Improved non-invasive MR brain thermometry for therapeutic hypothermia

改进的非侵入性 MR 脑部测温技术用于治疗性低温

• 批准号: 10369657
• 负责人: Candace C. Fleischer
• 金额: $ 23.4万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10369657
• 关键词: Accounting; Address; Adult; Aftercare; Anatomy; Biofeedback; Biological Markers; Body Temperature; Brain; Brain Injuries; Chemicals; Clinical; Consensus; Coupled; Data; Diffusion; Diffusion Magnetic Resonance Imaging; Environment; Evaluation; Fever; Fiber; Frequencies; Goals; Heart Arrest; Heterogeneity; Implant; Injury; Intervention; Ischemia; Ischemic Stroke; Linear Models; Location; Magnetic Resonance; Magnetic Resonance Spectroscopy; Magnetism; Maintenance; Mammals; Measurement; Measures; Medical; Methods; Modeling; Monitor; Morphologic artifacts; N-acetylaspartate; Nervous System Physiology; Operative Surgical Procedures; Patient Monitoring; Patient Selection; Patient-Focused Outcomes; Patients; Phase; Physiologic Thermoregulation; Predisposition; Primates; Prognosis; Protocols documentation; Proxy; Recovery; Regulation; Reporting; Reproducibility; Research; Severities; Standardization; Stroke; Temperature; Therapeutic; Thermometry; Tissue Preservation; Tissues; Trauma; Traumatic Brain Injury; University Hospitals; Variant; Water; base; brain health; clinical implementation; cohort; dosage; gray matter; healthy volunteer; improved; improved outcome; induced hypothermia; injury recovery; magnetic field; mortality; natural hypothermia; neurological recovery; neuroprotection; novel; novel strategies; patient stratification; personalized approach; recruit; tool; treatment response; white matter

Project Summary The importance of brain temperature for neuroprotection and recovery after trauma cannot be understated. Patient outcomes after cardiac arrest and stroke are strongly associated with temperature, where modest increases in body and brain temperatures correlate positively with severity of brain injury and mortality. Conversely, induced hypothermia or cooling is recognized as a therapeutic measure to mitigate further injury of the brain and maximally preserve tissue for recovery after cardiac arrest, stroke, and brain trauma. Therapeutic hypothermia is implemented using core body temperature monitoring and biofeedback, but it is well- established that these measurements are inaccurate and inconsistent proxies of brain temperature. Implanted temperature probes have demonstrated that brain temperature is higher than body temperature and these differences are further exaggerated after injury. As cooling has not been optimized in terms of dosage or patient selection, and patient outcomes after treatment are variable, brain temperature measurements may be a critical yet unexplored aspect of improving and optimizing this promising intervention. Clinical brain thermometry is limited to invasive temperature probes surgically implanted at a single location and is impractical in most patient cohorts. While several magnetic resonance (MR)-based thermometry methods have been proposed and demonstrated in research environments, most are still limited to relative estimations of temperature and are highly vulnerable to tissue heterogeneity-related errors. The overall goal of this R21 Trailblazer proposal is to develop a new approach for MR chemical shift thermometry and, in parallel, characterize brain-body temperature differences in patients during hypothermia treatment. We will develop a tissue-specific approach for MR thermometry, correcting for temperature-independent chemical shifts that introduce errors in absolute measurements (Aim 1). As brain-body temperature decoupling may be an important marker for injury and treatment monitoring, brain thermometry will be implemented in cardiac arrest patients undergoing therapeutic hypothermia to non-invasively measure brain-body temperature differences (Aim 2). We anticipate that these studies will expand our understanding of brain thermoregulation and neuroprotection during therapeutic hypothermia and provide a crucial first step towards a personalized approach to temperature management.

项目概要 脑温度对于神经保护和创伤后恢复的重要性不可低估。 心脏骤停和中风后的患者结局与温度密切相关，其中适度 身体和大脑温度的升高与脑损伤的严重程度和死亡率呈正相关。 相反，诱导低温或冷却被认为是减轻进一步损伤的治疗措施。 大脑并最大限度地保存组织以供心脏骤停、中风和脑外伤后的恢复。治疗性 低温治疗是通过核心体温监测和生物反馈来实现的，但效果很好 确定这些测量值是不准确且不一致的大脑温度替代值。植入 温度探针已证明大脑温度高于体温，并且这些 受伤后差异会进一步放大。由于冷却在剂量或剂量方面尚未优化 患者的选择和治疗后的患者结果是可变的，脑温度测量可能会变化 改进和优化这一有前途的干预措施的一个关键但尚未探索的方面。临床脑 测温仅限于通过手术植入单个位置的侵入式温度探头，并且 对于大多数患者群体来说是不切实际的。虽然几种基于磁共振 (MR) 的测温方法已经 虽然已在研究环境中提出并论证，但大多数仍仅限于相对估计 温度并且极易受到组织异质性相关错误的影响。此次R21的总体目标 Trailblazer 的提案是开发一种新的 MR 化学位移测温方法，同时， 表征低温治疗期间患者脑-体温差异的特征。我们将开发一个 MR测温的组织特异性方法，校正与温度无关的化学位移 引入绝对测量误差（目标 1）。由于脑-体温解耦可能是 损伤和治疗监测的重要标志，脑部测温将在心脏骤停中实施 接受低温治疗以无创测量脑-体温差异的患者 （目标 2）。我们预计这些研究将扩大我们对大脑温度调节和 低温治疗期间的神经保护，并为个性化治疗提供关键的第一步 温度管理方法。