No-Gd MRI for Monitoring Disease Status in Multiple Sclerosis

我们 患者 目的是在多发性硬化（MS）的常规随访MRI中消除钆（Gd）注射 使用定量易感性作图（QSM）作为对NIH发出的呼吁的直接响应， 和FDA重新评估对患者重复给予Gd。我们率先推出了QSM， 处理来自梯度回波MRI（GRE）的经常被丢弃的相位数据。我们发现铁- 含有促炎性小胶质细胞的细胞通常在MS病变边缘积聚。我们已经开始申请 QSM在研究多发性硬化症中的应用，并已证明QSM可以检测MS病变周围的铁边缘。 我们已经获得MS患者的初步数据，QSM测量的敏感性增加可以 准确地指示BBB闭合，如髓磷脂消化，髓磷脂碎片去除， 铁的积累。为了将我们的病理生理学和生物物理学见解转化为患者护理，我们建议 使用QSM的无Gd MRI随访MS患者。我们将进行一项经济的多中心研究， 一个5分钟的GRE序列，以目前的MS MRI随访方案，而不会产生任何扫描费用的NIH。 我们将采用分层方法来评估技术有效性、诊断准确性、诊断准确性和诊断性。 思路和治疗效果的建议QSM为基础的无Gd MRI。因此，我们计划实现 目的1：通过以下具体目标建立由于髓鞘消化引起的易感性增加： 巨噬细胞目的2：优化无钆磁共振成像（no-Gd MRI）对MS患者随访的技术效果。目标3：评估 QSM无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.