Multi-parametric quantitative MRI for assessment of pancreas health in children

多参数定量 MRI 评估儿童胰腺健康

• 批准号: 10708779
• 负责人: Andrew Timothy Trout
• 金额: $ 66.27万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-26 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10708779
• 关键词: 3-Dimensional; Acute; Anesthesia procedures; Atrophic; Benchmarking; Blood Glucose; Child; Childhood; Data; Detection; Development; Diagnosis; Diagnostic; Digestion; Disease; Early Diagnosis; Early Intervention; Early identification; Elastases; Endocrine; Endoscopy; Enzymes; Exocrine pancreas; Exocrine pancreatic insufficiency; Failure; Fasting; Feces; Fibrosis; Fluids and Secretions; Future; Glycosylated hemoglobin A; Growth; Health; Human; Image; Incidence; Intravenous; Laboratories; Link; Liquid substance; Magnetic Resonance Imaging; Malabsorption Syndromes; Malnutrition; Manuals; Maps; Measurement; Measures; Modeling; Normal Range; Osteoporosis; Pancreas; Pancreatic Diseases; Pancreatic Function Tests; Pancreatic enzyme; Pancreatitis; Participant; Pathology; Patients; Performance; Procedures; Protocols documentation; Recording of previous events; Recurrence; Reference Standards; Relaxation; Scanning; Serum; Signal Transduction; Staging; Standardization; Structure; Techniques; Testing; Time; Tissues; accurate diagnosis; acute pancreatitis; chronic pancreatitis; clinical decision-making; decision research; diagnostic criteria; effective intervention; gastrointestinal; imaging modality; improved; magnetic resonance imaging biomarker; non-invasive imaging; noninvasive diagnosis; novel; nutrition; pancreatic juice; recruit; response

Exocrine pancreatic insufficiency (EPI) occurs when the pancreas is unable to secrete enzymes and fluids adequate for digestion. Acute recurrent (ARP) and chronic pancreatitis (CP) are increasingly recognized in children and are an increasingly important cause of EPI. EPI results in malabsorption which can lead to malnutrition and growth failure in children. If EPI can be recognized or even predicted, its deleterious effects can be reversed with pancreatic enzyme replacement. Accepted diagnostic criteria for CP rely on subjective imaging findings which are limited by interobserver disagreement and accurate, non-invasive diagnosis of EPI is challenging, if not impossible. Currently diagnosis of EPI requires invasive testing in the form of endoscopy under anesthesia (ePFTs). Thus, there is an unmet need for validated, non-invasive measures of pancreatic health and function in children. Quantitative MRI techniques, including MR pancreatic function testing (MR-PFTs), pancreas parenchymal volume, and parenchymal signal mapping are showing promise as non-invasive markers of pancreatic health and function. The overall aim of this study is to define associations between non-invasive, non-contrast, quantitative MRI measures and established measures of pancreas health and function (including EPI diagnosed by a reference standard of endoscopic PFTs [ePFTs]) in children. We propose to test multiple non-invasive, non-contrast, quantitative MRI techniques for their ability to identify EPI and stage pancreatitis (acute pancreatitis to ARP to CP) in children. Our central hypothesis is that the quantitative MRI techniques under study will have diagnostic performance for changes in pancreatic health, allowing detection of EPI and quantification of changes of pancreatitis. Our preliminary studies show that we can successfully apply quantitative MRI techniques, inclusive of MR-PFTs, volumetric imaging, and parenchymal signal mapping in children. We have defined normal values for these MRI measures with preliminary data suggesting that threshold values derived from normal children can non-invasively identify EPI with excellent sensitivity. This application aims to: 1) Evaluate the diagnostic performance of MRI markers for EPI as an indicator of pancreas health in children, 2) Develop processing pipelines for quantitative MRI of the pancreas, and 3) Define quantitative MRI markers that can distinguish stages of pancreatitis and identify early CP. The successful completion of this study will generate unique, valuable data regarding non-invasive staging of pancreatitis and diagnosis of EPI. This study will generate protocols and processing pipelines to facilitate future clinical decision making and research use of MRI as a non-invasive test for EPI and pancreatic disease. Data from this study will set the stage for future studies of non-invasive imaging of pancreatitis and EPI in children.

当胰腺无法分泌酶和液体足以消化时，外分泌胰腺功能不全（EPI）发生。急性复发（ARP）和慢性胰腺炎（CP）在儿童中越来越被识别，并且是EPI的越来越重要的原因。 EPI导致吸收不良，可能导致儿童营养不良和生长衰竭。如果可以识别甚至可以预测EPI，则可以通过胰酶替换来逆转其有害作用。 公认的CP诊断标准依赖于主观成像发现，这些发现受到观察者间分歧和准确，非侵入性诊断EPI的限制，即使不是不可能的，也是具有挑战性的。当前的EPI诊断需要在麻醉（EPFTS）下以内窥镜检查形式进行侵入性测试。因此，对儿童的胰腺健康和功​​能的无侵袭性测量未满足。定量MRI技术，包括MR胰腺功能测试（MR-PFTS），胰腺实质体积和实质信号映射，作为胰腺健康和功​​能的非侵入性标志物显示出希望。这项研究的总体目的是确定儿童中胰腺健康和功​​能的非侵入性，非对比度，定量MRI测量值以及确定的胰腺健康和功​​能的措施（包括通过内窥镜PFTS的参考标准[EPFTS]诊断的EPI）。 我们建议在儿童中测试多种非侵入性，无对解的定量MRI技术，以鉴定EPI和期胰腺炎（急性胰腺炎至ARP至CP）的能力。我们的中心假设是，所研究的定量MRI技术将具有胰腺健康变化的诊断性能，从而可以检测EPI和胰腺炎变化的定量。 我们的初步研究表明，我们可以成功应用定量的MRI技术，包括MR-PFTS，体积成像和儿童的实质映射。我们已经使用初步数据定义了这些MRI度量的正常值，表明从正常儿童中得出的阈值可以非侵入性地识别具有出色灵敏度的EPI。该应用的目的是：1）评估EPI作为儿童胰腺健康的MRI标记的诊断性能，2）开发用于胰腺定量MRI的处理管道，3）定义定量的MRI标记，这些标记可以区分胰腺炎阶段并确定早期CP。 这项研究的成功完成将产生有关胰腺炎非侵入性分期和EPI诊断的独特，有价值的数据。这项研究将生成方案和处理管道，以促进将来的临床决策和研究MRI作为EPI和胰腺疾病的非侵入性测试。这项研究的数据将为未来对儿童胰腺炎和EPI的非侵入性成像的研究奠定了基础。