Detection of Liver Fibrosis Using IVIM Diffusion and DCE MRI in HCV

使用 IVIM 扩散和 DCE MRI 检测 HCV 中的肝纤维化

• 批准号: 8118219
• 负责人: Bachir Taouli
• 金额: $ 33.8万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8118219
• 关键词: Algorithms; American; Antiviral Agents; Antiviral Therapy; Biological Markers; Caring; Chronic Hepatitis C; Cicatrix; Cirrhosis; Clinical; Collagen; Country; Data; Deposition; Detection; Diagnostic; Diffusion; Diffusion Magnetic Resonance Imaging; Disease; Disease Progression; Early Diagnosis; Evaluation; Fibrosis; Functional Magnetic Resonance Imaging; Health Care Costs; Hepatic; Hepatitis C; Histopathology; Imaging Techniques; Incidence; Inflammation; Interobserver Variability; Lead; Liver; Liver Cirrhosis; Liver Fibrosis; Liver diseases; Magnetic Resonance Imaging; Malignant neoplasm of liver; Metric; Modeling; Monitor; Morbidity - disease rate; Motion; Newly Diagnosed; Non-Invasive Cancer Detection; Patient Education; Patients; Performance; Perfusion; Population; Portal Hypertension; Primary carcinoma of the liver cells; Prospective Studies; Risk; Sample Size; Sampling; Secondary to; Source; Staging; Techniques; Testing; Time; Training; United States; Validation; Venous; Weight; base; cohort; cost; high risk; imaging modality; improved; liver biopsy; liver transplantation; mortality; novel; outcome forecast; predictive modeling; prognostic; public health relevance; tool

DESCRIPTION (provided by applicant): There is an expected increased incidence of chronic hepatitis C virus infection (HCV) in the Unites States within the next years, with subsequent increased risks of liver damage, including fibrosis and cirrhosis, which may eventually lead to hepatocellular carcinoma and end-stage liver disease requiring liver transplantation. This disease is/will be the source of enormous health care costs and morbidity/mortality. Most hepatologists still rely on liver biopsy findings in patients newly diagnosed with HCV, which enables the assessment of liver damage (fibrosis and inflammation). Liver biopsy has limitations, including cost, invasiveness, poor patient acceptance, limited sampling, inter-observer variability and is difficult to repeat. Non invasive tests to capture the extent of liver damage at a larger scale are urgently needed. These will gain more acceptance among patients and hepatologists. In this proposal, we would like to test and validate non invasive magnetic resonance imaging (MRI) methods based on advanced diffusion (intravoxel incoherent motion diffusion MRI: IVIM DW-MRI) and dynamic contrast-enhanced MRI (DCE-MRI) for the detection of fibrosis and cirrhosis in HCV patients. Based on our recent preliminary data, we believe that the combination of IVIM DW- and DCE-MRI has potential for detection of fibrosis and cirrhosis with excellent accuracy, while enabling coverage of the whole liver. In order to improve the diagnostic performance of MRI, we would like to build and validate a predictive model based on advanced functional MRI metrics (diffusion and perfusion). If validated, this novel non invasive algorithm will not only decreases the number of liver biopsies, but also enable earlier diagnosis of liver fibrosis when antiviral treatment is more effective, and enable a comprehensive evaluation of the liver (to assess for cirrhosis, portal hypertension and hepatocellular cancer). This could significantly reduce the cost of care, could become a useful tool for testing new antifibrogenic and antiviral drugs in HCV, and could be used to follow patients for detection of progression to cirrhosis. This will be a highly significant progress in liver diseases given the increased burden of HCV in this country, and would benefit a large number of Americans over the next decade. PUBLIC HEALTH RELEVANCE: Patients with hepatitis C virus infection (HCV) are at high risk of developing liver scarring (fibrosis), with ultimate risks of cirrhosis and liver cancer that may require liver transplant. We would like to develop non invasive advanced MRI techniques (diffusion and dynamic contrast-enhanced MRI) to assess the degree of liver damage in HCV. These techniques combined could reach high diagnostic performance for detection of liver fibrosis; and could decrease the number of necessary liver biopsies, which have risks and sample only a small portion of the liver.

描述（由申请人提供）：预计在未来几年内慢性丙型肝炎病毒感染（HCV）的发生率会增加，随后肝脏损害的风险增加，包括纤维化和肝硬化，最终可能导致肝细胞细胞病需要肝移植的癌和末期肝病。 该疾病是/将是巨大的医疗费用和发病率/死亡率的来源。 大多数肝病学家仍依靠新诊断为HCV的患者的肝活检结果，这可以评估肝损伤（纤维化和炎症）。肝活检有局限性，包括成本，侵入性，患者接受度差，采样有限，观察者间变异性且难以重复。 迫切需要进行非侵入性测试以捕获更大范围的肝损伤程度。这些将在患者和肝病学家中获得更多的接受。在此提案中，我们希望基于高级扩散（Intravoxel Incrermer运动扩散MRI：IVIM DW-MRI）和动态对比增强MRI（DCE-MRI）测试和验证非侵入性磁共振成像（MRI）方法（MRI）方法（DCE-MRI） HCV患者的纤维化和肝硬化。根据我们最近的初步数据，我们认为IVIM DW-和DCE-MRI的组合具有出色的准确性检测纤维化和肝硬化的潜力，同时可以覆盖整个肝脏。为了提高MRI的诊断性能，我们希望基于高级功能MRI指标（扩散和灌注）构建和验证预测模型。如果得到验证，这种新型的非侵入性算法不仅会减少肝活检的数量，而且还可以在抗病毒药物治疗更有效时对肝纤维化的早期诊断，并可以对肝脏进行全面评估（评估肝硬化，门户高血压，门静脉高压和门户高血压和门户高血压和肝细胞癌）。 这可能会大大降低护理成本，可能成为测试HCV中新的抗纤维化和抗病毒药物的有用工具，并可用于跟随患者检测到肝硬化的进展。鉴于该国HCV的负担增加，这将是肝病疾病的巨大进展，并且在未来十年中将使许多美国人受益。 公共卫生相关性：丙型肝炎病毒感染（HCV）患有肝脏疤痕（纤维化）的高风险，肝硬化和肝癌的最终风险可能需要肝移植。我们想开发非侵入性高级MRI技术（扩散和动态对比增强MRI），以评估HCV中肝损伤的程度。这些技术结合可以达到较高的诊断性能，以检测肝纤维化。并可以减少必要的肝活检的数量，这些肝脏活检的风险只有一小部分肝脏。