Non-Contrast Magnetic Resonance Angiography of Peripheral Vascular Disease

周围血管疾病的非对比磁共振血管造影

• 批准号: 7786580
• 负责人: Robert R. Edelman
• 金额: $ 43.22万
• 依托单位: NORTHSHORE UNIVERSITY HEALTHSYSTEM
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-03-01 至 2013-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7786580
• 关键词: Affect; Angiography; Arrhythmia; Arteries; Atrial Fibrillation; Blood; Blood Vessels; Blood flow; Caliber; Cardiac; Cardiovascular system; Cine Magnetic Resonance Imaging; Clinical; Clinical Trials; Contrast Media; Dependence; Diagnosis; Diagnostic Imaging; Disease; Exercise; Fatty acid glycerol esters; Fibrosis; Goals; Image; Impaired Renal Function; Kidney; Knowledge; Location; Magnetic Resonance Angiography; Methodology; Methods; Modeling; Morbidity - disease rate; Morphologic artifacts; Motion; Patients; Pattern; Pelvis; Peripheral; Peripheral Vascular Diseases; Physiologic pulse; Procedures; Pulsatile Flow; Recovery; Reporting; Resolution; Risk; Signal Transduction; Slice; Techniques; Technology; Testing; Thick; Time; Tissues; United States; base; cost; data acquisition; diagnostic accuracy; heart rhythm; image reconstruction; improved; mortality; new technology; novel strategies; patient safety; public health relevance; research study; simulation

DESCRIPTION (provided by applicant): Peripheral vascular disease (PVD) affects 8 million people in the United States, causes significant morbidity, and is associated with cardiovascular mortality. Given that many patients with PVD also suffer from impaired renal function, one must exercise caution in using CE-MRA because of concerns about the risks of nephrogenic systemic fibrosis (NSF), a serious and potentially lethal disorder. Recently, non-enhanced MRA techniques have been proposed to eliminate the risk of NSF. The overall goal of this proposal is to implement a methodology for non-contrast peripheral MRA that is insensitive to the timing of peak systolic flow; moreover, the technology should be fast, insensitive to patient motion, and accurate. For this purpose, we have implemented a novel approach consisting of a fat suppressed, single shot 2D saturation-recovery trueFISP (SR-TFI) pulse sequence. Although this approach for non-contrast MRA has not been previously reported, our initial clinical trials demonstrate excellent results even in the presence of severe PVD. The method does not require prior knowledge of flow patterns and eliminates the need for cine MRI to determine the timing of peak flow velocity, a requirement for FBI. Moreover, the method is less sensitive to patient motion than FBI and has proven robust for imaging of the pelvic arteries. For the small subset of patients in whom it is not possible to synchronize the data acquisition to the cardiac cycle (e.g. due to atrial fibrillation or other cardiac arrhythmias), we propose the use of ungated Ghost MRA. Ghost MRA uses the ghost artifacts generated by pulsatile flow to create an MRA with no signal contribution from background tissues. Our specific aims are: Specific Aim 1: To optimize multi-station flow-insensitive SR-TFI of the peripheral arteries with a total acquisition time < 10 minutes using spatial resolution on the order of 1-2 mm3. Specific Aim 2: To implement multi-station flow-dependent (Ghost) MRA of the peripheral arteries with an image acquisition time < 5 minutes per station using spatial resolution on the order of 1 mm. Specific Aim 3: Evaluate non-contrast MRA in comparison with CE-MRA and/or x-ray DSA in patients PUBLIC HEALTH RELEVANCE: We have developed a set of novel technologies that will largely eliminate the need to administer contrast agents during magnetic resonance angiography in order to diagnose peripheral vascular disease. This study will result in better image quality, greater diagnostic accuracy, lower procedure cost, and enhanced patient safety.

描述（由申请人提供）：周围血管疾病（PVD）在美国影响800万人，引起明显的发病率，并与心血管死亡率有关。鉴于许多PVD患者也患有肾功能受损，因此必须谨慎使用CE-MRA，因为担心肾病性全身纤维化（NSF）的风险，这是一种严重且潜在的致命疾病。最近，已经提出了非增强的MRA技术来消除NSF的风险。该提案的总体目标是实施一种对峰值收缩期流动不敏感的非对抗性外围MRA的方法。此外，该技术应快速，对患者运动不敏感并准确。为此，我们实施了一种新型方法，该方法包括抑制脂肪的单射击2D饱和回收truefisp（SR-TFI）脉冲序列。尽管这种非对比度MRA的方法先前尚未报告，但即使在存在严重的PVD的情况下，我们的初始临床试验也表现出了出色的结果。该方法不需要事先了解流动模式，而无需Cine MRI确定峰流速的时间，这是FBI的需求。此外，该方法对患者运动的敏感性不如FBI敏感，并且证明对骨盆动脉的成像证明了可靠的。对于不可能将数据获取同步到心脏周期的患者的小部分（例如，由于房颤或其他心律不齐），我们建议使用未隔离的幽灵MRA。 Ghost MRA使用搏动流量产生的幽灵伪影来创建MRA，而没有背景组织的信号贡献。 我们的具体目的是：特定目标1：使用空间分辨率在1-2 mm3阶的空间分辨率优化外围动脉的多站流动不敏感的SR-TFI，总采集时间<10分钟。 特定目标2：使用图像采集时间<5分钟的外围动脉的多站流动依赖（幽灵）MRA使用空间分辨率为1 mm。 特定目标3：与患者的CE-MRA和/或X射线DSA相比，评估非对比度MRA 公共卫生相关性：我们已经开发了一系列新型技术，这些技术将在很大程度上消除了在磁共振血管造影过程中施用对比剂以诊断外周血管疾病的必要性。这项研究将带来更好的图像质量，更高的诊断准确性，较低的程序成本以及增强的患者安全性。