Rapid Pediatric Cardiovascular MRI without Contrast Agent or Anesthesia

无需造影剂或麻醉的快速儿童心血管 MRI

• 批准号: 9308233
• 负责人: Daniel Kim
• 金额: $ 24.12万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-10 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9308233
• 关键词: Accounting; Adopted; Agreement; Algorithms; Anatomy; Anesthesia procedures; Benchmarking; Blood Vessels; Brain; Breathing; Caliber; Cardiac; Cardiovascular system; Chicago; Child; Childhood; Clinical; Clinical Research; Congenital Abnormality; Contrast Media; Data; Deposition; Development; Diagnostic; Diagnostic tests; Disease Progression; EFRAC; Echocardiography; Evaluation; Freezing; Future; Gadolinium; General Anesthesia; Health; Health Care Costs; Heart; Image; Intervention; Ionizing radiation; Kidney; Live Birth; MRI Scans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Medicine; Methods; Monitor; Morphologic artifacts; Morphology; Motion; Noise; Palliative Surgery; Parents; Patients; Pediatric Hospitals; Performance; Physiologic pulse; Physiological; Population; Protocols documentation; Radial; Reader; Reporting; Research; Resources; Risk; Risk stratification; Safety; Sampling; Scanning; Side; Slice; Surveys; Technology; Testing; Time; Universities; X-Ray Computed Tomography; base; cardiovascular imaging; cardiovascular visualization; clinical practice; clinical translation; compare effectiveness; congenital heart disorder; cost; design; financial incentive; high reward; high risk; imaging modality; innovation; insight; interest; new technology; outcome prediction; pediatric patients; reconstruction; respiratory; response; satisfaction; standard of care; success; temporal measurement; tool

Project Summary/Abstract: Congenital heart disease (CHD) is the most common type of birth defect, accounting for nearly 1% of live births in the US. Even after corrective or palliative surgeries and/or interventions, frequent monitoring, including imaging, is necessary during childhood and beyond. Cardiovascular MRI is an excellent diagnostic tool for children with CHD. MRI offers a clear advantage over computed tomography because it does not involve ionizing radiation. MRI provides clearer visualization of cardiovascular anatomy than echocardiography. Despite these advantages over other imaging modalities, MRI accounts for only 2% of pediatric cardiac diagnostic tests. This underutilization is due to long scan times (typically 60-90 min) and requisite administration of a gadolinium-based contrast agent (GBCA) and general anesthesia (GA), both of which add health risk and healthcare cost. In direct response, we will develop and evaluate rapid cardiovascular MRI and magnetic resonance angiography (MRA) methods that do not require GA or GBCA administration. The scientific premise of this proposal is based on cutting-edge undersampling strategies such as compressed sensing (CS), radial k-space sampling, and simultaneous multi-slice (SMS) excitation which are well-suited for accelerating cardiovascular MRI and MRA pulse sequences. We will synergistically combine these undersampling strategies to develop 2D dynamic MRI methods that “freeze” physiologic and patient motion and 3D MRA methods with self-navigation of respiratory motion. The specific objectives of this application are: (1) to develop rapid image acquisition and reconstruction methods that will be integrated into a single protocol for imaging pediatric patients without GA or GBCA administration and (2) to test whether a 15-min protocol (objective 1) produces high diagnostic performance in patients with CHD. This study leverages extensive clinical and research resources existing at Ann & Robert H. Lurie Children’s Hospital of Chicago (~1,000 cardiovascular MRI scans per year) and Northwestern University (cardiovascular imaging research). A rapid, free-breathing MRI protocol is a major step forward in MRI technology, because it has the potential to eliminate GA and GBCA administration, while dramatically increasing scan efficiency. Elimination of GA and GBCA administration will reduce associated risks, as well as healthcare costs, and thereby generate greater interest in referring pediatric patients for “safer” cardiovascular MRI. A faster scan will reduce operational cost and provide a financial incentive for imaging centers to adopt cardiovascular MRI into clinical practice. This R21 application is designed to yield preliminary data needed to pursue a future R01 application aimed at comparing the effectiveness between our new (fast, no GA, no GBCA) and standard-of- care (slow, GA, GBCA) cardiovascular MRI protocols in a diverse pediatric population.

项目摘要/摘要：先天性心脏病（CHD）是最常见的出生缺陷类型， 即使在进行矫正或姑息手术和/或之后，仍占美国活产的近 1%。 儿童期及以后的干预措施、频繁监测（包括影像学检查）是必要的。 与 MRI 相比，心血管 MRI 是一种出色的儿童先心病诊断工具。 计算机断层扫描，因为它不涉及电离辐射，可以提供更清晰的可视化。 尽管 MRI 比其他成像方式有这些优势，但心血管解剖学优于超声心动图。 仅占儿科心脏诊断测试的 2%，这种未充分利用的原因是扫描时间较长。 （通常 60-90 分钟）和必要的钆基造影剂 (GBCA) 管理以及一般 麻醉（GA），这两者都会增加健康风险和医疗成本作为直接应对措施，我们将开发和实施。 评估不需要的快速心血管 MRI 和磁共振血管造影 (MRA) 方法 GA 或 GBCA 管理。 该提案的科学前提是基于尖端的欠采样策略，例如压缩 传感 (CS)、径向 k 空间采样和同步多层 (SMS) 激励，非常适合 加速心血管 MRI 和 MRA 脉冲序列 我们将协同地将这些结合起来。 欠采样策略开发“冻结”生理和患者运动的 2D 动态 MRI 方法 以及具有呼吸运动自导航功能的 3D MRA 方法 该应用的具体目标是： (1) 开发将集成到单一协议中的快速图像采集和重建方法 用于对未给予 GA 或 GBCA 的儿科患者进行成像，以及 (2) 测试 15 分钟方案是否有效 （目标 1）对 CHD 患者具有较高的诊断性能。 这项研究利用了 Ann & Robert H. Lurie Children's 现有的广泛临床和研究资源 芝加哥医院（每年约 1,000 次心血管 MRI 扫描）和西北大学（心血管 快速、自由呼吸的 MRI 方案是 MRI 技术的一大进步，因为它 有可能消除 GA 和 GBCA 管理，同时显着提高扫描效率。 取消 GA 和 GBCA 管理将降低相关风险以及医疗费用，并且 扫描速度更快，因此对转诊儿科患者进行“更安全”的心血管 MRI 产生了更大的兴趣。 降低运营成本，并为成像中心采用心血管 MRI 提供经济激励 该 R21 应用程序旨在产生追求未来 R01 所需的初步数据。 应用程序旨在比较我们的新（快速、无 GA、无 GBCA）和标准之间的有效性 不同儿科人群的护理（慢速、GA、GBCA）心血管 MRI 方案。