High-Resolution Lymphatic Mapping of the Upper Extremities with MRI

使用 MRI 进行上肢高分辨率淋巴图谱分析

• 批准号: 10663718
• 负责人: Leo Lee Tsai
• 金额: $ 6.05万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10663718
• 关键词: 3-Dimensional; Acceleration; Adoption; Affect; Agreement; Algorithms; Anatomy; Back; Breast Cancer survivor; Bypass; Cadaver; Cancer Etiology; Categories; Clinical; Cost of Illness; Data; Development; Diagnostic radiologic examination; Diameter; Dissection; Edema; Excision; Exclusion; Goals; Hand; Human; Image; Imaging Techniques; Incidence; Individual; Indocyanine Green; Injections; Interdisciplinary Study; Knowledge; Label; Lead; Limb structure; Location; Lower Extremity; Lymph; Lymph Node Mapping; Lymphangiography; Lymphatic; Lymphatic System; Lymphedema; Lymphography; Magnetic Resonance; Magnetic Resonance Imaging; Malignant Neoplasms; Maps; Measures; Medical Care Costs; Methods; Operative Surgical Procedures; Pathway interactions; Patients; Penetration; Peripheral; Persons; Physiologic pulse; Positioning Attribute; Prevalence; Prevention; Preventive measure; Progressive Disease; Protocols documentation; Quality of life; Reference Standards; Research; Research Personnel; Resolution; Risk; Scanning; Schedule; Scientist; Severities; Signal Transduction; Site; Surgeon; Swelling; Techniques; Testing; Therapeutic; Time; Tissues; Upper Extremity; Validation; Variant; cancer surgery; cancer therapy; clinical application; clinical training; clinical translation; deep learning; design; detection method; draining lymph node; experimental study; healthy volunteer; in vivo; in vivo evaluation; lymph nodes; lymphatic drainage; lymphatic imaging; lymphatic vessel; lymphoscintigraphy; malignant breast neoplasm; multidisciplinary; novel; prevent; programs; repaired; simulation; targeted imaging; tool; trial design; ultrasound

Project Summary Lymphedema is a condition in which the clearance of lymph is compromised, resulting in edema and swelling of limbs, with potentially devastating impact on quality of life and medical costs. The most common cause of lymphedema in the US is from cancer-related surgery. Lymphedema is progressive and has no cure. It is not known why some patients develop lymphedema while others do not. Studies of cadavers have shown that the lymphatic anatomy can vary across individuals, and it is believed that these variations may increase the risk for certain individuals to develop lymphedema. If this is true, steps may be taken to prevent lymphedema from developing, for example with a bypass at the time of surgery. However, there is no practical way to obtain a complete lymphatic anatomical map within an extremity in vivo. Current imaging techniques are limited by penetration depth, low resolution, invasiveness, and partial coverage. The challenge is to map lymphatic channels, with diameters of 0.4-0.8 mm, and to trace them from all regions of an extremity back to draining lymph nodes. This proposal focuses on the development of a novel high resolution magnetic resonance (MR) lymphography technique (hrMRL) for lymphatic mapping of the upper extremities in living people. hrMRL will be a combination of a fast spin echo sequence with tailored variable flip angles, background subtraction, and acceleration via undersampling with compressed sensing and deep learning. The first aim will be to construct and optimize each of these components in an iterative fashion using phantoms, followed by testing on 10 healthy subjects, with the goal of obtaining maps of the lymphatic channels of an entire extremity within a target time of 20 minutes, suitable for clinical adoption. In the second aim, hrMRL will first be used to obtain full lymphatic anatomic maps of the upper extremity of 35 healthy volunteers who previously underwent indocyanine green (ICG) lymphography, which will serve as a gold-standard reference. hrMRL will then be validated aginst ICG by comparing both maps and determining their degree of agreement. hrMRL is also expected to resolve additional lymphatic channels undetected by ICG, allowing us the opportunity to create more comprehensive maps and to characterize new pathways, in particular the deep lymphatic channels. If successful, hrMRL would be immediately impactful in the clinical setting, where it could guide measures to avoid onset of lymphedema, shifting the lymphedema management algorithm from one of supportive and corrective therapies to one of prevention, with the goal of reducing the incidence of this debilitating and costly disease.

项目摘要 淋巴水肿是损害淋巴清除率的疾病，导致水肿和肿胀 四肢，可能对生活质量和医疗费用产生毁灭性的影响。最常见的原因 美国的淋巴水肿来自与癌症相关的手术。淋巴水肿是进行的，无法治愈。它不是 知道为什么有些患者会患上淋巴水肿，而另一些患者则不出现。对尸体的研究表明 淋巴解剖结构可能会因个体而异，并且据信这些变化可能会增加 某些人发展淋巴水肿。如果这是真的，则可以采取步骤来防止淋巴水肿 开发，例如在手术时进行旁路。但是，没有实用的方法来获得 体内末端的完整淋巴解剖图。当前的成像技术受到限制 穿透深度，低分辨率，侵入性和部分覆盖范围。挑战是映射淋巴 通道，直径为0.4-0.8毫米，并从四肢的所有区域追踪到排水淋巴 节点。该提案的重点是新型高分辨率磁共振的发展（MR） 淋巴技术（HRMRL）用于上肢的淋巴图。 HRMRL将是 快速自旋回波序列与量身定制的可变翻转角度，背景减法和 通过压缩感测和深度学习通过不足采样加速。第一个目的是建造 并使用幻影以迭代方式优化这些组件，然后对10个健康进行测试 受试者，目的是在目标时间内获得整个末端的淋巴通道的地图 20分钟，适合临床采用。在第二个目标中，HRMRL将首先用于获得全淋巴 35名健康志愿者的上肢的解剖图 （ICG）淋巴检查，将作为金标准参考。然后，HRMRL将通过 比较这两个地图并确定其一致性程度。 HRMRL也有望解决额外 ICG未发现的淋巴渠道，使我们有机会创建更全面的地图，并 表征新途径，特别是深淋巴通道。如果成功的话，hrmrl将是 在临床环境中立即影响，它可以指导措施避免淋巴水肿的发作， 将淋巴水肿管理算法从一种支持和纠正疗法之一转移到其中一种 预防，目的是减少这种衰弱和昂贵的疾病的发生率。