No-Gd MRI for Monitoring Disease Status in Multiple Sclerosis

我们的 病人 目的：消除多发性硬化症(MS)常规随访MRI中注射Gd的情况 使用定量易感图谱(QSM)作为对NIH发出的呼叫的直接响应 和FDA重新评估患者重复服用Gd的情况。我们率先推出了QSM，它是由 对梯度回波磁共振成像(GRE)中经常被丢弃的相位数据进行处理。我们发现铁- 含有促炎的小胶质细胞常聚集在MS病变边缘。我们已经开始申请 QSM用于多发性硬化症的研究，并已证明QSM可以检测MS病变周围的铁圈。 我们已经获得了MS患者的初步数据，QSM上测量的易感性增加可以 准确地指示血脑屏障闭合，这得到了髓鞘消化、髓鞘碎片去除、 和铁的积累。为了将我们的病理生理和生物物理见解转化为患者护理，我们建议 应用QSM对MS患者进行无Gd MRI随访。我们将通过添加以下内容来执行经济多中心研究 5分钟的GRE序列到当前的MS MRI随访方案，而不会向NIH招致任何扫描费用。 我们将使用分层方法来评估技术效率、诊断准确性、诊断 提出了基于QSM的NO-Gd MRI的思路和治疗效果。因此，我们计划实现我们的 目的通过以下具体目标：目标1：建立因髓鞘消化而增加的易感性 巨噬细胞。目的2：优化无Gd磁共振技术在MS患者随访中的技术效果。目标3：评估 基于QSM的非Gd MRI的诊断准确性、诊断思路和治疗效果。

Our patients objective is to eliminate gadolinium (Gd) injections i n routine follow-up MRI of multiple sclerosis (MS) using quantitative susceptibility mapping (QSM) asa direct response to the calls issued by the NIH and FDA to re-evaluate repetitive Gd administration to patients. We have pioneered QSM that is generated by processing the often-discarded phase data from gradient echo MRI (GRE). We have discovered that iron- containing proinflammatory microglia often accumulate at the MS lesion rim. We have initiated applications of QSM in studying multiple sclerosis, and have demonstrated that QSM can detect iron rims around MS lesions. We have obtained preliminary data in MS patients that the susceptibility increase as measured on QSM can accurately indicate BBB closure, as supported by the biophysics of myelin digestion, myelin debris removal, and iron accumulation. Totranslate our pathophysiologic and biophysical insights into patient care,we propose a no-Gd MRI using QSM to follow up MS patients. We will perform an economical multicenter study by adding a 5 min GRE sequence to the current MS MRI follow-up protocol without incurring any scan costs to the NIH. We will employ a hierarchical approach to assess the technical efficacy, diagnostic accuracy, diagnostic thinking, and therapeutic efficacy of the proposed QSM based no-Gd MRI. Accordingly, we plan to achieve our objective through the following specific aims: Aim 1: Establish susceptibility increase due to myelin digestion by macrophages. Aim 2: Optimize the technical efficacy of no-Gd MRI to follow up MS patients. Aim 3: Evaluate the diagnostic accuracy, diagnostic thinking, and therapeutic efficacy of QSM based no-Gd MRI.