Rapid Comprehensive Cardiac MRI Exam for Diagnosis of Coronary Artery Disease

快速综合心脏 MRI 检查诊断冠状动脉疾病

• 批准号: 10171902
• 负责人: Mehmet Akcakaya
• 金额: $ 48.74万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-26 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10171902
• 关键词: 3-Dimensional; Acceleration; Accounting; Anatomy; Award; Back; Breathing; Cardiac; Catheters; Cause of Death; Cessation of life; Chest; Chest Pain; Clinical; Coronary; Coronary Angiography; Coronary Arteriosclerosis; Coronary Stenosis; Data; Development; Diagnosis; Diagnostic; Evaluation; Excision; Extravasation; Gadolinium; Gatekeeping; Gold; Healthcare; Heart; Image; Imaging Techniques; Ionizing radiation; Machine Learning; Magnetic Resonance Imaging; Medical Care Costs; Methods; Morphologic artifacts; Myocardial perfusion; Noise; Patients; Perfusion; Physiological; Preparation; Procedures; Property; Resolution; Risk; Roentgen Rays; Sampling; Scanning; Scheme; Signal Transduction; Slice; Source; Symptoms; Techniques; Testing; Time; United States; Work; absorption; accurate diagnosis; artificial neural network; base; clinical translation; cohort; cost; diagnosis standard; disease diagnosis; heart function; high resolution imaging; imaging modality; improved; non-invasive imaging; noninvasive diagnosis; novel; prevent; rapid technique; reconstruction; temporal measurement; tool

PROJECT SUMMARY/ABSTRACT Coronary artery disease (CAD) is the leading cause of death in the United States. The clinical gold standards to diagnose and guide treatment of patients with CAD are based on invasive catheter-based procedures, such as x-ray coronary angiography (XCA) for anatomic assessment or fractional flow reserve (FFR) for physiologic assessment. However, there are costs and risks associated with such invasive procedures. Such concerns are further highlighted by the fact that large studies have shown nearly two-thirds of patients referred for their initial elective invasive XCA were found to have no significant stenoses. Thus, better non-invasive diagnostic tools are needed. Cardiac MRI (CMR) is the only non-invasive imaging modality that provides a comprehensive assessment of CAD in a single examination, including an assessment of myocardial perfusion, cardiac function and viability, as well as angiographic evaluation of stenoses, without requiring ionizing radiation. These properties also allow for repeat testing as may be clinically indicated. However, despite its great potential to serve as the non- invasive gatekeeper for costly invasive procedures, lengthy examination times have prevented CMR from clinical translation. Although several accelerated imaging techniques have been proposed, these still require trade-offs between coverage, resolution and signal-to-noise ratio. In this proposal, we will develop and validate novel acquisition and reconstruction strategies to enable a highly accelerated high-resolution whole heart CMR exam for comprehensive CAD assessment in under 10 minutes. We will develop fast and low specific absorption rate outer volume suppression modules to reduce the source of aliasing artifacts from the chest and the back. This will enable higher rates for simultaneous multi-slice imaging in perfusion and cine CMR, improving coverage substantially with minimal noise amplification. For coronary MRI and viability imaging, simultaneous multi-slab imaging will be introduced to CMR, facilitating high isotropic resolution acquisitions with fast coverage. These acquisitions will be supplemented with regularized leakage-blocking and patient- specific machine learning reconstructions for further artifact and noise removal. Finally, we will implement and validate the proposed rapid comprehensive CMR exam in a cohort of suspected CAD patients, comparing our approach with conventional clinical CMR for the assessment of function, perfusion, and viability, and with invasive XCA for the assessment of coronary stenosis. Successful completion of this project has the potential to transform CMR into a leading rapid non-invasive tool for safe and accurate diagnosis of CAD, improving the healthcare of several million patients with chest pain and other CAD symptoms annually.

项目概要/摘要 冠状动脉疾病（CAD）是美国的首要死因。临床金标准 诊断和指导 CAD 患者的治疗是基于侵入性导管程序，例如 如用于解剖学评估的 X 射线冠状动脉造影 (XCA) 或用于生理学评估的血流储备分数 (FFR) 评估。然而，此类侵入性手术存在相关成本和风险。此类担忧是 进一步强调的是，大型研究表明，近三分之二的患者转诊至初始治疗 选择性侵入性 XCA 未发现明显狭窄。因此，更好的非侵入性诊断工具 需要。 心脏 MRI (CMR) 是唯一可对心脏进行全面评估的非侵入性成像方式。 CAD 单次检查，包括心肌灌注、心脏功能和活力的评估， 以及狭窄的血管造影评估，无需电离辐射。这些属性还允许 用于根据临床需要进行重复测试。然而，尽管它作为非 昂贵的侵入性手术的侵入性看门人、漫长的检查时间阻碍了 CMR 临床翻译。尽管已经提出了几种加速成像技术，但这些技术仍然需要 覆盖范围、分辨率和信噪比之间的权衡。在此提案中，我们将开发并验证 新颖的采集和重建策略可实现高度加速的高分辨率全心 CMR 10 分钟内完成综合 CAD 评估考试。我们将开发快速、低具体 吸收率外部体积抑制模块可减少胸部混叠伪影的来源 后面。这将使灌注和电影 CMR 中的同步多切片成像速率更高， 以最小的噪声放大显着提高覆盖范围。对于冠状动脉 MRI 和活力成像， CMR 中将引入同时多板成像，促进高各向同性分辨率采集 具有快速覆盖。这些收购将得到正规化的泄漏阻断和患者治疗的补充。 特定的机器学习重建，以进一步消除伪影和噪声。最后，我们将实施并 在一组疑似 CAD 患者中验证拟议的快速综合 CMR 检查，比较我们的 使用传统的临床 CMR 方法来评估功能、灌注和活力，并使用 侵入性 XCA 用于评估冠状动脉狭窄。该项目的成功完成具有潜力 将 CMR 转变为领先的快速非侵入性工具，用于安全、准确地诊断 CAD，提高 每年为数百万患有胸痛和其他 CAD 症状的患者提供医疗保健。