Novel Myocardial Perfusion Stress Test using Arterial Spin Labeling

使用动脉旋转标记的新型心肌灌注压力测试

• 批准号: 9751363
• 负责人: Krishna S Nayak
• 金额: $ 50.38万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9751363
• 关键词: Address; American; Angiography; Animal Model; Animals; Aorta; Blood; Blood flow; Brain; Calibration; Cardiac; Cardiac health; Cardiology; Cardiovascular system; Chronic Kidney Failure; Clinical; Contrast Media; Coronary; Coronary Angiography; Coronary Arteriosclerosis; Coronary Stenosis; Coronary artery; Detection; Diagnostic; Diastole; End stage renal failure; Engineering; Evaluation; Family suidae; Gadolinium; General Population; Goals; Growth; Heart; Heart Diseases; Human; Image; Intervention; Intravenous; Ionizing radiation; Ions; Kidney; Kidney Failure; Label; Left; Left ventricular structure; Liver; Magnetic Resonance Imaging; Measurement; Measures; Methods; Modeling; Morphologic artifacts; Motion; Motivation; Myocardial Ischemia; Myocardial perfusion; Myocardial tissue; Noise; Operative Surgical Procedures; Patient Recruitments; Patients; Performance; Perfusion; Photons; Physiologic pulse; Positron-Emission Tomography; Prevalence; Pulsatile Flow; Radiation Dose Unit; Radioisotopes; Regional Perfusion; Renal function; Reproducibility; Research; Risk; Role; Safety; Scanning; Schedule; Scheme; Severities; Signal Transduction; Slice; Source; Spin Labels; Stress; Stress Tests; Students; Subgroup; Supervision; Systole; Techniques; Technology; Testing; Thallium Myocardial Perfusion Imaging Stress Test; Time; Tissues; United States; Variant; Vasodilation; Ventricular; Work; X-Ray Computed Tomography; base; cardiovascular imaging; clinically relevant; cost; experience; experimental study; heart motion; high risk; imaging modality; innovation; interest; method development; mortality; novel; novel strategies; patient screening; patient subsets; perfusion imaging; public health relevance; radio frequency; research clinical testing; screening; skills; training project; undergraduate student

 DESCRIPTION (provided by applicant): This project will develop a new ultra-safe technique for myocardial perfusion stress testing in humans. Rationale: A growing number of patients in the United States require frequent cardiovascular assessment, to determine the presence and significance of coronary artery disease (CAD). Non-invasive myocardial perfusion stress testing is a method of choice, but we are not able to use current tests as frequently as we would like in these patients due to ionizing radiation and/or risks associated with contrast agents. Our proposed technique will not require any ionizing radiation or any potentially toxic contrast agents, and could therefore be performed repeatedly with no incremental risk to the patient. Innovation: We will utilize arterial spin labeled magnetic resonance imaging (ASL-MRI), an established technology for measuring brain perfusion in humans and myocardial perfusion in small animals. To our knowledge, its application to clinical myocardial perfusion imaging and stress testing is novel. Current methods for human cardiac ASL are able to detect increases in blood flow due to vasodilation, but provide only single slice coverage and barely adequate measurement variability (per-segment variations of roughly 0.16 mL-blood / g-tissue / min). We will address these limitations by developing and optimizing innovative new labeling schemes that enable evaluation of all 17 left ventricular segments, while taking into account cardiac motion, pulsatile flow, and potential sources of artifact. We will also integrate several new MRI technologies, for the first time, into the cardiac ASL experiment: simultaneous multi-slice imaging, background suppression, and blood pool suppression. Approach: The new test will be developed and experimentally optimized in a porcine model of CAD. We will first develop and optimize a labeling method that is compatible with whole-heart spatial coverage and maximizes the strength of the ASL signal. We will then develop and optimize an imaging method that interrogates all 17 left ventricular segments and maximizes the ASL temporal signal-to-noise ratio. After this is completed, we will perform a clinical evaluation of the optimized ASL-MRI stress test in patients with suspected CAD, and will compare the new test with both single-photon emitted computed tomography (SPECT) and invasive coronary angiography with fractional flow reserve (FFR). We will determine test-retest reproducibility of the new test in a subset of the patients. This study will enable whole-heart ASL-MRI stress testing, optimize and validate its ability to measure myocardial perfusion reserve, and enhance its feasibility as a firs-line test for CAD screening. Broader Impact: The proposed myocardial perfusion stress test could have a broader role for screening of patients with suspected CAD, due to its safety and its potential for simplicity and low cost. The technical work, particularly the labeling and imaging schemes, are likely to have implications for kidney and liver ASL-MRI. Finally, this work will provide training projects for postdoctoral, graduate, and undergraduate engineering students and clinical fellows interested in advanced cardiovascular imaging.

 描述（由申请人提供）：该项目将开发一种新的超安全技术，用于人体心肌灌注压力测试。理由：美国越来越多的患者需要频繁的心血管评估，以确定冠状动脉的存在和重要性。非侵入性心肌灌注压力测试是一种选择方法，但由于电离辐射和/或与造影剂相关的风险，我们无法在这些患者中频繁使用当前的测试。拟议的技术不需要任何电离辐射或任何潜在的有毒造影剂，因此可以重复执行，不会增加患者的风险。 创新：我们将利用动脉自旋标记磁共振成像（ASL-MRI），这是一种成熟的技术。据我们所知，其在临床心肌灌注成像和压力测试中的应用是新颖的，目前的人类心脏 ASL 方法能够检测由于血管舒张而导致的血流量增加。单切片覆盖范围和几乎没有足够的测量变异性（每个节段的变化约为 0.16 mL 血液/g 组织/分钟）我们将通过开发和优化创新的新标记方案来解决这些限制，该方案能够评估所有 17 个左心室节段，同时考虑到心脏运动、脉动血流和潜在的伪影来源，我们还将首次将几种新的 MRI 技术集成到心脏 ASL 实验中：同步多切片成像、背景抑制和血液。方法：新的测试将在 CAD 猪模型中进行开发和实验优化，我们将首先开发和优化与全心脏空间覆盖兼容并最大化 ASL 信号强度的标记方法。然后开发和优化一种成像方法，询问所有 17 个左心室节段并最大化 ASL 时间信噪比。完成后，我们将对疑似患者进行优化的 ASL-MRI 负荷测试的临床评估。 CAD，并将新测试与单光子发射计算机断层扫描 (SPECT) 和血流储备分数 (FFR) 的侵入性冠状动脉造影进行比较，我们将确定新测试在一部分患者中的重复测试结果。该研究将实现全心 ASL-MRI 压力测试，优化和验证其测量心肌灌注储备的能力，并增强其作为 CAD 筛查一线测试的可行性：拟议的更广泛的影响。由于其安全性、简单性和低成本的潜力，心肌灌注负荷试验在筛查疑似 CAD 患者方面可能发挥更广泛的作用，技术工作，特别是标记和成像方案，可能对肾脏和肝脏产生影响。最后，这项工作将为博士后、研究生和本科生以及对高级心血管成像感兴趣的临床研究员提供培训项目。

项目成果

MaxGIRF: Image reconstruction incorporating concomitant field and gradient impulse response function effects.

MaxGIRF：结合伴随场和梯度脉冲响应函数效应的图像重建。

• 发表时间: 2022-08
• 影响因子: 3.3
• 作者: Lee, Nam G;Ramasawmy, Rajiv;Lim, Yongwan;Campbell;Nayak, Krishna S
• 通讯作者: Nayak, Krishna S

Numerical approximation to the general kinetic model for ASL quantification.

ASL 量化一般动力学模型的数值近似。

• 发表时间: 2020
• 影响因子: 3.3
• 作者: Lee, Nam G;Javed, Ahsan;Jao, Terrence R;Nayak, Krishna S
• 通讯作者: Nayak, Krishna S

Single-shot EPI for ASL-CMR.

ASL-CMR 的单次 EPI。

• 发表时间: 2020-08
• 影响因子: 3.3
• 作者: Javed, Ahsan;Nayak, Krishna S
• 通讯作者: Nayak, Krishna S

Analysis of physiological noise in quantitative cardiac magnetic resonance.

定量心脏磁共振中的生理噪声分析。

• 发表时间: 2019
• 影响因子: 3.7
• 作者: Jao, Terrence;Nayak, Krishna
• 通讯作者: Nayak, Krishna

Demonstration of velocity selective myocardial arterial spin labeling perfusion imaging in humans.

人体速度选择性心肌动脉自旋标记灌注成像的演示。

• 发表时间: 2018-07
• 影响因子: 3.3
• 作者: Jao, Terrence R;Nayak, Krishna S
• 通讯作者: Nayak, Krishna S