Non-invasive hemodynamic and biomechanic imaging methods for early risk prediction in aortic dissection

用于主动脉夹层早期风险预测的非侵入性血流动力学和生物力学成像方法

• 批准号: 10716472
• 负责人: Nicholas Scott Burris
• 金额: $ 68.84万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 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 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10716472
• 关键词: 3-Dimensional; 4D MRI; Acute; Adverse event; Anatomy; Angiography; Aorta; Aortic Aneurysm; Aortic Rupture; Behavior; Biological Markers; Biomechanics; Blood flow; Cardiac; Caring; Cessation of life; Characteristics; Chest; Chronic; Chronic Phase; Clinical; Clinical Assessment Tool; Compensation; Country; Data; Development; Diameter; Disease; Disease Progression; Dissection; Emerging Technologies; Enrollment; Equilibrium; Evaluation; Evolution; Follow-Up Studies; Functional Imaging; Functional disorder; Goals; Growth; Hospitals; Image; Image Analysis; Imaging Techniques; Intervention; Life; Machine Learning; Magnetic Resonance Imaging; Maps; Measurement; Measures; Medical; Medical Imaging; Medicine; Methods; Michigan; Motivation; Operative Surgical Procedures; Outcome; Patient Recruitments; Patients; Periodicity; Phase; Physics; Play; Positioning Attribute; Process; Prognosis; Pulsatile Flow; Risk; Risk Estimate; Role; Rupture; Scanning; Statistical Models; Techniques; Technology Assessment; Time; Tissues; Unnecessary Procedures; Work; X-Ray Computed Tomography; biomedical referral center; cost; experience; follow-up; hemodynamics; high risk; imaging biomarker; imaging modality; improved; individualized medicine; innovation; longitudinal, prospective study; minimally invasive; mortality; non-invasive imaging; novel; overtreatment; patient population; personalized predictions; personalized risk prediction; predictive tools; pressure; primary outcome; prospective; repaired; risk prediction; spatiotemporal; treatment strategy; 3-Dimensional; 4D MRI; Acute; Adverse event; Anatomy; Angiography; Aorta; Aortic Aneurysm; Aortic Rupture; Behavior; Biological Markers; Biomechanics; Blood flow; Cardiac; Caring; Cessation of life; Characteristics; Chest; Chronic; Chronic Phase; Clinical; Clinical Assessment Tool; Compensation; Country; Data; Development; Diameter; Disease; Disease Progression; Dissection; Emerging Technologies; Enrollment; Equilibrium; Evaluation; Evolution; Follow-Up Studies; Functional Imaging; Functional disorder; Goals; Growth; Hospitals; Image; Image Analysis; Imaging Techniques; Intervention; Life; Machine Learning; Magnetic Resonance Imaging; Maps; Measurement; Measures; Medical; Medical Imaging; Medicine; Methods; Michigan; Motivation; Operative Surgical Procedures; Outcome; Patient Recruitments; Patients; Periodicity; Phase; Physics; Play; Positioning Attribute; Process; Prognosis; Pulsatile Flow; Risk; Risk Estimate; Role; Rupture; Scanning; Statistical Models; Techniques; Technology Assessment; Time; Tissues; Unnecessary Procedures; Work; X-Ray Computed Tomography; biomedical referral center; cost; experience; follow-up; hemodynamics; high risk; imaging biomarker; imaging modality; improved; individualized medicine; innovation; longitudinal, prospective study; minimally invasive; mortality; non-invasive imaging; novel; overtreatment; patient population; personalized predictions; personalized risk prediction; predictive tools; pressure; primary outcome; prospective; repaired; risk prediction; spatiotemporal; treatment strategy

PROJECT SUMMARY/ABSTRACT Aortic dissection (AD) is a disease characterized by sudden tearing of the inner layers of the aortic wall creating a false lumen (FL) channeling aortic blood flow. The vast majority of acute AD patients survive into the chronic phase, although long-term outcomes are poor with about 50% of patients experiencing aorta-related mortality or requiring surgical repair by 10 years. A major contributor to poor long-term outcomes is growth of the FL. Thoracic endovascular aortic repair (TEVAR) is a minimally invasive surgical therapy which can halt FL growth and reduce AD mortality; however, this treatment comes with cost, risk of procedural complications, and is less effective over time owing to increased tissue stiffness. Accurate prediction of disease trajectory at early phases is limited with current metrics but is highly desirable as this would allow TEVAR to be targeted to high-risk patients in a timely manner, sparing those at lower risk from potentially unnecessary procedures. Current methods for estimating risk in AD are largely based on anatomic metrics (e.g., aortic diameter), which poorly capture functional aspects of AD. To overcome these limitations, we propose to apply advanced imaging techniques, namely 4D Flow magnetic resonance imaging (MRI) and 4D computed tomography angiography (CTA), to characterize and quantify functional processes such as FL pressure and FL wall stiffness, which elude current imaging approches and have been implicated as important factors in predicting long-term behavior of AD. We hypothesize that assessments of these functional metrics will, improve our prediction of false lumen growth rate (FLGR) compared to standard anatomic metrics. We plan to prospectively recruit patients with either uncomplicated type B (n=30) or surgically repaired type A (n=45) aortic dissection to undergo baseline 4D Flow and 4D CTA imaging in the subacute period (1-3 months post-dissection) as well as follow-up studies at 1- and 2-years post-dissection, with the primary outcome being FLGR. To achieve these goals, the Aims of this proposal are: 1) Identify baseline hemodynamic and biomechanical metrics in the subacute period of AD that predict FL growth rate over time. FL pressure will be quantified from 4D Flow MRI using indirect and direct methods based on physics-based image analysis, with regional FL wall stiffness quantified by merging FL pressure with cyclic aortic wall deformation by 4D CT; 2) Determine the trajectories of functional metrics over time that best predict progressive FL growth. Longitudinal changes in pressure and wall stiffness between baseline and 1- and 2-year follow-up scans will be assessed to identify patients who achieve a new equilibrium versus those who continue to progress; 3) Develop a clinical assessment tool to predict risk of progressive FL growth combining functional metrics, anatomic parameters and patient characteristics with a focus on simplicity and accuracy for dissection-type specific prediction of the FLGR at the earliest possible time point. This work seeks to shift the paradigm of AD assessment from pure anatomic characterization by integrating functional imaging biomarkers to provide accurate predictions of disease trajectory and allow for optimal determination of surgical candidacy and timing.

项目摘要/摘要 主动脉夹层（AD）是一种疾病，其特征是主动脉壁的内部层突然撕裂 假管腔（FL）引导主动脉血流。绝大多数急性广告患者能够生存为慢性 阶段，尽管长期结局很差，约有50％的患者患有主动脉相关死亡率或 需要手术修复10年。造成长期不良结果的主要贡献者是佛罗里达州的增长。胸椎 血管内主动脉修复（TEVAR）是一种微创手术疗法，可以阻止FL生长并减少 广告死亡率；但是，这种治疗带有成本，程序上并发症的风险，并且效率较低 由于组织刚度增加而导致的时间。早期疾病轨迹的准确预测受到限制 当前指标，但非常可取，因为这将使Tevar及时地针对高危患者 方式，从潜在不必要的程序中保留较低风险的人。当前估计方法 AD的风险主要基于解剖指标（例如主动脉直径），该指标捕获功能方面很差 广告。为了克服这些局限性，我们建议采用高级成像技术，即4D流 磁共振成像（MRI）和4D计算机断层扫描血管造影（CTA），以表征和表征 量化功能过程，例如FL压力和FL壁刚度，避免了电流成像 并被认为是预测AD长期行为的重要因素。我们假设这一点 对这些功能指标的评估将提高我们对错误管腔生长速率（FLGR）的预测 标准解剖指标。我们计划前瞻性地招募任何一个简单的B型患者（n = 30） 或手术修复的A型A（n = 45）主动脉夹层以进行基线4D流和4D CTA成像。 亚急性时期（隔离后1-3个月）以及距离1年和2年的后续研究，并具有 主要结果是FLGR。为了实现这些目标，该提案的目的是：1）确定基准 在AD的亚急性期间，血液动力学和生物力学指标可以预测FL的生长速率。佛罗里达州 将使用基于物理图像的间接和直接方法从4D流MRI量化压力 分析，通过将FL压力与环状主动脉壁变形合并的区域FL壁刚度通过 4D CT; 2）确定随时间推移的功能指标的轨迹，从而可以最好地预测渐进的FL生长。 基线和1年和2年随访之间的压力和壁刚度的纵向变化将是 评估以识别达到新均衡的患者，而那些继续进步的患者； 3）发展 一种临床评估工具，可预测结合功能指标的渐进式FL生长风险 参数和患者特征，重点是简单性和准确性的解剖型特异性 最早可能的时间点预测FLGR。这项工作旨在改变广告评估的范式 通过整合功能成像生物标志物来提供准确的预测，从纯净的解剖学表征 疾病轨迹，并允许最佳确定手术候选人资格和时机。