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.

当胰腺无法分泌足够消化的酶和液体时，就会发生胰腺外分泌功能不全（EPI）。急性复发性 (ARP) 和慢性胰腺炎 (CP) 在儿童中的发病率越来越高，并且是 EPI 的一个日益重要的病因。 EPI 会导致吸收不良，从而导致儿童营养不良和生长障碍。如果可以识别甚至预测 EPI，则可以通过胰酶替代来逆转其有害影响。 公认的 CP 诊断标准依赖于主观影像学结果，而主观影像学结果受到观察者间分歧的限制，并且准确、非侵入性的 EPI 诊断即使不是不可能，也是具有挑战性的。目前 EPI 的诊断需要麻醉下内窥镜检查 (ePFT) 形式的侵入性检测。因此，对儿童胰腺健康和功​​能的有效、非侵入性测量的需求尚未得到满足。定量 MRI 技术，包括 MR 胰腺功能测试 (MR-PFT)、胰腺实质体积和实质信号图谱，显示出作为胰腺健康和功​​能的非侵入性标记物的前景。本研究的总体目标是确定儿童非侵入性、非对比、定量 MRI 测量与既定的胰腺健康和功​​能测量（包括通过内镜 PFT [ePFT] 参考标准诊断的 EPI）之间的关联。 我们建议测试多种非侵入性、非对比、定量 MRI 技术，以确定其识别儿童 EPI 和分期胰腺炎（急性胰腺炎到 ARP 到 CP）的能力。我们的中心假设是，正在研究的定量 MRI 技术将对胰腺健康变化具有诊断性能，从而能够检测 EPI 并量化胰腺炎的变化。 我们的初步研究表明，我们可以成功地在儿童中应用定量 MRI 技术，包括 MR-PFT、体积成像和实质信号映射。我们已经为这些 MRI 测量值定义了正常值，初步数据表明源自正常儿童的阈值可以非侵入性地识别 EPI，并且具有出色的灵敏度。该应用的目的是：1) 评估 EPI MRI 标记物作为儿童胰腺健康指标的诊断性能，2) 开发胰腺定量 MRI 的处理流程，以及 3) 定义可区分胰腺炎阶段的定量 MRI 标记物并识别早期 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。这项研究将生成协议和处理流程，以促进未来的临床决策和研究使用 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儿童胰腺炎和 EPI 的无创成像研究奠定基础。