Hemodynamic and inflammatory imaging in evaluation of abdominal aortic aneurysms

血流动力学和炎症成像评估腹主动脉瘤

基本信息

批准号：
9411005
负责人：
Michael Douglas Hope
金额：
$ 39.14万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-01-01 至 2019-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9411005
关键词：
Abdominal Aortic Aneurysm Anatomy Aneurysm Aortic Diseases Aortitis Blood Vessels Blood flow Caliber Central Artery Cessation of life Clinical Computer Simulation Contrast Media Data Descriptor Dimensions Disease Disease Progression Early Intervention Evaluation Functional Imaging Goals Growth Hematological Disease Image Imaging Techniques Inflammation Inflammatory Intervention Knowledge Life Magnetic Resonance Imaging Measurement Metabolic Motivation Operative Surgical Procedures Outcome Pathologic Patient risk Patients Pattern Phase Population Process Property Regimen Reporting Resources Risk Risk Assessment Rupture Ruptured Abdominal Aortic Aneurysm Series Site Stress Stretching Time Vascular Diseases base experience ferumoxytol hemodynamics improved improved outcome innovation macrophage older men patient stratification public health relevance rapid growth screening shear stress surveillance imaging vascular abnormality

项目摘要

DESCRIPTION (provided by applicant): Abdominal aortic aneurysms (AAA) are common and can be life-threatening if they progress to rupture. They have been reported in 5% of older men and account for over 15,000 deaths per year. Basic vessel dimensions are currently the primary imaging measurement used clinically to risk-stratify patients. But there is more to the story than dimensions. Wall stress estimated with computational modeling may better predict growth and rupture than diameters. Growth is often not continuous, and instead marked by periods of rapid growth followed by quiescence. Small series report that unrelated surgical procedures can precipitate AAA rupture. These findings suggest that episodic and heterogeneous inflammatory processes in concert with adverse hemodynamics are important for the progression of AAA disease. The complexity of aortic disease is more fully revealed with new functional imaging techniques than with conventional anatomic analysis alone. While AAA has been extensively studied, the mechanisms of disease progression have not been fully elucidated. If better understood, the management of patients with small AAAs (< 5.5cm) could be significantly improved. Many of these aneurysms can be followed safely with a long screening interval of 2-3 years, but some may progress to rupture. Identifying this subset would greatly streamline the surveillance imaging of the millions of patients with AAA. On the other hand, the majority of AAAs never rupture, and identifying low risk patients could help better manage resources and subject only those patients at truly elevated risk to intervention. Aortic wall inflammation can be evaluated with the MRI contrast agent ferumoxytol, which has macrophage- selective properties on delayed imaging. MRI also offers a unique and comprehensive assessment of aortic hemodynamics. Blood flow imaging with time-resolved, 3D phase-contrast MRI (4D Flow) allows quantification of key secondary vascular parameters including turbulence and wall shear stress (WSS). Cine Displacement Encoding with Stimulated Echos (DENSE) can quantify regional stretch differences experienced by the vessel wall. Computational modeling based on MRI volumetric data can be used to calculate wall stress. The goal of our study is to uncover important inflammatory changes and adverse hemodynamics that are not addressed with current imaging, and use them to predict disease progression. We seek to meaningfully advance the assessment of risk in patients who do not meet current intervention thresholds and improve outcomes by refining surveillance imaging regimens and decisions regarding early intervention for AAAs.

描述（由申请人提供）：腹主动脉瘤（AAA）很常见，如果进展到破裂可能会危及生命。据报道，5% 的老年男性患有此病，每年导致 15,000 多人死亡。基本血管尺寸目前是临床上用于对患者进行风险分层的主要成像测量。但这个故事的意义不只是维度。通过计算模型估计的壁应力可以比直径更好地预测生长和破裂。增长通常不是连续的，而是以快速增长期和随后的静止期为标志。小编报道称，不相关的手术操作会导致AAA破裂。这些发现表明，间歇性和异质性炎症过程与不良血流动力学相结合对于 AAA 疾病的进展很重要。新的功能成像技术比单独的传统解剖分析更能全面揭示主动脉疾病的复杂性。虽然 AAA 已得到广泛研究，但疾病进展的机制尚未完全阐明。如果更好地理解，小 AAA（< 5.5 厘米）患者的治疗可以得到显着改善。许多动脉瘤可以安全地进行 2-3 年的长期筛查间隔，但有些可能会发展至破裂。识别这个子集将极大地简化数百万 AAA 患者的监测成像。另一方面，大多数 AAA 永远不会破裂，识别低风险患者可以帮助更好地管理资源，并仅对那些真正风险较高的患者进行干预。主动脉壁炎症可能是使用 MRI 造影剂 ferumoxytol 进行评估，该造影剂对延迟成像具有巨噬细胞选择性特性。 MRI 还可以对主动脉血流动力学进行独特且全面的评估。采用时间分辨 3D 相衬 MRI (4D Flow) 的血流成像可以量化关键的次要血管参数，包括湍流和壁剪切应力 (WSS)。带受激回声的电影位移编码 (DENSE) 可以量化血管壁经历的区域拉伸差异。基于 MRI 体积数据的计算模型可用于计算壁应力。我们研究的目标是发现当前影像学无法解决的重要炎症变化和不良血流动力学，并利用它们来预测疾病进展。我们寻求有意义地推进对不符合当前干预阈值的患者的风险评估，并通过完善监测成像方案和有关 AAA 早期干预的决策来改善结果。

项目成果

期刊论文数量（11）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Patient-specific finite element analysis of ascending thoracic aortic aneurysm.

升胸主动脉瘤的患者特异性有限元分析。

DOI：
发表时间：
2014
期刊：
The Journal of heart valve disease
影响因子：
0
作者：
Wisneski,AndrewD;Mookhoek,Aart;Chitsaz,Sam;Hope,MichaelD;Guccione,JuliusM;Ge,Liang;Tseng,ElaineE
通讯作者：
Tseng,ElaineE

Vascular inflammation in a growing iliac artery aneurysm.

不断生长的髂动脉瘤中的血管炎症。

DOI：
10.1097/rlu.0000000000000731
发表时间：
2015
期刊：
Clinical nuclear medicine
影响因子：
10.6
作者：
Hope,MichaelD;Gasper,WarrenJ;Rapp,Joseph;Owens,ChristopherD;Haraldsson,Henrik;Saloner,David
通讯作者：
Saloner,David

Prevalence and significance of incidentally noted dilation of the ascending aorta on routine chest computed tomography in older patients.