Novel Myocardial Perfusion Stress Test using Arterial Spin Labeling

使用动脉旋转标记的新型心肌灌注压力测试

• 批准号: 9124428
• 负责人: Krishna S Nayak
• 金额: $ 43.28万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9124428
• 关键词: Accounting; Address; American; Angiography; Animal Model; Animals; Aorta; Blood; Blood flow; Brain; Calibration; Cardiac; Cardiac health; Cardiology; Cardiovascular system; Chronic Kidney Failure; Clinical; Contrast Media; Coronary; Coronary Angiography; Coronary Arteriosclerosis; Coronary Stenosis; Coronary artery; Detection; Diagnostic; Diastole; Dose; End stage renal failure; Engineering; Evaluation; Family suidae; Gadolinium; General Population; Goals; Growth; Heart; Heart Diseases; Human; Image; Intravenous; Ionizing radiation; Kidney; Kidney Failure; Label; Left; Left ventricular structure; Liver; Magnetic Resonance Imaging; Measurement; Measures; Methods; Modeling; Morphologic artifacts; Motion; Motivation; Myocardial Ischemia; Myocardial perfusion; Myocardial tissue; Noise; Operative Surgical Procedures; Patient Recruitments; Patients; Performance; Perfusion; Photons; Physiologic pulse; Positron-Emission Tomography; Prevalence; Pulsatile Flow; Radiation; Radioisotopes; Regional Perfusion; Renal function; Reproducibility; Research; Risk; Role; Safety; Scanning; Schedule; Scheme; Severities; Signal Transduction; Slice; Source; Spin Labels; Stress; Stress Tests; Students; Subgroup; Systole; Techniques; Technology; Testing; Thallium Myocardial Perfusion Imaging Stress Test; Time; Tissues; United States; Variant; Vasodilation; Ventricular; Work; X-Ray Computed Tomography; base; cardiovascular imaging; clinically relevant; cost; experience; gadolinium oxide; heart motion; high risk; imaging modality; innovation; interest; method development; mortality; novel; patient subsets; public health relevance; radiofrequency; research clinical testing; research study; screening; skills; training project

 DESCRIPTION (provided by applicant): This project will develop a new ultra-safe technique for myocardial perfusion stress testing in humans. Rationale: A growing number of patients in the United States require frequent cardiovascular assessment, to determine the presence and significance of coronary artery disease (CAD). Non-invasive myocardial perfusion stress testing is a method of choice, but we are not able to use current tests as frequently as we would like in these patients due to ionizing radiation and/or risks associated with contrast agents. Our proposed technique will not require any ionizing radiation or any potentially toxic contrast agents, and could therefore be performed repeatedly with no incremental risk to the patient. Innovation: We will utilize arterial spin labeled magnetic resonance imaging (ASL-MRI), an established technology for measuring brain perfusion in humans and myocardial perfusion in small animals. To our knowledge, its application to clinical myocardial perfusion imaging and stress testing is novel. Current methods for human cardiac ASL are able to detect increases in blood flow due to vasodilation, but provide only single slice coverage and barely adequate measurement variability (per-segment variations of roughly 0.16 mL-blood / g-tissue / min). We will address these limitations by developing and optimizing innovative new labeling schemes that enable evaluation of all 17 left ventricular segments, while taking into account cardiac motion, pulsatile flow, and potential sources of artifact. We will also integrate several new MRI technologies, for the first time, into the cardiac ASL experiment: simultaneous multi-slice imaging, background suppression, and blood pool suppression. Approach: The new test will be developed and experimentally optimized in a porcine model of CAD. We will first develop and optimize a labeling method that is compatible with whole-heart spatial coverage and maximizes the strength of the ASL signal. We will then develop and optimize an imaging method that interrogates all 17 left ventricular segments and maximizes the ASL temporal signal-to-noise ratio. After this is completed, we will perform a clinical evaluation of the optimized ASL-MRI stress test in patients with suspected CAD, and will compare the new test with both single-photon emitted computed tomography (SPECT) and invasive coronary angiography with fractional flow reserve (FFR). We will determine test-retest reproducibility of the new test in a subset of the patients. This study will enable whole-heart ASL-MRI stress testing, optimize and validate its ability to measure myocardial perfusion reserve, and enhance its feasibility as a firs-line test for CAD screening. Broader Impact: The proposed myocardial perfusion stress test could have a broader role for screening of patients with suspected CAD, due to its safety and its potential for simplicity and low cost. The technical work, particularly the labeling and imaging schemes, are likely to have implications for kidney and liver ASL-MRI. Finally, this work will provide training projects for postdoctoral, graduate, and undergraduate engineering students and clinical fellows interested in advanced cardiovascular imaging.

 描述（由申请人提供）：该项目将开发一种新的超安全技术，用于人类的心肌透明测试：美国越来越多的患者需要进行冠状动脉疾病的存在和意义（CAD ）在这些患者中，IKE是由于辐射和/或与对比剂相关的风险。 MRI），一种用于人类大脑灌注的建立和小动物的心肌灌注。并且几乎没有足够的（大约0.16 ml-lood / g-tissue / min的每段变化）。第一次进行伪像的潜在来源，进入心脏ASL实验：同时进行多片成像，背景抑制和血液池替代：新的测试。最大化的ASL信号的强度将优化成像方法。使用可疑的CAD，并将新的测试与单相发出的断层扫描（SPECT）和侵入性冠状动脉造影术与分数花（FFR）进行比较，我们将确定本研究的一部分中的新测试启用整个心脏ASL ASL -MRI应力测试，优化和验证以测量心肌灌注孔丝sT，以进行CAD筛查：支撑性的心肌灌注压力测试可能在筛查患者的筛查中具有更广泛的作用安全性和低成本的潜力。有兴趣的成像。