Improved MRI guidance of pediatric catheterization via autonomous multi-beat data synthesis

项目摘要 心血管插管是一种测量血流动力学和治疗的微创方法。 异常，如血管狭窄。传统上，X光透视引导插管，但它使用 电离辐射，软组织对比度差，即使使用外源性造影剂也是如此。 这在儿童中是有问题的，因为他们特别容易受到辐射，经常需要重复 评估，而且可能有复杂的解剖结构，很难导航。核磁共振引导提供了一种非 电离替代品，可以改善软组织对比度，提高评估能力。除了指导之外 诊断性导管术，15年前人类第一次研究表明，核磁共振可以引导心脏 缩窄血管成形术等干预措施。然而，自那时以来，临床应用一直受到以下几个方面的限制 核磁共振安全的介入设备和2)相对较差的实时核磁共振图像质量在 程序。核磁共振安全设备的数量正在增加，低场磁共振已经成为一种新的 显著减少设备发热。然而，糟糕的实时图像质量仍然是一个重大障碍。尽管 并行成像和加速图像重建，图像质量受到有限的MRI集合的限制 样本可用于单次拍摄、实时采集的图像重建。 解决方案：该方案旨在利用多拍信息来改善实时MRI图像 儿科干预期间的质量。其目标是通过增加可用的数据来提高图像质量 通过突出显示节拍之间的运动来重建图像并改进设备可视化。中环 假设在介入环境下，多拍信息将改善实时MRI图像质量 和设备可视化，从而提高了操作员的信心和性能。为了检验这一假设， 多拍对介入图像质量的影响(目标1)、对设备可视化的影响(目标2)和临床 在儿科患者中的效用(目标3)被评估。这项提议得到了一个包括儿科医生在内的团队的支持 处于MRI引导干预前沿的心脏病学家和先前的研究经验开发了一种闭合式- 循环核磁共振数据收集技术，有力地识别相似的心跳。该平台最初是 专为不同的应用而设计-改进成人心律失常的非干预性MRI成像。这里, 它适用于在新的患者群体(儿科)中探索一种新的成像范式(介入成像) 患者)用于PI。这项工作有望为实时MRI引导的心血管疾病建立一种新的方法 通过解决目前限制图像引导信心的领域进行干预：糟糕的解剖学和器械 视觉化。成功不仅将改善儿童心血管介入治疗的MRI指导，而且 也为MRI指导心血管和非心血管疾病(活组织检查、引流、 热疗)成人手术。

Project Summary Cardiovascular catheterization is a minimally-invasive approach to measure hemodynamics and treat abnormalities, such as vascular stenosis. Conventionally, X-ray fluoroscopy guides catheterizations, but it uses ionizing radiation and suffers from poor soft tissue contrast even with the use of exogenous contrast agents. This is problematic in children as they are particularly susceptible to radiation, often require repeat assessments, and can have complex anatomy that is difficult to navigate. MRI guidance provides a non- ionizing alternative that can improve soft tissue contrast and enhance evaluations. In addition to guiding diagnostic catheterization, first-in-human studies 15 years ago demonstrated that MRI could guide cardiac interventions such as coarctation angioplasty. However, clinical adoption since then has been limited by 1) few MRI-safe interventional devices and 2) the relatively poor real-time MRI image quality available during procedures. The number of MRI-safe devices is increasing, and low-field MRI has emerged as a new way to significantly reduce device heating. Yet, poor real-time image quality remains a significant barrier. Despite parallel imaging and accelerated image reconstructions, image quality is constrained by the limited set of MRI samples available for image reconstruction in a single-shot, real-time acquisition. The solution: This proposal aims to leverage multi-beat information to improve real-time MRI image quality during pediatric interventions. The goal is to improve image quality by increasing data available for image reconstruction and improve device visualization by highlighting motion between beats. The central hypothesis is that, in the interventional setting, multi-beat information will improve real-time MRI image quality and device visualization, leading to improved operator confidence and performance. To test this hypothesis, multi-beat’s impact on interventional image quality (Aim 1), impact on device visualization (Aim 2), and clinical utility in pediatric patients (Aim 3) are evaluated. The proposal is supported by a team that includes pediatric cardiologists at the forefront of MRI-guided interventions and prior research experience developing a closed- loop MRI data collection technique which robustly identifies similar heartbeats. The platform was originally designed for a different application – improving non-interventional MRI imaging of adults with arrythmia. Here, it is adapted to explore a new imaging paradigm (interventional imaging) in a new patient population (pediatric patients) for the PI. The work is expected to establish a new approach for real-time MRI-guided cardiovascular interventions by addressing the areas that currently limit image guided confidence: poor anatomic and device visualization. Success would not only improve MRI guidance of cardiovascular interventions in children but also create new opportunities for MRI guidance of cardiovascular and non-cardiovascular (biopsy, drainage, thermal therapy) procedures for adults.