Noninvasive measurement of oxygenation using quantitative susceptibility mapping (supplement)

使用定量磁化率图无创测量氧合（补充）

• 批准号: 10864405
• 负责人: Pascal Spincemaille
• 金额: $ 70.03万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10864405
• 关键词: Acceleration; Automation; Blood; Calcium; Cardiac; Catheterization; Cessation of life; Clinical; Clip; Congestive Heart Failure; Data; Decision Making; Development; Diagnosis; Disease; Failure; Fibrosis; Geometry; Goals; Heart; Heart failure; Individual; Ionizing radiation; Link; Magnetic Resonance Imaging; Magnetism; Manuals; Maps; Measurement; Measures; Methods; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Prolapse; Modality; Morbidity - disease rate; Myocardium; Operative Surgical Procedures; Outcome; Outcomes Research; Patient-Focused Outcomes; Patients; Phase; Physiological; Prediction of Response to Therapy; Predisposition; Prognosis; Pulmonary Hypertension; Radiation exposure; Recurrence; Reference Standards; Research; Resolution; Risk; Scanning; Severities; Shapes; Signal Transduction; Structure; Techniques; Testing; Therapeutic; Treatment outcome; United States; Validation; calcification; cardiac magnetic resonance imaging; cohort; implantable device; improved; improved outcome; insight; machine learning algorithm; magnetic field; mitral valve replacement; mortality; non-compliance; parent project; predicting response; prognostic; repair strategy; repaired; response; risk stratification; success; tool; treatment optimization; treatment response; ultrasound

PROJECT SUMMARY/ABSTRACT The goal of this research is to develop and validate cardiac quantitative susceptibility mapping (QSM) for the assessment of mitral annular calcification severity, towards the long-term objective of improving prediction of therapeutic response, therapeutic decision-making and clinical outcomes for patients with mitral valve prolapse (MVP). MVP occurs in over 7 million individuals in the United States and over 170 million worldwide. It is a leading cause of degenerative mitral regurgitation (DMR) which represents the most frequent form of mitral regurgitation (MR) requiring surgery. Percutaneous (mitral valve clip placement) or surgical (mitral valve repair) treatment can reduce MR, thus avoiding harmful untreated regurgitation or mitral valve replacement (MVR). However, MR recurs in 10-30% of patients, which impacts prognosis and increases risk for congestive heart failure and death. It is therefore critical to have early predictors of therapeutic success to optimize treatments and improve outcomes for patients with MVP. Mitral annular calcium (MAC) is one such key predictor of response to surgical and percutaneous repair in patients with MVP. MAC is known to decrease surgical treatment success and to increase morbidity and mortality. MAC is currently diagnosed using ultrasound (echo), which lacks quantitation, or CT, which exposes the patient to ionizing radiation and is not capable of measuring other predictors such as fibrosis or directly assessing MR itself. Cardiac MRI (CMRI) can measures these predictors but is currently incapable of quantifying MAC – thus limiting the utility of this powerful modality for assessment of physiologic determinants of MR and its response to therapy. Nevertheless, calcification has a strong effect on the MR signal due to its strong diamagnetic susceptibility, which significantly modifies the magnetic at and round the MAC. While severe MAC can be qualitatively detected using the resulting low magnitude signal, it is less sensitive at mild or moderate MAC levels and is not quantitative. QSM – an MRI technique pioneered by our group – is able to directly measure susceptibility and thus calcium content. We have obtained encouraging preliminary data showing the feasibility of using cardiac QSM to detect MAC and have shown preliminary validation of this method against cardiac CT reference. In this proposal, we propose to develop cardiac QSM acquisition and processing methods and perform its validation among a cohort of MVP patients through the following Specific Aims. (1) We will compare conventional to accelerated QSM for quantification of MAC among patients with MVP undergoing percutaneous or surgical repair. (2) We will develop and validate a fully automated machine learning algorithm to quantify MAC. (3) We will test whether QSM independently predicts therapeutic response to mitral valve repair. The expected outcome of this research is a non-invasive MRI based method to measure mitral annulus calcification severity, which is a key predictor of success of percutaneous or surgical treatment for mitral valve prolapse. Cardiac QSM holds broad significance towards the goal of therapeutic optimization for valvular disease.

项目摘要/摘要 这项研究的目的是开发和验证心脏定量易感映射（QSM） 评估二尖一环计算严重程度，以提高预测的长期目标 二尖瓣脱垂患者的治疗反应，治疗决策和临床结果 （MVP）。 MVP发生在美国超过700万人，全球超过1.7亿。是一个 退化二尖瓣反流（DMR）的主要原因，代表最常见的二尖瓣形式 需要手术的反流（MR）。经皮（二尖瓣夹夹放置）或手术（二尖瓣修复） 治疗可以减少MR，从而避免有害未处理的反流或二尖瓣置换（MVR）。 但是，先生在10-30％的患者中复发，这会影响提示并增加充血性心脏的风险 失败和死亡。因此，重要的是要对理论成功的早期预测指标来优化治疗 并改善MVP患者的预后。二尖瓣环钙（MAC）就是这样的关键预测指标 MVP患者的手术和经皮修复。已知MAC可以减少手术治疗成功 并增加发病率和死亡率。 Mac目前使用超声（ECHO）诊断，该超声缺乏 定量或CT，将患者暴露于电离辐射，无法测量其他 预测因素，例如纤维化或直接评估MR本身。心脏MRI（CMRI）可以测量这些预测因子 但是目前无法量化Mac - 因此限制了这种强大方式进行评估的实用性 身体确定MR及其对治疗的反应。然而，钙化对 MR信号由于其强大的磁化敏感性而引起 Mac。虽然可以使用由此产生的低幅度信号来定性地检测到严重的MAC，但较少 在轻度或中等MAC水平上敏感，不是定量的。 QSM - 我们的MRI技术由我们的 组 - 能够直接测量敏感性，从而钙化钙含量。我们得到了令人鼓舞的 初步数据，显示使用心脏QSM检测MAC的可行性并显示了初步 通过心脏CT参考验证此方法。在此提案中，我们建议开发心脏QSM 采集和处理方法并通过MVP患者进行验证 遵循特定目标。 （1）我们将比较常规的QSM，以量化Mac MVP患者接受经皮或手术修复。 （2）我们将开发并验证完全自动化的 机器学习算法以量化Mac。 （3）我们将测试QSM是否独立预测治疗。 对二尖瓣修复的响应。这项研究的预期结果是一种基于侵入性MRI的方法 测量二尖瓣钙化严重程度，这是经皮或外科手术成功的关键预测指标 二尖瓣脱垂的处理。心脏QSM对治疗目标具有广泛的意义 瓣膜疾病的优化。