Computed Tomographic Insights Into Pulmonary Hypertension

项目摘要 肺动脉高压是一种最常见的疾病，常合并多种疾病。 西方世界的疾病包括慢性阻塞性肺病、心力衰竭和肺内血栓。它的单独存在或 与其他情况相结合，会导致严重的发病率和死亡率。已开发的药物 对于第一组疾病的成功治疗在第二组(由于左心疾病)中没有显示出太多的效用，并且 III组(因肺部疾病)PH。有人提出，这可能是由于无法识别 对这种治疗有反应的PH亚型。此外，非侵入性筛查和早期检测 仍然具有挑战性。放射科医生一直在观察远端血管系统的丧失(修剪)， 增加血管的“曲折”，以及肺血管的近端扩张。开发的算法和 由Rahaghi博士和应用胸部成像实验室(ACIL)小组实施的3D 应用CT扫描重建和量化肺血管结构。拉哈吉博士已经 已经在多个队列中部署了这些算法，生成了出版物和初步数据。 在他的第一个目标中，拉哈吉博士将探索肺血管结构的差异 不同类型肺动脉高压患者与非肺动脉高压患者的相关性研究 这些发现对疾病的严重性有很大影响。在第二个目标中，他将研究肺血管 结构可以预测右心功能不全，这是疾病进展中的一个关键事件，可以预测 预后不佳，表明需要更积极的治疗。在第三个目标中，他将研究肺脏 运动中的血管结构及其与肺血管力学的关系。 这项工作将在布里格姆的肺和重症监护医学部进行 哈佛医学院的核心教学医院--妇女医院，在两位导师的指导下， 沃什科医生是临床肺部成像专家，韦克斯曼医生是临床肺部疾病专家 高血压。该遗址是美国国家卫生研究院资助的PVDOMICS项目的六个国家之一 努力对肺动脉高压进行分型。Rahaghi博士的团队包括应用胸部成像的成员 实验室，包括一个数学家和计算机科学家团队，他们拥有长达十年的 在为肺部图像处理创建计算机算法方面的合作。 拉哈吉博士毕生致力于成为一名专注于定量研究的内科科学家 科学及其在医学上的应用。他拥有物理学背景和生物工程博士学位。 这是NIH赞助的医学科学家培训计划的一部分。他计划利用他通过以下方式获得的知识 与肺动脉高压患者的互动及其工程和研究设计知识 以改善PH患者的护理和预后。

Project Summary Pulmonary hypertension is a disease that occurs most frequently as complicating comorbidity of very common disease in the western world including COPD, Heart Failure and Blood Clots in the lung. Its presence alone or in combination with other conditions leads to significant morbidity and mortality. Medications developed successfully for Group I disease have not shown as much utility in Group II (Due to left heart disease) and Group III (due to lung disease) PH. It has been proposed that this may be due to an inability to identify subtypes of PH that respond to this type of treatment. Additionally, non-invasive screening and early detection remain challenging. Radiologists have been making observations of the loss of distal vasculature (pruning), increase vascular “tortuosity”, and proximal dilation of the pulmonary vasculature. Algorithms developed and implemented by Dr. Rahaghi and the Applied Chest Imaging Laboratory (ACIL) group permit the 3D reconstruction and quantification of the structure of pulmonary vasculature using CT scans. Dr. Rahaghi has already deployed these algorithms in multiple cohorts generating publications and preliminary data. In his first aim, Dr. Rahaghi will explore the differences in the structure of the pulmonary vasculature between different groups of pulmonary hypertension and subjects without pulmonary hypertension and relate these findings to disease severity. In the second aim, he will study the extent to which pulmonary vascular structure can predict right ventricular dysfunction, a key event in the progression of disease that is predictive of poor outcome and signals the need for more aggressive treatment. In the third aim, he will study pulmonary vascular structure and its relationship to pulmonary vascular mechanics during exercise. This work will be performed at the Division of Pulmonary and Critical Care Medicine at Brigham and Women's Hospital, a core teaching hospital of Harvard Medical School, under the supervision of two mentors, Dr. Washko who is an expert in clinical lung imaging and Dr. Waxman who is an expert in clinical pulmonary hypertension. The site is one of six in the nation chosen as part of the PVDOMICS project which is NIH funded effort to subtype pulmonary hypertension. Dr. Rahaghi's team includes members of the Applied Chest Imaging Laboratory which includes a team of mathematicians and computer scientists who have a decade long collaboration in creating computer algorithms for image-processing of the lung. Dr. Rahaghi has a life-long dedication to becoming a physician-scientist with a focus on quantitative sciences and their applications to medicine. He has a background in physics and a Ph.D. in Bioengineering as part of a NIH sponsored medical-scientist training program. He plans to use the knowledge he gains by interacting with patients who have pulmonary hypertension and his knowledge of engineering and study design to improve care and outcomes in PH.