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

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.

项目概要/摘要 主动脉夹层（AD）是一种以主动脉壁内层突然撕裂为特征的疾病 引导主动脉血流的假腔 (FL)。绝大多数急性 AD 患者存活下来后进入慢性期 阶段，尽管长期结果很差，大约 50% 的患者经历主动脉相关死亡或 需要10年进行手术修复。导致长期结果不佳的一个主要原因是 FL 的生长。胸椎 主动脉腔内修复术 (TEVAR) 是一种微创手术疗法，可以阻止 FL 生长并减少 AD 死亡率；然而，这种治疗方法会带来成本、手术并发症的风险，并且效果较差 由于组织硬度增加而需要时间。早期疾病轨迹的准确预测受到以下因素的限制： 目前的指标，但非常理想，因为这将使 TEVAR 能够及时针对高风险患者 方式，使那些风险较低的人免受潜在不必要的手术的影响。目前的估计方法 AD 的风险主要基于解剖指标（例如主动脉直径），而这些指标很难捕捉到功能方面的信息 公元。为了克服这些限制，我们建议应用先进的成像技术，即 4D Flow 磁共振成像 (MRI) 和 4D 计算机断层扫描血管造影 (CTA)，以表征和 量化 FL 压力和 FL 壁刚度等功能过程，这些过程无法使用当前的成像方法 并被认为是预测 AD 长期行为的重要因素。我们假设 与其他功能指标相比，对这些功能指标的评估将改善我们对假腔增长率 (FLGR) 的预测 符合标准解剖学指标。我们计划前瞻性招募无并发症的 B 型患者 (n=30) 或经手术修复的 A 型 (n=45) 主动脉夹层，在以下区域接受基线 4D Flow 和 4D CTA 成像 亚急性期（解剖后 1-3 个月）以及解剖后 1 年和 2 年的后续研究， 主要结果是 FLGR。为了实现这些目标，本提案的目标是： 1) 确定基线 AD 亚急性期的血流动力学和生物力学指标可预测 FL 随着时间的推移的增长率。 FL 压力将通过 4D Flow MRI 使用基于物理图像的间接和直接方法进行量化 分析，通过将 FL 压力与周期性主动脉壁变形相结合来量化区域 FL 壁刚度 4D CT； 2) 确定功能指标随时间的变化轨迹，以最好地预测 FL 的渐进增长。 基线与 1 年和 2 年随访扫描之间压力和壁刚度的纵向变化将 进行评估以确定达到新平衡的患者与继续进展的患者； 3）开发 一种临床评估工具，可结合功能指标、解剖学指标来预测进行性 FL 生长的风险 参数和患者特征，重点关注特定解剖类型的简单性和准确性 在尽可能早的时间点预测 FLGR。这项工作旨在改变 AD 评估的范式 从纯粹的解剖学表征到整合功能成像生物标志物以提供准确的预测 疾病轨迹并允许最佳确定手术候选资格和时机。

项目成果

lGeneralized super-resolution 4D Flow MRI-using ensemble learning to extend across the cardiovascular system.

l 广义超分辨率 4D Flow MRI - 使用集成学习扩展到整个心血管系统。

• 发表时间: 2023-11-21
• 作者: Ericsson, Leon;Hjalmarsson, Adam;Akbar, Muhammad Usman;Ferdian, Edward;Bonini, Mia;Hardy, Brandon;Schollenberger, Jonas;Aristova, Maria;Winter, Patrick;Burris, Nicholas;Fyrdahl, Alexander;Sigfridsson, Andreas;Schnell, Susanne;Figueroa, C Albe
• 通讯作者: Figueroa, C Albe