Quantitative Susceptibility Mapping for Stroke Risk Prediction of Vulnerable Carotid Plaques

用于预测易损颈动脉斑块中风风险的定量敏感性图

• 批准号: 10609912
• 负责人: Ajay Gupta
• 金额: $ 68.9万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-15 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10609912
• 关键词: Age; Algorithms; Area; Arterial Fatty Streak; Blood; Blood Vessels; Carotid Artery Plaques; Carotid Endarterectomy; Carotid Stenosis; Carotid stent; Cephalic; Clinical; Contrast Media; Data; Detection; Development; Diagnosis; Discrimination; Embolism; Erythrocytes; Evaluation; Extravasation; Fingerprint; Hemoglobin; Hemorrhage; Hemosiderin; Histology; Histopathology; Image; Imaging Device; Individual; Inflammation; Ipsilateral; Iron; Ischemic Stroke; Lead; Magnetic Resonance Imaging; Magnetism; Maps; Measures; Medical; Methemoglobin; Motion; Noise; Outcome; Outcomes Research; Oxidative Stress; Patients; Phase; Physiologic pulse; Predisposition; Property; Protocols documentation; ROC Curve; Reproducibility; Research; Risk; Risk Factors; Rupture; Sampling; Scanning; Schedule; Signal Induction; Stenosis; Stroke; Stroke prevention; Testing; Thrombus; Time; Tissues; Vascular Diseases; Vascularization; X-Ray Computed Tomography; calcification; cell injury; clinical imaging; clinical risk; diagnostic accuracy; efficacy evaluation; ex vivo imaging; experience; high risk; image reconstruction; imaging modality; improved; in vivo imaging; non-invasive imaging; novel strategies; patient stratification; personalized medicine; reconstruction; risk prediction; risk stratification; secondary outcome; stroke risk; superparamagnetism; thromboembolic stroke

Our main objective is to use quantitative susceptibility mapping (QSM) in establishing reliable noninvasive MRI for identification and risk stratification of unstable carotid atherosclerotic plaques. Currently, decisions about carotid revascularization to prevent stroke, such as carotid endarterectomy or carotid artery stenting, are based on whether there is ?50% carotid artery stenosis. However, this strategy uses only one feature of vulnerable plaque and frequently misclassifies patients. Using imaging to identify other features of rupture-prone carotid plaques with high risk for thromboembolic stroke, in combination with stenosis assessment, proves to be a more effective approach for risk evaluation. Of these features, intraplaque hemorrhage (IPH) is associated with a 4 to 6-fold higher risk of stroke, while calcification is associated with a 50% lower stroke risk. In the conventional approach, IPH and calcification are defined as hyperintensity and hypointensity, respectively, in a plaque region on the T1-weighted (T1w) image acquired as part of the multi-contrast MRI (mcMRI) protocol. However, T1w hyperintensity only captures the transient methemoglobin phase of hemorrhage. In the ensuing hemosiderin phase, IPH appears hypointense due to the strong susceptibility-induced dephasing effects of the superparamagnetic hemosiderin (susceptibility>150 ppm), which can be misinterpreted as calcification, although calcification is strongly diamagnetic (-2.3 ppm). The key scientific premise of this proposal is that QSM can reliably resolve T1w hypointensity into IPH hemosiderin versus calcification based on their different magnetic property, and therefore will significantly improve imaging characterization and risk stratification of patients with atherosclerotic carotid plaques. We have pioneered QSM development and demonstrated the exquisite sensitivity of QSM for hemorrhage and calcification in carotid plaque. In this project, we will further improve the utility of carotid plaque QSM for routine clinical imaging by developing a multi-contrast QSM (mcQSM) approach which can provide not only QSM but also traditional mcMRI contrasts in 5 min scan time. We will develop a nonlinear QSM reconstruction algorithm which is robust against noise and motion and can separate co-existing IPH and calcification to improve IPH detection in calcified vessels. We will then establish the improvement in diagnostic accuracy of mcQSM over mcMRI for detecting IPH and calcification in patients who are scheduled for carotid endarterectomy. Finally, we will test the hypothesis that mcQSM will provide significantly higher discrimination for stroke than mcMRI. A successful outcome of this proposal will make carotid plaque QSM ready for widespread and routine clinical use in the emerging era of personalized medicine to reduce the individual and societal burden of stroke.

我们的主要目标是使用定量易感映射（QSM）来建立可靠的无创MRI 用于识别和风险分层不稳定的颈动脉粥样硬化斑块。目前，关于决定 颈动脉血运重建以防止中风，例如颈动脉内膜切除术或颈动脉支架，是基于 关于是否有50％颈动脉狭窄。但是，此策略仅使用脆弱的一个功能 斑块和经常误导患者。使用成像来识别可破裂的其他颈动脉的其他功能 结合狭窄评估的血栓栓塞中风风险高的斑块被证明是 更有效的风险评估方法。在这些功能中，内部出血（IPH）与 中风风险高4至6倍，而钙化则与中风风险降低50％有关。在 常规方法，IPH和钙化分别定义为高强度和高压 T1加权（T1W）图像上的斑块区域作为多对比度MRI（MCMRI）方案的一部分获得。 然而，T1W高强度仅捕获出血的瞬时高铁蛋白相。随后 铁皮素期，IPH由于强烈的敏感性引起的脱落作用而显得低位 超顺磁性敏感性（敏感性> 150 ppm），可以误解为钙化， 尽管钙化是强烈的磁性（-2.3 ppm）。该提议的主要科学前提是 QSM可以根据其不同 磁性特性，因此将显着改善成像表征和风险分层 动脉粥样硬化颈动脉斑块的患者。我们已经开创了QSM的开发，并证明了 QSM对颈动脉斑块中出血和钙化的灵敏度。在这个项目中，我们将进一步 通过开发多对比度QSM来改善颈动脉斑块QSM进行常规临床成像的实用性 （MCQSM）方法不仅可以提供QSM，还可以在5分钟扫描时间内提供传统的MCMRI对比。 我们将开发一种非线性QSM重建算法，该算法可抵抗噪声和运动，并且可以 单独的共存IPH和钙化以改善钙化血管中的IPH检测。然后我们将建立 MCQSM比MCMRI的诊断准确性提高了患者的IPH和钙化 计划进行颈动脉内膜切除术。最后，我们将测试MCQSM提供的假设 中风的歧视明显高于MCMRI。该提议的成功结果将做出 颈动脉斑块QSM准备在新兴的个性化时代进行广泛和常规的临床用途 减少中风的个体和社会负担的医学。