Rapid Comprehensive Cardiac MRI Exam for Diagnosis of Coronary Artery Disease

项目总结/摘要 冠状动脉疾病（CAD）是美国的主要死亡原因。临床黄金标准 诊断和指导CAD患者的治疗是基于侵入性导管手术， 作为用于解剖评估的X线冠状动脉造影（XCA）或用于生理评估的血流储备分数（FFR） 考核然而，存在与这种侵入性手术相关的成本和风险。这种担忧是 进一步强调的事实是，大型研究表明，近三分之二的患者被转介到他们的初始 发现选择性侵入性XCA没有显著狭窄。因此，更好的非侵入性诊断工具 是必要的。 心脏MRI（CMR）是唯一的非侵入性成像方式，可提供全面的评估， 单次检查中的CAD，包括心肌灌注、心脏功能和存活力评估， 以及狭窄的血管造影评估，而不需要电离辐射。这些特性还允许 根据临床指征进行重复检测。然而，尽管它有很大的潜力作为非- 昂贵的侵入性程序的侵入性看门人，冗长的检查时间阻止了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。在本提案中，我们将开发和验证 实现高度加速的高分辨率全心脏CMR的新型采集和重建策略 在10分钟内完成CAD综合评估考试。我们将开发快速和低特异性 吸收率外部容积抑制模块，以减少来自胸部的混叠伪影的来源，以及 后面这将使灌注和电影CMR中的同时多切片成像的速率更高， 以最小的噪声放大实质上改善覆盖。对于冠状动脉MRI和活力成像， 同时多板成像将被引入到CMR中，促进高各向同性分辨率采集 快速覆盖。这些收购将补充定期堵漏和病人- 特定的机器学习重建，以进一步去除伪影和噪声。最后，我们将实施和 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 采用常规临床CMR评估功能、灌注和活力， 有创XCA用于评估冠状动脉狭窄。该项目的成功完成有可能 将CMR转化为领先的快速无创工具，用于安全准确地诊断CAD， 每年有数百万胸痛和其他CAD症状患者的医疗保健。

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.