Rapid Real-Time Cardiovascular MRI for Detecting Coronary Artery Disease

用于检测冠状动脉疾病的快速实时心血管 MRI

• 批准号: 9753768
• 负责人: Daniel Kim
• 金额: $ 37.62万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9753768
• 关键词: Address; Agreement; Algorithms; Angiography; Arrhythmia; Basic Science; Breathing; Cardiac; Cardiac Catheterization Procedures; Cardiovascular system; Catheters; Cessation of life; Cicatrix; Clinical; Clinical Research; Clinical Services; Clinical Trials; Coronary; Coronary Angiography; Coronary Arteriosclerosis; Coronary Stenosis; Data; Development; Diagnosis; Diagnostic; Diagnostic Imaging; Diagnostic tests; Digital Imaging and Communications in Medicine; Evaluation; Exposure to; Fibrosis; Financial Hardship; Goals; Gold; Guidelines; Heart Diseases; Image; Imaging Techniques; Imaging technology; Inferior; Ionizing radiation; MRI Scans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Medical Imaging; Methods; Modality; Motion; Myocardial perfusion; Nuclear; Patients; Performance; Perfusion; Physiologic pulse; Play; Population Heterogeneity; Positron-Emission Tomography; Protocols documentation; Radial; Radiation; Radiation Dose Unit; Research; Resources; Risk; Roentgen Rays; Role; Sampling; Scanning; Site; Stress; Stress Echocardiography; Surveys; Technology; Testing; Time; Universities; X-Ray Computed Tomography; accurate diagnosis; base; cardiovascular imaging; coronary computed tomography angiography; cost effective; design; diagnostic accuracy; evaluation/testing; experience; heart function; heart imaging; imaging modality; innovation; operation; perfusion imaging; radiation risk; reconstruction; satisfaction; single photon emission computed tomography; success

Project Summary/Abstract: Coronary artery disease (CAD) is a leading cause of sickness and death in the US. Noninvasive cardiac imaging plays a vital role in diagnosing, risk stratifying, and guiding treatment decisions in patients with known or suspected CAD. However, the limitations of current imaging strategies are well documented. In a previous study of nearly 400,000 patients without known heart disease undergoing elective cardiac catheterization following a positive pre-test (mostly stress echocardiography and nuclear perfusion imaging), approximately 60% of them were found to not have obstructive CAD. According to recent AHA guidelines, radiation risk is an important consideration when choosing a diagnostic test. Indeed, there is an unmet clinical need to advance radiation-free diagnostic imaging tests for accurate diagnosis of functionally significant obstructive CAD. Since no single test is 100% accurate, one cost-effective approach to increase accuracy is to perform a comprehensive assessment within a single modality. Among available cardiac imaging modalities, MRI is arguably the most versatile and capable of a comprehensive evaluation of CAD, including cardiac function, perfusion, coronary angiography, and viability, while not requiring ionizing radiation. Despite substantial successes from both basic research and clinical trials, and even after decades of advancements, cardiac MRI continues to be hampered by (i) long exam times (~ 60-90 min), (ii) complexities in operation such as breath- holding requirements, and (iii) poor performance in patients with arrhythmias. To overcome these obstacles, we will develop a rapid (15 min), real-time (arrhythmia and motion insensitive) cardiovascular MRI protocol that can be performed during free breathing, while producing diagnostic accuracy comparable to a standard clinical MRI protocol (60-90 min). The central hypothesis of this application is that a rapid (15-min) MRI protocol produces diagnostic accuracy comparable to a standard clinical MRI protocol. The specific objectives in support of testing our central hypothesis are: (1) to develop rapid image acquisition and reconstruction methods that will be integrated into a single protocol streamlined for detecting CAD and (2) to evaluate the agreement between rapid and standard MRI results. This study leverages extensive clinical and research resources existing at Northwestern University (~200 cardiac stress MRI scans per year; cardiovascular imaging research). A rapid, free-breathing MRI protocol is a major step forward in MRI technology, because it will dramatically increase scan efficiency, simplify scan operation, and reduce financial burdens for imaging centers with limited expertise and resources to offer cardiovascular MRI as a routine clinical service. Success of this 3-year R01 application will yield preliminary data needed to pursue a renewal application aimed at validating diagnostic accuracy of a rapid MRI protocol against catheter X-ray angiography in a diverse population at multiple sites.

项目摘要/摘要：冠状动脉疾病（CAD）是疾病和死亡的主要原因 我们。非侵入性心脏成像在诊断，风险分层和指导治疗方面起着至关重要的作用 已知或怀疑CAD患者的决定。但是，当前成像策略的局限性是 据记录。在先前对未知心脏病的近40万名患者的研究中 阳性预测试后的选修心脏导管插入术（主要是应力超声心动图和核 灌注成像），发现其中约60％没有阻塞性CAD。根据最近的说法 AHA指南，在选择诊断测试时，辐射风险是一个重要的考虑因素。确实，有 未满足的临床需求，以推进无辐射诊断成像测试，以准确诊断功能 明显的阻塞性CAD。 由于没有单个测试是100％准确的，因此提高准确性的一种具有成本效益的方法是执行 单个方式的全面评估。在可用的心脏成像方式中，MRI为 可以说是对CAD的全面评估，包括心脏功能，包括心脏功能， 灌注，冠状动脉造影和活力，同时不需要电离辐射。尽管很大 基础研究和临床试验的成功，即使经过数十年的进步，心脏MRI （i）长期考试时间（〜60-90分钟）继续阻碍（ii）运行中的复杂性，例如呼吸 持有要求，（iii）心律不齐患者的性能差。为了克服这些障碍， 我们将开发快速（15分钟）的实时（心律不齐和运动不敏感）心血管MRI方案 可以在自由呼吸过程中执行，同时产生与标准临床相当的诊断精度 MRI协议（60-90分钟）。 该应用的中心假设是快速（15分钟）MRI方案产生诊断准确性 与标准临床MRI方案相当。支持测试我们的中心的具体目标 假设是：（1）开发快速图像采集和重建方法，这些方法将集成到 简化用于检测CAD的单一协议，（2）评估快速与标准之间的一致性 MRI结果。这项研究利用西北大学现有的广泛临床和研究资源 （每年200个心脏应力MRI扫描；心血管成像研究）。快速，自由呼吸的MRI 协议是MRI技术迈出的重要一步，因为它将大大提高扫描效率， 简化扫描操作，并减少具有有限专业知识和资源的成像中心的财务负担 提供心血管MRI作为常规临床服务。该3年R01申请的成功将产生 追求旨在验证快速MRI诊断准确性的续签应用所需的初步数据 在多个地点的多样化人群中针对导管X射线血管造影的方案。