High-Resolution Lymphatic Mapping of the Upper Extremities with MRI

使用 MRI 进行上肢高分辨率淋巴图谱分析

• 批准号: 10937235
• 负责人: Leo Lee Tsai
• 金额: $ 12.06万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10937235
• 关键词: Resolution; Lymphatic; Mapping; Upper; Extremities

Project Summary Lymphedema is a condition in which the clearance of lymph is compromised, resulting in edema and swelling of limbs, with potentially devastating impact on quality of life and medical costs. The most common cause of lymphedema in the US is from cancer-related surgery. Lymphedema is progressive and has no cure. It is not known why some patients develop lymphedema while others do not. Studies of cadavers have shown that the lymphatic anatomy can vary across individuals, and it is believed that these variations may increase the risk for certain individuals to develop lymphedema. If this is true, steps may be taken to prevent lymphedema from developing, for example with a bypass at the time of surgery. However, there is no practical way to obtain a complete lymphatic anatomical map within an extremity in vivo. Current imaging techniques are limited by penetration depth, low resolution, invasiveness, and partial coverage. The challenge is to map lymphatic channels, with diameters of 0.4-0.8 mm, and to trace them from all regions of an extremity back to draining lymph nodes. This proposal focuses on the development of a novel high resolution magnetic resonance (MR) lymphography technique (hrMRL) for lymphatic mapping of the upper extremities in living people. hrMRL will be a combination of a fast spin echo sequence with tailored variable flip angles, background subtraction, and acceleration via undersampling with compressed sensing and deep learning. The first aim will be to construct and optimize each of these components in an iterative fashion using phantoms, followed by testing on 10 healthy subjects, with the goal of obtaining maps of the lymphatic channels of an entire extremity within a target time of 20 minutes, suitable for clinical adoption. In the second aim, hrMRL will first be used to obtain full lymphatic anatomic maps of the upper extremity of 35 healthy volunteers who previously underwent indocyanine green (ICG) lymphography, which will serve as a gold-standard reference. hrMRL will then be validated aginst ICG by comparing both maps and determining their degree of agreement. hrMRL is also expected to resolve additional lymphatic channels undetected by ICG, allowing us the opportunity to create more comprehensive maps and to characterize new pathways, in particular the deep lymphatic channels. If successful, hrMRL would be immediately impactful in the clinical setting, where it could guide measures to avoid onset of lymphedema, shifting the lymphedema management algorithm from one of supportive and corrective therapies to one of prevention, with the goal of reducing the incidence of this debilitating and costly disease.

项目概要 淋巴水肿是一种淋巴液清除功能受损，导致淋巴水肿和肿胀的病症。 肢体，对生活质量和医疗费用具有潜在的毁灭性影响。最常见的原因是 在美国，淋巴水肿是由癌症相关手术引起的。淋巴水肿是进行性的，无法治愈。它不是 已知为什么有些患者会出现淋巴水肿，而另一些患者则不会。对尸体的研究表明， 淋巴解剖结构因人而异，人们相信这些差异可能会增加患淋巴癌的风险 某些人会出现淋巴水肿。如果这是真的，则可以采取措施预防淋巴水肿 发展，例如在手术时进行搭桥。然而，没有实际的方法来获得 四肢体内完整的淋巴解剖图。当前的成像技术受到以下限制 穿透深度、低分辨率、侵入性和部分覆盖。挑战在于绘制淋巴图 直径为 0.4-0.8 毫米的通道，并从四肢的所有区域追踪它们直至引流淋巴 节点。该提案重点关注新型高分辨率磁共振（MR）的开发 淋巴造影技术（hrMRL），用于对活人上肢进行淋巴图谱分析。 hrMRL 将是 快速自旋回波序列与定制的可变翻转角、背景扣除和 通过压缩感知和深度学习的欠采样加速。第一个目标是构建 并使用模型以迭代方式优化每个组件，然后对 10 个健康个体进行测试 受试者，目标是在目标时间内获得整个肢体的淋巴管图 20分钟，适合临床采用。在第二个目标中，hrMRL将首先用于获得完整的淋巴 35 名曾接受吲哚菁绿治疗的健康志愿者的上肢解剖图 （ICG）淋巴造影，这将作为金标准参考。然后，hrMRL 将通过 ICG 进行验证 比较两张地图并确定它们的一致程度。 hrMRL 预计还将解决额外的问题 ICG 未检测到的淋巴通道，使我们有机会创建更全面的地图并 表征新途径，特别是深部淋巴通道。如果成功，hrMRL 将是 在临床环境中立即产生影响，可以指导避免淋巴水肿发作的措施， 将淋巴水肿管理算法从一种支持性和纠正性疗法转变为一种 预防，目标是减少这种使人衰弱且代价高昂的疾病的发生率。