，表明进展，或 如果钙增加发生在正重塑的动脉中，则表明斑块负担不是 增加，因此动脉粥样硬化没有进展。非物质性质和体积的变化 随着时间的推移，钙化斑块对于评估退化或稳定性尤其重要，即从 Shoelson 和 Welty 的临床项目中的脂肪向纤维斑块或脂肪斑块的消退可能表明最 适当的饮食干预和治疗以促进消退和/或稳定。这类 由于将跟踪受试者，因此还可以从全身脂肪和肝脂肪中获得信息 纵向重复MDCTA扫描钙化和非钙化斑块、全身和肝脏 30个月时的脂肪含量。