Noninvasive Assessment of Liver Stiffness with Tagged MRI

使用标记 MRI 对肝硬化进行无创评估

• 批准号: 8098877
• 负责人: Leon Axel
• 金额: $ 25.1万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2013-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8098877
• 关键词: Alcoholic Hepatitis; Autopsy; Biopsy; Biopsy Specimen; Blinded; Cardiac; Cirrhosis; Clinical; Computer software; Development; Disease; Disease Progression; Evaluation; Exposure to; Fibrosis; Finite Element Analysis; Hepatitis C; Image; Image Analysis; Imagery; Lead; Life; Liver; Liver Cirrhosis; Liver Fibrosis; Liver diseases; Magnetic Resonance Imaging; Measures; Mechanics; Methods; Minor; Modeling; Modification; Motion; Operative Surgical Procedures; Palpation; Patient Care; Patients; Prevention; Primary carcinoma of the liver cells; Property; Public Health; Recruitment Activity; Research; Research Project Grants; Risk; Series; Severities; Software Tools; Staging; Symptoms; System; Testing; Time; Viral hepatitis; base; clinical application; cost; effective therapy; heart motion; high risk; imaging modality; improved; liver biopsy; public health relevance; research clinical testing; tool

DESCRIPTION (provided by applicant): Liver disease is a major and growing public health concern. While many patients presenting with viral or alcoholic hepatitis will recover well, others will have significant progression of their disease (more than 50% of patients with exposure to hepatitis C become chronically infected), often initially without externally apparent symptoms. This can lead to the late development of frank liver cirrhosis, with its attendant potentially life-threatening complications, and an increased risk of developing hepatocellular carcinoma. While many patients can be successfully treated in the earlier stages of the disease, treatment is much less successful once full-blown cirrhosis has developed. However, the available treatments are not without their own cost and potential risks, and cannot be given routinely to all patients at their initial presentation. Thus, the ability to detect progression of liver disease at an earlier stage would enable more effective treatment and the prevention of later complications, while avoiding treatment of those patients who do not require it. Unfortunately, the currently available noninvasive means of detecting the early progression of the disease are limited in their accuracy, thus often leading to a need for repeated liver biopsies to follow those patients who are felt to be at a higher risk of developing cirrhosis. This proposed research is focused on the initial development and testing of a new method for the noninvasive evaluation of liver stiffness, based on tagged magnetic resonance imaging (tMRI), which is expected to provide a sensitive early marker for the development of liver fibrosis, an important hallmark of the progression toward cirrhosis. Cardiac motion produces transmitted motion in the liver that can be seen and measured with tMRI. Fibrosis of the liver has been seen to produce qualitative and quantitative changes in this liver motion in our initial results. The proposed research will develop improved tools to study the changes in this motion associated with liver fibrosis, and will correlate them with the degree of fibrosis as a means to validate the results. This new method for assessment of liver stiffness produces images that can be directly and intuitively understood; it can be implemented on conventional MRI systems, requiring only minor imaging software modification and the use of suitable software tools for analysis of the resulting images; and it can be rapidly carried out. These features all make it potentially suitable for incorporation in routine liver MRI evaluations when there is a question of possible increased liver stiffness. Thus, there is a significant potential for an important beneficial impact of this research on patient care. PUBLIC HEALTH RELEVANCE: Liver disease is an important and growing public health problem, with there frequently being clinically silent progression to the later serious complications of cirrhosis. However, conventional noninvasive methods of detecting liver fibrosis, a hallmark of developing cirrhosis, are unreliable, often resulting in the need for repeated liver biopsies (with their associated discomfort and risk) to follow patients at risk for progressive liver disease. The overall aim of this project is the development and evaluation of a new method for assessing the stiffness of the liver, specifically, the use of tagged magnetic resonance imaging (tMRI) to measure the motion and deformation induced in the liver by the motion of the heart; if successful, this could provide a way to avoid the need for biopsy in following many patients with liver disease.

描述（由申请人提供）：肝病是一个主要且日益增长的公共卫生问题。尽管许多患有病毒或酒精性肝炎的患者会恢复良好，但其他患者将在其疾病中显着进展（超过50％的患有丙型肝炎的患者长期感染），通常没有外部明显的症状。这可能会导致弗兰克肝肝硬化的晚期发展，其伴随的潜在威胁生命的并发症，并增加患肝细胞癌的风险。尽管在疾病的早期阶段可以成功治疗许多患者，但一旦成熟的肝硬化发展，治疗的成功率要少得多。但是，可用的治疗方法并非没有自身的成本和潜在风险，也不能在所有患者的初始介绍中常规地给予。因此，在较早阶段检测肝病进展的能力将能够更有效的治疗和预防以后的并发症，同时避免治疗那些不需要的患者。不幸的是，当前可用的无创方法检测疾病的早期进展的准确性受到限制，因此通常会导致需要重复的肝活检以跟随那些被认为面临更高风险患肝硬化风险的患者。这项拟议的研究集中在基于标记的磁共振成像（TMRI）的最初开发和测试肝脏刚度的新方法上，预计该方法将为肝纤维化的发展提供敏感的早期标志物，这是肝纤维化的发展，这是进展朝着cirrhosis的重要标志。心脏运动在肝脏中产生传播运动，可以用TMRI看到和测量。在我们的最初结果中，已经看到肝纤维化在这种肝运动中产生质量和定量变化。拟议的研究将开发改进的工具来研究与肝纤维化相关的这种运动的变化，并将其与纤维化程度相关联，以作为验证结果的一种手段。这种评估肝僵硬度的新方法会产生可以直接和直观地理解的图像。它可以在常规MRI系统上实现，仅需要次要的成像软件修改，并使用合适的软件工具来分析所得图像；它可以迅速进行。这些功能都使其有可能适合在可能增加肝脏刚度的问题时掺入常规肝脏MRI评估中。因此，这项研究对患者护理产生了重要的有益影响。 公共卫生相关性：肝病是一个重要且日益严重的公共卫生问题，经常在临床上沉默地对后来严重的肝硬化并发症。然而，传统的无创方法检测肝纤维化是发展的标志，是不可靠的，通常导致需要重复的肝活检（与其相关的不适和风险），以跟随患有进展性肝病风险的患者。该项目的总体目的是开发和评估一种评估肝脏刚度的新方法，特别是使用标记的磁共振成像（TMRI）来测量通过心脏运动在肝脏中诱导的运动和变形；如果成功，这可以提供一种方法，以避免追随许多肝病患者进行活检。