Exploration of Fractal Analysis for Characterisation and Quantification of Myocardial Ischaemia on Multi-Modality Perfusion Imaging

多模态灌注成像心肌缺血特征和定量分形分析的探索

• 批准号: 392304398
• 负责人: Professor Dr. Marc Dewey
• 金额: --
• 依托单位: Klinik für Radiologie (mit dem Bereich Kinderradiologie) (CCM)
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2018
• 资助国家: 德国
• 起止时间: 2017-12-31 至 2023-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/392304398?language=en
• 关键词: Exploration; Fractal; Analysis; Characterisation; Quantification

Diagnostic implications of the fractal structure of the vasculature and perfusion are well known but have been poorly studied with radiological imaging. The funded project applied fractal analysis to dynamic CT perfusion (CTP) imaging in chronic myocardial ischaemia to differentiate a stenotic, macrovascular from a microvascular pathophysiology of ischaemia based by quantifying changes in the myocardial perfusion pattern. Microvascular ischaemia is of clinical importance because it cannot be treated by invasive coronary angiography but often requires invasive testing. Impaired vasodilation at the microvascular level can be triggered by a variety of possible underlying pathophysiological mechanisms. These might lead to manifest ischaemia of the myocardium. Microvascular changes in the perfusion pattern, which, according to the overarching hypothesis of the project, differ from those seen in macrovascular ischaemia because of the vascular scale affected in each case. The results of this project were able to confirm our hypothesis. Thus, fractal analysis can also be used to improve the diagnosis of macrovascular ischaemia, especially regarding specificity. Finally, fractal analysis reliably identified microvascular ischaemia in a single diagnostic modality even in the presence of moderate stenoses. With Kakuya Kitagawa (Japan), we were able to attract the first DFG Mercator Fellow in radiology. A prospective multicenter study coordinated by him provided valuable data for establishing fractal analysis. In addition, his clinical and scientific expertise contributed significantly to the success of the project. Our method is subject to a patent issued in Europe and the USA and further applications in neoplasia and inflammation were identified throughout the project. Based on our results, we propose a second funding period to prospectively implement fractal analysis clinically and to test its pathophysiological limits. The former will be achieved by a Mercator Fellowship with Aaron So (Canada): In a prospective, multicenter study on CTP led by him, fractal analysis will be prospectively integrated, and its clinical potential will be validated with an invasive reference standard. In cooperation with Prof. Kitagawa, we will challenge fractal analysis in clinically difficult pathophysiologies such as ischaemia in patients with atrial fibrillation or hemodialysis. Finally, we will apply fractal analysis for myocardial characterisation in routine CT angiography: We have reason to believe that fractal analysis can extract prognostic information from the myocardium, which correlate with the occurrence of major adverse cardiovascular events (MACE). The multicenter DISCHARGE study (n=1808) will serve as the data basis.

血管系统和血流灌注的分形结构的诊断意义是众所周知的，但用放射成像研究得很少。该资助项目将分形分析应用于慢性心肌缺血的动态CT灌注(CTP)成像，以量化心肌灌注模式的变化为基础，区分缺血的狭窄、大血管和微血管病理生理学。微血管缺血具有重要的临床意义，因为它不能通过有创冠状动脉造影术治疗，但往往需要有创检查。微血管水平的血管扩张受损可由各种可能的潜在病理生理机制触发。这可能导致明显的心肌缺血。微血管改变，根据项目的总体假设，这与大血管缺血不同，因为每个病例所影响的血管规模不同。这个项目的结果能够证实我们的假设。因此，分形分析也可以用来提高对大血管缺血的诊断，特别是在特异性方面。最后，即使在存在中度狭窄的情况下，分形分析也能可靠地在单一诊断模式下识别微血管缺血。通过Kakuya Kitagawa(日本)，我们能够吸引第一位DFG墨卡托放射学研究员。由他协调的一项前瞻性多中心研究为建立分形分析提供了有价值的数据。此外，他的临床和科学专业知识对该项目的成功做出了重大贡献。我们的方法获得了在欧洲和美国颁发的专利，并在整个项目中确定了在肿瘤和炎症方面的进一步应用。基于我们的结果，我们建议第二个资助期，以前瞻性地在临床上实施分形分析，并测试其病理生理学限度。前者将通过墨卡托与Aaron So(加拿大)的合作实现：在他领导的一项关于CTP的前瞻性多中心研究中，将前瞻性地整合分形分析，其临床潜力将通过侵入性参考标准进行验证。与北川教授合作，我们将挑战在临床困难的病理生理学方面的分形分析，例如房颤或血液透析患者的缺血。最后，我们将分形分析应用于常规CT血管成像中的心肌特征：我们有理由相信，分形分析可以从心肌中提取预后信息，这些信息与主要不良心血管事件(MACE)的发生相关。多中心出院研究(n=1808)将作为数据基础。