MR evaluation of macro- and micro-vascularity in diabetic peripheral artery disease

糖尿病外周动脉疾病大血管和微血管的 MR 评估

• 批准号: 10037537
• 负责人: Mitsue Miyazaki
• 金额: $ 50.58万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10037537
• 关键词: 3-Dimensional; Affect; Allergic Reaction; American; Amputation; Angiography; Ankle; Arteries; Atherosclerosis; Blood; Blood Glucose; Blood Vessels; Blood Volume; Blood flow; Breathing; Bypass; Cause of Death; Cessation of life; Clinical; Clinical Protocols; Clinical assessments; Contrast Media; Deposition; Development; Devices; Diabetes Mellitus; Diabetic Foot; Diagnosis; Diagnostic; Diagnostic Imaging; Digital Subtraction Angiography; Distal; Dose; Early Diagnosis; Early treatment; Evaluation; Event; Gadolinium; Glycosylated hemoglobin A; Goals; Gold; Hemoglobin concentration result; Image; Imaging Device; Impairment; Individual; Inferior; Injections; Intermittent Claudication; Iodine; Ionizing radiation; Kidney; Lead; Left; Limb structure; Lower Extremity; Magnetic Resonance Angiography; Measurement; Measures; Metals; Metatarsal bone structure; Methods; Modality; Monitor; Morphologic artifacts; Myocardial Infarction; Operative Surgical Procedures; Outcome; Patients; Performance; Perfusion; Peripheral; Peripheral arterial disease; Population; Predisposition; Quality of life; Radiation exposure; Recovery; Reproducibility; Resolution; Risk; Safety; Sampling; Scanning; Severities; Specificity; Stenosis; Stents; Stroke; Surgeon; Symptoms; Techniques; Time; Tissues; Toes; Translating; United States; Vascular blood supply; age group; cardiovascular risk factor; clinical imaging; cohort; comorbidity; contrast enhanced; diabetic; diabetic patient; diagnostic accuracy; follow-up; foot; imaging biomarker; imaging modality; improved; indexing; innovation; non-diabetic; novel; prevent; side effect; standard of care; tool

Peripheral artery disease (PAD) is an atherosclerotic disease with narrowing blood vessel lumen, and is often associated with diabetes due to elevated blood sugar level. If left untreated, PAD can lead to blockage of vessels, resulting in tissue death and possible amputation of a limb. About 10 million Americans are affected by lower extremity PAD. Among other risks, the risk of PAD is markedly increased among subjects with diabetes, the 7th leading cause of death in the U.S. The rate of ischemic events is higher in diabetic individuals with PAD than in comparable non-diabetic populations. Current tools for diagnosing and monitoring PAD in diabetic patients rely on ankle-brachial index (ABI). However, ABI has a low sensitivity of detecting PAD and may not reveal a large proportion of asymptomatic patients with hidden stenosis of PAD. Currently, CT angiography (CTA) has gained wide acceptance that is preferred by vascular surgeons due to simple, fast, diagnostic and reproducible image quality, and less invasive for detecting PAD. Nevertheless, repeated PAD CTA examinations are not desired from the safety concerns like long ionizing radiation exposure and high dose iodine contrast medium. A safe and robust imaging modality, which can accurately visualize the entire peripheral vasculature, is critically in need. Non-contrast magnetic resonance angiography (NC-MRA), without a Gadolinium contrast injection, non-invasiveness, and non-radiation would be an ideal diagnostic and follow- up tool for diabetic patients with and without PAD. Current NC-MRA techniques permit depiction of entire peripheral vascular imaging; however, there are following limitations in current NC-MRA as compared to CTA: inferior spatial resolution, prolong examination time, non-reproducible diagnostic image quality, artifacts, and limitation in follow-up of PAD patients with surgical devices such as stents and bypass grafts. The project aims to develop an advanced fresh-blood imaging (FBI) for fast, safe, robust, diagnostic, reproducible NC-MRA and an innovative, free-breathing, ungated, non-subtracted NC-MRA technique using 3D ultra-short TE (UTE) for follow up on the patients with surgical devices. In addition, micro-vascularity of diabetic foot will be investigated using a new non-contrast MR perfusion (NC-MRP) technique. This five-year project consists of an initial two- year technical development and optimization, followed by a clinical assessment study that will validate both advanced FBI, 3D UTE, and NC-MRP on diabetic patients with and without PAD regardless of the presence of surgical devices. Our specific aims are as follows: Aim 1A: To develop an advanced FBI with centric ky-kz trajectory with a new exponential refocusing flip angle; Aim 1B: To develop the free-breathing, ungated, non- subtraction 3D UTE NC-MRA technique; Aim 2: To develop the NC-MRP technique to measure micro- vascularity of the foot; and Aim 3: To compare the diagnostic accuracy of advanced FBI and 3D UTE developed in Aims 1 and evaluate micro-vascularity by NC-MRP in Aim 2 on diabetes with or without PAD with CTA/DSA. We will also correlate micro-vascularity measures with various diabetic levels of HbA1c and ABI.

外周动脉疾病（PAD）是一种血管腔狭窄的动脉粥样硬化性疾病，通常是 由于血糖水平升高而与糖尿病有关。如果不及时治疗，PAD 可能会导致 血管，导致组织死亡并可能截肢。约1000万美国人受到影响 通过下肢 PAD。除其他风险外，患有以下疾病的受试者发生 PAD 的风险显着增加： 糖尿病是美国第七大死因。糖尿病患者的缺血事件发生率较高 PAD 患者的患病率高于可比的非糖尿病人群。当前用于诊断和监测 PAD 的工具 糖尿病患者依赖踝臂指数（ABI）。然而，ABI 检测 PAD 的灵敏度较低， 可能无法揭示大部分无症状的 PAD 狭窄患者。目前，CT 血管造影（CTA）因其简单、快速、 具有诊断性和可重复性的图像质量，并且检测 PAD 时侵入性较小。尽管如此，重复PAD 出于长时间电离辐射暴露和高剂量等安全考虑，不需要进行 CTA 检查 碘造影剂。安全可靠的成像方式，可以准确地可视化整个 外周血管系统，急需。非对比磁共振血管造影 (NC-MRA)，无 a 钆造影剂注射、非侵入性和非辐射将是理想的诊断和后续治疗 适用于患有和不患有 PAD 的糖尿病患者的工具。当前的 NC-MRA 技术允许描述整个 周围血管成像；然而，与CTA相比，当前的NC-MRA存在以下局限性： 空间分辨率较差、检查时间延长、诊断图像质量不可重复、伪影和 使用支架和旁路移植物等手术装置对 PAD 患者进行随访的局限性。该项目的目标 开发先进的新鲜血液成像 (FBI)，用于快速、安全、稳健、诊断、可重复的 NC-MRA 和 一种创新、自由呼吸、非门控、非减法 NC-MRA 技术，使用 3D 超短 TE (UTE) 对使用手术设备的患者进行随访。此外，还将研究糖尿病足的微血管分布 使用新的非对比磁共振灌注（NC-MRP）技术。这个为期五年的项目包括最初的两个项目 年技术开发和优化，然后进行临床评估研究，以验证两者 先进的 FBI、3D UTE 和 NC-MRP 适用于患有或不患有 PAD 的糖尿病患者，无论是否存在 手术设备。我们的具体目标如下： 目标 1A：发展以 ky-kz 为中心的先进 FBI 具有新的指数重聚焦翻转角的轨迹；目标 1B：发展自由呼吸、非门控、非 减影3D UTE NC-MRA技术；目标 2：开发 NC-MRP 技术来测量微观 足部血管分布；目标 3：比较先进 FBI 和 3D UTE 的诊断准确性 在目标 1 中开发，并在目标 2 中通过 NC-MRP 评估伴或不伴 PAD 的糖尿病的微血管分布 CTA/DSA。我们还将微血管测量与各种糖尿病患者的 HbA1c 和 ABI 水平相关联。