Dual-Venc 5D flow for Assessment of Congenital Heart Disease in Pediatrics

Dual-Venc 5D 流程用于评估儿科先天性心脏病

• 批准号: 10679809
• 负责人: Elizabeth Weiss
• 金额: $ 4.34万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 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 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10679809
• 关键词: 3-Dimensional; 4D MRI; Acceleration; Address; Adult; Age; Anesthesia procedures; Arteries; Blood flow; Body Size; Breathing; Bypass; Cardiac; Case Study; Cessation of life; Child; Childhood; Circulation; Clinical; Complex; Complication; Data; Development; Diagnostic Imaging; Disease Progression; Doppler Echocardiography; Echocardiography; Electrocardiogram; Environment; Failure; Fontan Procedure; General Anesthesia; Goals; Heart; Heart Rate; Heart Transplantation; Imaging Techniques; Individual; Infant; Legal patent; Life; Live Birth; Lung; Magnetic Resonance Imaging; Measurement; Measures; Methods; Monitor; Noise; Operative Surgical Procedures; Patient Monitoring; Patients; Pattern; Pediatrics; Phase; Physicians; Physiology; Population; Procedures; Prospective Studies; Pulmonary Circulation; Pulmonary Vascular Resistance; Pulmonary artery structure; Pulsatile Flow; Radial; Reproducibility; Resolution; Respiration; Route; Running; Sampling; Scanning; Secondary to; Series; Single ventricle congenital heart disease; Techniques; Testing; Time; United States; Validation; Veins; Venous; Viscosity; Work; analysis pipeline; cardiac magnetic resonance imaging; cohort; congenital heart disorder; data acquisition; diagnostic tool; expiration; flexibility; heart function; hemodynamics; image reconstruction; imaging modality; improved; in vivo; middle age; novel; palliation; pediatric patients; pressure; reconstruction; recruit; respiratory; standard of care; temporal measurement; tool

Project Abstract/Summary Congenital heart disease (CHO) afflicts up to 2% of live births in the United States. Among the most severe CHO is single ventricle disease (SVD) where infants are born with only one sufficiently functional ventricle. SVD often requires a series of surgeries that is completed with the Fontan procedure. This results in a circulation that bypasses a right-heart-driven pulmonary circulation, instead, routing systemic venous return directly to the pulmonary arteries. While it is a life-saving procedure, a common complication later in life is failing Fontan physiology which often results in heart transplant, initiation of palliation, or death. Despite regular monitoring of these patients, the underlying mechanisms leading to Fontan failure are poorly understood. Several modes of Fontan failure are hypothesized to be secondary to changes in 3D blood flow dynamics inside the Fontan connection. Current standard-of care imaging methods (echocardiography and 2D phase contrast MRI) capture only 1D hemodynamics and have substantial user variability. 4D flow MRI, a technique pioneered by our lab, was developed to address these challenges, and enable volumetric, 3D velocity measurement over the cardiac cycle. While this technique has been used to study Fontan hemodynamics, among other CHDs, it is not optimal for thorough, life-long monitoring. 4D flow has long, unpredictable scan times which are not amenable to small children requiring anesthesia during cardiac MRI studies. Additionally, 4D flow has a limited velocity dynamic range, lacks flexible reconstruction for different temporal and spatial resolution, and does not capture respiratory driven flow, a hemodynamic feature known to be important in the Fontan connection. To address these limitations, we have developed a method termed 5D flow MRI, a free-running technique with flexible, compressed sensing reconstruction that captures 3D velocities along the cardiac and respiratory cycles. The first aim of this proposal is to develop an under 10 minutes dual-velocity encode (venc) 5D flow method along with a streamlined processing and analysis pipeline. This will enable accurate, simultaneous measurement of flow in veins and arteries while remaining sufficiently short for patients requiring general anesthesia. The second aim of this proposal is to validate this method and to optimize the reconstruction and acquisition parameters. This will be crucial for understanding the reliability of the metrics compared to clinical standards and to ensure that respiratory resolved flow is accurate. The third aim of this proposal is to apply the developed sequence in a cohort of patients with the Fontan connection. I hypothesize that: 1. Dual-venc 5D flow will be faster and simpler than clinically standard acquisitions, 2. Respiratory resolved flow measurements reveal additional hemodynamic information, 3. Voxel-wise parameters derived from 5D flow, such as respiratory driven peak velocities, correlate with pulmonary vascular resistance, an invasive measurement.

项目摘要/总结 在美国，高达 2% 的活产婴儿患有先天性心脏病 (CHO)。最严重的 CHO 是单心室疾病 (SVD)，婴儿出生时只有一个功能充分的心室。 SVD 通常需要进行一系列手术，并通过 Fontan 手术完成。这导致循环绕过右心驱动的肺循环，而是将全身静脉直接回流至肺动脉。虽然这是一种挽救生命的手术，但晚年常见的并发症是 Fontan 生理功能衰竭，这通常会导致心脏移植、开始姑息治疗或死亡。尽管对这些患者进行定期监测，但导致 Fontan 失败的潜在机制仍知之甚少。 假设 Fontan 失败的几种模式是继发于 Fontan 连接内部 3D 血流动力学变化的。当前的标准护理成像方法（超声心动图和 2D 相差 MRI）仅捕获 1D 血流动力学，并且具有很大的用户可变性。 4D 血流 MRI 是我们实验室首创的技术，旨在解决这些挑战，并能够在心动周期内进行体积 3D 速度测量。虽然该技术已用于研究 Fontan 血流动力学以及其他先心病，但它并不是彻底、终身监测的最佳选择。 4D 血流扫描时间长且不可预测，不适合在心脏 MRI 研究期间需要麻醉的小孩。此外，4D 流的速度动态范围有限，缺乏针对不同时间和空间分辨率的灵活重建，并且无法捕获呼吸驱动流（已知在 Fontan 连接中很重要的血流动力学特征）。为了解决这些限制，我们开发了一种称为 5D 流 MRI 的方法，这是一种具有灵活的压缩传感重建功能的自由运行技术，可捕获心脏和呼吸周期的 3D 速度。 该提案的第一个目标是开发一种 10 分钟内的双速编码 (venc) 5D 流方法以及简化的处理和分析管道。这将能够准确、同步地测量静脉和动脉的流量，同时为需要全身麻醉的患者保持足够短的时间。该提案的第二个目的是验证该方法并优化重建和采集参数。这对于了解指标与临床标准相比的可靠性以及确保呼吸解析流量的准确性至关重要。该提案的第三个目标是将开发的序列应用于一组具有 Fontan 连接的患者。我假设：1. Dual-venc 5D 流量将比临床标准采集更快、更简单，2. 呼吸解析流量测量揭示额外的血流动力学信息，3. 从 5D 流量导出的体素参数，例如呼吸驱动的峰值速度，与肺血管阻力（一种侵入性测量）相关。