Rapid Comprehensive Cardiac MRI Exam for Diagnosis of Coronary Artery Disease

快速综合心脏 MRI 检查诊断冠状动脉疾病

• 批准号: 10383694
• 负责人: Mehmet Akcakaya
• 金额: $ 51.04万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-26 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10383694
• 关键词: 3-Dimensional; Acceleration; Accounting; Anatomy; Award; Back; Breathing; Catheters; Cause of Death; Cessation of life; Chest; Chest Pain; Clinical; Coronary; Coronary Angiography; Coronary Arteriosclerosis; Coronary Stenosis; Data; Development; Diagnosis; Diagnostic; Evaluation; Excision; Extravasation; Gadolinium; Gatekeeping; Gold; Healthcare; Heart; Image; Imaging Techniques; Ionizing radiation; Machine Learning; Magnetic Resonance Imaging; Medical Care Costs; Methods; Morphologic artifacts; Myocardial perfusion; Noise; Patients; Perfusion; Physiological; Preparation; Procedures; Property; Resolution; Risk; Roentgen Rays; Sampling; Scanning; Scheme; Signal Transduction; Slice; Source; Symptoms; Techniques; Testing; Time; United States; Work; absorption; accurate diagnosis; artificial neural network; base; cardiac magnetic resonance imaging; clinical translation; cohort; cost; diagnosis standard; diagnostic tool; disease diagnosis; heart function; high resolution imaging; imaging modality; improved; non-invasive imaging; noninvasive diagnosis; novel; prevent; rapid technique; reconstruction; temporal measurement; tool

PROJECT SUMMARY/ABSTRACT Coronary artery disease (CAD) is the leading cause of death in the United States. The clinical gold standards to diagnose and guide treatment of patients with CAD are based on invasive catheter-based procedures, such as x-ray coronary angiography (XCA) for anatomic assessment or fractional flow reserve (FFR) for physiologic assessment. However, there are costs and risks associated with such invasive procedures. Such concerns are further highlighted by the fact that large studies have shown nearly two-thirds of patients referred for their initial elective invasive XCA were found to have no significant stenoses. Thus, better non-invasive diagnostic tools are needed. Cardiac MRI (CMR) is the only non-invasive imaging modality that provides a comprehensive assessment of CAD in a single examination, including an assessment of myocardial perfusion, cardiac function and viability, as well as angiographic evaluation of stenoses, without requiring ionizing radiation. These properties also allow for repeat testing as may be clinically indicated. However, despite its great potential to serve as the non- invasive gatekeeper for costly invasive procedures, lengthy examination times have prevented CMR from clinical translation. Although several accelerated imaging techniques have been proposed, these still require trade-offs between coverage, resolution and signal-to-noise ratio. In this proposal, we will develop and validate novel acquisition and reconstruction strategies to enable a highly accelerated high-resolution whole heart CMR exam for comprehensive CAD assessment in under 10 minutes. We will develop fast and low specific absorption rate outer volume suppression modules to reduce the source of aliasing artifacts from the chest and the back. This will enable higher rates for simultaneous multi-slice imaging in perfusion and cine CMR, improving coverage substantially with minimal noise amplification. For coronary MRI and viability imaging, simultaneous multi-slab imaging will be introduced to CMR, facilitating high isotropic resolution acquisitions with fast coverage. These acquisitions will be supplemented with regularized leakage-blocking and patient- specific machine learning reconstructions for further artifact and noise removal. Finally, we will implement and validate the proposed rapid comprehensive CMR exam in a cohort of suspected CAD patients, comparing our approach with conventional clinical CMR for the assessment of function, perfusion, and viability, and with invasive XCA for the assessment of coronary stenosis. Successful completion of this project has the potential to transform CMR into a leading rapid non-invasive tool for safe and accurate diagnosis of CAD, improving the healthcare of several million patients with chest pain and other CAD symptoms annually.

项目摘要/摘要 冠状动脉疾病（CAD）是美国死亡的主要原因。临床金标准 为了诊断和指导CAD患者的治疗是基于侵入性导管的程序，例如 作为解剖学评估或分数流量储备（FFR）的X射线冠状动脉造影（XCA） 评估。但是，这种侵入性程序存在成本和风险。这样的担忧是 进一步强调了这一事实，大型研究表明，将近三分之二的患者参考了他们的初始研究 发现攻击性的XCA没有明显的促进性。因此，更好的非侵入性诊断工具 需要。 心脏MRI（CMR）是唯一的非侵入性成像方式，可全面评估 一次检查中的CAD，包括评估心肌灌注，心脏功能和生存能力， 以及对狭窄的血管造影评估，而无需电离辐射。这些属性也允许 对于可能在临床上可能表明的重复测试。然而，尽管它有很大的潜力作为非 侵入性的看门人用于昂贵的侵入性程序，冗长的检查时间阻止了CMR 临床翻译。尽管已经提出了几种加速成像技术，但这些技术仍然需要 覆盖范围，分辨率和信噪比之间的权衡。在此提案中，我们将开发和验证 新颖的获取和重建策略，以实现高度加速的高分辨率全心CMR 考试在10分钟内进行全面的CAD评估。我们将发展快速，低特异性 吸收速率外体积抑制模块，以减少胸部和异叠伪影的来源 背面。这将使在灌注和Cine CMR中同时进行多切片成像的速率更高， 通过最小的噪声扩增，可以大大改善覆盖范围。对于冠状动脉MRI和可行性成像， 同时将引入CMR，同时引入高各向同性的分辨率采集 具有快速覆盖范围。这些收购将补充正规泄漏阻塞和患者 - 特定的机器学习重建，用于进一步的人工制品和降噪。最后，我们将实施并 在可疑的CAD患者队列中验证拟议的快速综合CMR考试，与我们的 与常规临床CMR接近功能，灌注和生存力的评估 侵入性XCA评估冠状动脉狭窄。成功完成该项目有潜力 将CMR转变为领先的快速非侵入性工具，以安全，准确地诊断CAD，从而改善 每年有数百万胸痛和其他CAD症状的患者的医疗保健。