Detection of Liver Fibrosis Using IVIM Diffusion and DCE MRI in HCV

使用 IVIM 扩散和 DCE MRI 检测 HCV 中的肝纤维化

• 批准号: 8322069
• 负责人: Bachir Taouli
• 金额: $ 33.72万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8322069
• 关键词: Algorithms; American; Antiviral Agents; Antiviral Therapy; Biological Markers; Caring; Chronic Hepatitis C; Cicatrix; Cirrhosis; Clinical; Collagen; Country; Data; Deposition; Detection; Diagnostic; Diffusion; Diffusion Magnetic Resonance Imaging; Disease; Disease Progression; Early Diagnosis; Evaluation; Fibrosis; Functional Magnetic Resonance Imaging; Health Care Costs; Hepatic; Hepatitis C; Histopathology; Imaging Techniques; Incidence; Inflammation; Interobserver Variability; Lead; Liver; Liver Cirrhosis; Liver Fibrosis; Liver diseases; Magnetic Resonance Imaging; Malignant neoplasm of liver; Metric; Modeling; Monitor; Morbidity - disease rate; Motion; Newly Diagnosed; Non-Invasive Cancer Detection; Patient Education; Patients; Performance; Perfusion; Population; Portal Hypertension; Primary carcinoma of the liver cells; Prospective Studies; Risk; Sample Size; Sampling; Secondary to; Source; Staging; Techniques; Testing; Time; Training; United States; Validation; Venous; Weight; base; cohort; cost; high risk; imaging modality; improved; liver biopsy; liver transplantation; mortality; novel; outcome forecast; predictive modeling; prognostic; public health relevance; tool

DESCRIPTION (provided by applicant): There is an expected increased incidence of chronic hepatitis C virus infection (HCV) in the Unites States within the next years, with subsequent increased risks of liver damage, including fibrosis and cirrhosis, which may eventually lead to hepatocellular carcinoma and end-stage liver disease requiring liver transplantation. This disease is/will be the source of enormous health care costs and morbidity/mortality. Most hepatologists still rely on liver biopsy findings in patients newly diagnosed with HCV, which enables the assessment of liver damage (fibrosis and inflammation). Liver biopsy has limitations, including cost, invasiveness, poor patient acceptance, limited sampling, inter-observer variability and is difficult to repeat. Non invasive tests to capture the extent of liver damage at a larger scale are urgently needed. These will gain more acceptance among patients and hepatologists. In this proposal, we would like to test and validate non invasive magnetic resonance imaging (MRI) methods based on advanced diffusion (intravoxel incoherent motion diffusion MRI: IVIM DW-MRI) and dynamic contrast-enhanced MRI (DCE-MRI) for the detection of fibrosis and cirrhosis in HCV patients. Based on our recent preliminary data, we believe that the combination of IVIM DW- and DCE-MRI has potential for detection of fibrosis and cirrhosis with excellent accuracy, while enabling coverage of the whole liver. In order to improve the diagnostic performance of MRI, we would like to build and validate a predictive model based on advanced functional MRI metrics (diffusion and perfusion). If validated, this novel non invasive algorithm will not only decreases the number of liver biopsies, but also enable earlier diagnosis of liver fibrosis when antiviral treatment is more effective, and enable a comprehensive evaluation of the liver (to assess for cirrhosis, portal hypertension and hepatocellular cancer). This could significantly reduce the cost of care, could become a useful tool for testing new antifibrogenic and antiviral drugs in HCV, and could be used to follow patients for detection of progression to cirrhosis. This will be a highly significant progress in liver diseases given the increased burden of HCV in this country, and would benefit a large number of Americans over the next decade. PUBLIC HEALTH RELEVANCE: Patients with hepatitis C virus infection (HCV) are at high risk of developing liver scarring (fibrosis), with ultimate risks of cirrhosis and liver cancer that may require liver transplant. We would like to develop non invasive advanced MRI techniques (diffusion and dynamic contrast-enhanced MRI) to assess the degree of liver damage in HCV. These techniques combined could reach high diagnostic performance for detection of liver fibrosis; and could decrease the number of necessary liver biopsies, which have risks and sample only a small portion of the liver.

描述（由申请人提供）：预计未来几年美国慢性丙型肝炎病毒感染（HCV）的发病率将会增加，随之而来的是肝损伤的风险增加，包括纤维化和肝硬化，最终可能导致肝细胞性肝癌需要肝移植的癌症和终末期肝病。 这种疾病正在/将会成为巨大的医疗保健费用和发病率/死亡率的根源。 大多数肝病专家仍然依赖新诊断的丙肝患者的肝活检结果，这使得能够评估肝损伤（纤维化和炎症）。肝活检具有局限性，包括成本、侵入性、患者接受度差、采样有限、观察者间差异且难以重复。 迫切需要进行非侵入性测试来更大规模地了解肝损伤的程度。这些将获得更多患者和肝病专家的认可。在本提案中，我们希望测试和验证基于先进扩散（像素内不相干运动扩散 MRI：IVIM DW-MRI）和动态对比增强 MRI（DCE-MRI）的非侵入性磁共振成像（MRI）方法进行检测HCV 患者的纤维化和肝硬化。根据我们最近的初步数据，我们相信 IVIM DW- 和 DCE-MRI 的结合具有以极高的准确性检测纤维化和肝硬化的潜力，同时能够覆盖整个肝脏。为了提高 MRI 的诊断性能，我们希望建立并验证基于先进功能 MRI 指标（扩散和灌注）的预测模型。如果得到验证，这种新颖的非侵入性算法不仅可以减少肝活检的数量，而且可以在抗病毒治疗更有效时更早诊断肝纤维化，并可以对肝脏进行全面评估（评估肝硬化、门静脉高压和肝硬化）。肝细胞癌）。 这可以显着降低护理成本，可以成为测试 HCV 中新型抗纤维形成和抗病毒药物的有用工具，并且可以用于跟踪患者以检测肝硬化的进展情况。鉴于美国丙肝病毒负担的增加，这将是肝脏疾病方面的一个非常重大的进展，并将在未来十年使大量美国人受益。 公共卫生相关性：丙型肝炎病毒感染 (HCV) 患者出现肝脏疤痕（纤维化）的风险很高，最终有可能需要肝移植的肝硬化和肝癌风险。我们希望开发非侵入性先进 MRI 技术（扩散和动态对比增强 MRI）来评估 HCV 肝损伤程度。这些技术相结合可以达到检测肝纤维化的高诊断性能；并且可以减少必要的肝脏活检的数量，这种活检存在风险并且只能对肝脏的一小部分进行采样。