4D DSA and 4D Fluoroscopy: Validation of Diagnostic and Therapeutic Capabilities

4D DSA 和 4D 透视：诊断和治疗能力的验证

• 批准号: 8608595
• 负责人: Charles A. Mistretta
• 金额: $ 60.3万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-02-01 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8608595
• 关键词: Acceleration; Agreement; Algorithms; Angiography; Animals; Area; Arteries; Blood Vessels; Clinical; Computer software; Contrast Media; Devices; Diagnostic; Dose; Engineering; Evaluation; Fluoroscopy; Gadolinium; Human; Image; Imagery; Injection of therapeutic agent; Intervention; Intra-Arterial Injections; Intravenous; Laboratories; Maps; Measurement; Medical Imaging; Methods; Modality; Movement; Operative Surgical Procedures; Patients; Phase; Positioning Attribute; Procedures; Process; Radiology Specialty; Reporting; Research; Research Design; Resolution; Retrospective Studies; Roentgen Rays; Safety; Savings; Series; System; Techniques; Therapeutic; Time; Translations; Validation; Veins; Work; arm; base; clinical practice; digital imaging; gadolinium oxide; image reconstruction; intravenous injection; pre-clinical; pressure; public health relevance; reconstruction; simulation; tool; virtual

DESCRIPTION (provided by applicant): In 1980 when DSA was introduced there was initial enthusiasm that the technique would, for the first time, enable the ability to perform angiographic procedures, on a wide spread basis, using an intravenous injection of contrast medium. Unfortunately, this enthusiasm rather quickly dissipated as it became evident that because of the overlap of arteries and veins on any single projection, multiple acquisitions were required for adequate diagnostic evaluations (each of these was associated with a very significant contrast medium dose as well as additional x-ray exposure). Quickly, the use of the real time digital imaging capabilities was adapted for use with intra-arterial contrast injections. Conventional DSA provides 2D images at variable frame rates (a time series). Similarly, X-ray fluoroscopy offers a 2D display at high frame rates. Over the last 3 decades, DSA has been used primarily in conjunction with intra-arterial injections for diagnostic purposes while other angiographic modalities such as CTA and MRA have been used in connection with intravenous injections. Although current 3D rotational DSA does provide a 3D reconstruction, the images contain no temporal information, and although vessel overlap can be overcome to some extent through the use of rotational views, the combination of arteries and veins in the reconstructed volume often makes optimal visualization difficult. Because of the geometrical constraints that limit positioning of the C-arm gantries fluoroscopy implemented using C-arm systems often cannot provide optimal views for delivery and deployment (working views) of interventional devices. This not only impairs the safety of some interventions but also often results in an inability to offer patients endovascular treatment, requiring that they undergo more invasive traditional surgical interventions. During the past several years we have developed MRA techniques involving sub-Nyquist acquisition and constrained reconstruction that permit acceleration factors up to 1000. These have removed the traditional tradeoffs between spatial and temporal resolution and have provided contrast-enhanced MRA techniques using as little as 1 cc of intravenous gadolinium and phase contrast techniques that have facilitated new applications such as non-invasive measurement of vascular pressure gradients 1-4. The principles of constrained reconstruction have also been extended to other areas of medical imaging where significant dose reductions or SNR increases have been reported 5-7. Many of these principles can be applied to X-ray DSA to greatly increase the rate at which 3D time resolved volumes can be obtained. We have recently developed a C-arm based 4D DSA method that provides a series of fully time resolved 3D DSA volumes (4D-DSA) at frame rates of up to 30/s with higher temporal and spatial resolution than current MRA and CTA techniques. We also have developed a 4D Fluoroscopy method that permits fluoroscopic viewing of virtual roadmaps at any desired angle without a need to reposition the C-arm gantries. The purpose of the proposed research is to validate these techniques and to bring them to a point where they are ready for wide spread dissemination and clinical usage.

描述（由申请人提供）：在1980年引入DSA时，最初的热情是，该技术首次能够使用静脉注射对比介质的静脉注射能力，以广泛的差距进行血管造影程序。不幸的是，这种热情很快就消失了，因为很明显，由于动脉和静脉在任何单个投影上的重叠，需要进行多次收购来进行足够的诊断评估（每一种都与非常重要的对比度介质剂量以及其他X射线暴露有关）。很快，将实时数字成像功能的使用适用于动脉内对比度注射。 常规DSA以可变帧速率（时间序列）提供2D图像。同样，X射线透视镜以高框架速率提供2D显示。在过去的30年中，DSA主要用于诊断目的的动脉内注射，而其他血管造影方式（例如CTA和MRA）已与静脉注射有关。尽管当前的3D旋转DSA确实提供了3D重建，但图像不包含时间信息，尽管可以通过使用旋转视图在某种程度上克服船只重叠，但在重建体积中，动脉和静脉的组合通常会使最佳可视化变得困难。由于限制了使用C-ARM系统实施的C-ARM GANTRIS的定位的几何约束，通常无法为介入设备的交付和部署（工作视图）提供最佳视图。这不仅会损害某些干预措施的安全性，而且通常会导致无法为患者提供血管内治疗，要求他们接受更具侵入性的传统手术干预措施。在过去的几年中，我们开发了MRA技术，涉及次数的获取和限制的重建，使加速因素允许高达1000个。这些技术可以消除了空间和时间分辨率之间的传统权衡，并提供了对静脉炎的阶段不合格技术的对比度增强的MRA技术，这些技术均不在静脉炎的阶段技术，这些技术是不合时宜的。血管压力梯度1-4。约束重建的原理也已扩展到其他医学成像领域，在这些领域，已报告了大量剂量减少或SNR的增加5-7。这些原理中的许多可以应用于X射线DSA，以极大地提高可获得3D分解量的速率。我们最近开发了一种基于C-ARM的4D DSA方法，该方法提供了一系列完全分辨的3D DSA量（4D-DSA），其帧速率高达30/s，比当前MRA和CTA技术更高，具有更高的时间和空间分辨率。我们还开发了一种4D荧光镜方法，该方法允许以任何所需角度对虚拟路线图的荧光观察无需重新放置C臂卫生液。拟议的研究的目的是验证这些技术，并将它们提升到准备大量传播和临床用法的地步。