Prediction and assessment of COPD lung volume reduction outcomes with polarized MRI

使用偏振 MRI 预测和评估 COPD 肺减容结果

• 批准号: 9228404
• 负责人: RAHIM R RIZI
• 金额: $ 76.3万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2020-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9228404
• 关键词: Ablation; Address; Affect; Air; Alveolar; Animals; Area; Attenuated; Chronic Obstructive Airway Disease; Clinical; Communities; Data; Decision Making; Defect; Development; Devices; Diffusion; Disease; Dyspnea; Effectiveness; Elastases; Ensure; Environmental air flow; Evaluation; Excision; Exertion; Future; Gases; Goals; Health; High Prevalence; High Resolution Computed Tomography; Image; Intervention; Longitudinal Studies; Lung; Lung Volume Reductions; Lung diseases; Lung volume reduction surgery; Magnetic Resonance Imaging; Maps; Measures; Medical; Methods; Modeling; Morbidity - disease rate; Nature; Operative Surgical Procedures; Oryctolagus cuniculus; Outcome; Oxygen; Palliative Care; Patients; Pattern; Performance; Perfusion; Periodicity; Phase; Physical Capacity; Physiological; Procedures; Public Health; Pulmonary Emphysema; Pulmonary Function Test/Forced Expiratory Volume 1; Pulmonary function tests; Research; Resected; Respiratory physiology; Smoke; Smoker; Smoking; Spirometry; Symptoms; Techniques; Technology; Thick; Tissues; Treatment Efficacy; Uncertainty; United States; X-Ray Computed Tomography; base; cohort; cost; disability; exercise capacity; imaging approach; improved; individual patient; innovation; mortality; public health relevance; pulmonary function; response; years lived with disability

 DESCRIPTION (provided by applicant): Chronic obstructive pulmonary disease (COPD) is an increasingly urgent public health concern on both the national and global levels. Not only is the disorder a major cause of mortality, but the dyspnea, reduced capacity for physical exertion, and periodic exacerbations that it causes result in tremendous disability and cost. Treatment options for established COPD remain limited in number, diversity, and effectiveness. However, in recent years, significant innovation has been accomplished in the field of lung volume reduction (LVR), which seeks to enhance global lung function through the removal, occlusion, or obliteration of hyperinflated, emphysematous regions. While LVR has traditionally been implemented through surgical resection, the development of less invasive bronchoscopic techniques (BLVR) is ongoing and represents an extremely promising arena of COPD therapy. This application proposes to develop a hyperpolarized 129Xe magnetic resonance imaging (HP 129Xe MRI) approach for planning BLVR intervention and assessing its pulmonary effects. The core problem faced by all LVR approaches is that they have demonstrated highly variable outcomes; it consequently remains unclear exactly what types of patient will benefit most from this therapy and why. Clinicians currently base their decisions of whether to carry out LVR and which regions to target using high-resolution computed tomography (HRCT) to measure the extent of emphysema and its distribution. While HRCT is highly capable of accurately assessing these features, it does not provide the functional information necessary to gain a comprehensive understanding of an individual patient's regional pulmonary status. We thus posit that the incorporation of functional parameters obtained with HP 129Xe MRI will allow for more informed decision-making in regards to which patients should undergo LVR and how the procedure should be tailored according to the lung health of the particular patient. In applying HP 129Xe MRI to this medical area of need, a corollary goal will be achieved: the refinement of this hyperpolarized technique such that it can extract pulmonary information with the sensitivity of the more well-established HP 3He MRI approach. 3He has become drastically more expensive in recent years due to its scarcity, and the hyperpolarized community recognizes that a shift to the much less expensive and more easily obtainable 129Xe is necessary to ensure the translational applicability of this important technology. We seek here to use Xe to derive three lung parameters-specific ventilation (SV), alveolar oxygen tension (pAO2), 129 and apparent diffusion coefficient (ADC)-with approximately the same sensitivity and efficiency that we have previously attained using 3He. This development will enhance the clinical future of hyperpolarized MRI not only in the area of LVR, but also in the non-invasive assessment of COPD and lung diseases more broadly.

 描述（由申请人提供）：慢性阻塞性肺病（COPD）是国家和全球层面日益紧迫的公共卫生问题，该疾病不仅是死亡的主要原因，而且还导致呼吸困难、体力消耗能力下降、慢性阻塞性肺病的治疗选择在数量、多样性和有效性方面仍然有限，但近年来，在肺减容领域取得了重大创新。 (LVR) 旨在通过切除、闭塞或消除过度充气的肺气肿区域来增强整体肺功能，虽然 LVR 传统上是通过手术切除来实施的，但微创支气管镜技术 (BLVR) 的发展仍在进行中，并代表了一种新的技术。该申请建议开发一种超极化 129Xe 磁共振成像 (HP 129Xe MRI) 方法来规划 BLVR 干预并评估其效果。所有 LVR 方法面临的核心问题是它们的结果差异很大；因此，目前尚不清楚哪些类型的患者将从这种治疗中受益最多以及为什么临床医生目前决定是否进行 LVR。使用高分辨率计算机断层扫描 (HRCT) 测量肺气肿的范围及其分布的目标区域虽然 HRCT 非常能够准确评估这些特征，但它无法提供全面了解个体所需的功能信息。患者局部肺部因此，我们认为，功能参数与 HP 129Xe MRI 的结合将有助于就哪些患者应接受 LVR 以及如何根据特定患者的肺部健康状况调整手术做出更明智的决策。 HP 129Xe MRI 应用于这一医疗领域的需求，将实现一个必然的目标：改进这种超极化技术，使其能够以更完善的 HP 3He MRI 的灵敏度提取肺部信息3He 由于其稀缺性，近年来变得更加昂贵，超极化社区认识到，为了确保这项重要技术的转化适用性，有必要转向更便宜且更容易获得的 129Xe。使用 Xe 导出三个肺参数 - 特定通气量 (SV)、肺泡氧张力 (pAO2)、129 和表观扩散系数 (ADC) - 其灵敏度和效率与我们之前获得的大致相同使用 3He 的这一进展将增强超极化 MRI 的临床前景，不仅在 LVR 领域，而且在更广泛的 COPD 和肺部疾病的无创评估中。