Expanding on a new paradigm for MRI in pediatric congenital heart disease

项目摘要 先天性心脏病(CHD)是最常见的缺陷，影响约1%的活产儿。最初 为成人开发和优化的心脏磁共振成像(CMR)越来越多地应用于 超声心动图与有创血管造影术在小儿冠心病患者中的应用 心脏和血管的功能评估。对于儿童来说，非侵入性、不受限制的领域 视野和无电离辐射使MRI成为一种有吸引力的成像方式，因为许多人需要 序贯成像和长期随访评估。然而，目前针对非常年幼儿童的CMR 需要全身麻醉和有创插管才能获得可接受的诊断图像 质量。在过去的5年里，我们率先开发了阿魏酸甘油酯增强的CMR技术，提供了前所未有的 图像质量和诊断价值；这项技术改变了儿童冠心病CMR的临床应用方式 在我们的中心演出。我们对阿魏酸甘油酯的诊断性应用消除了对Gd的任何担忧 在生物组织中的积累，在这次更新的R01中，我们的目标是开发下一代CMR，它可以 无需侵入性插管，并可能减少麻醉/镇静暴露。我们进一步 建议在我们改进的CMR框架的基础上开发高级解剖学和血流动力学 复杂冠心病的建模技术。这些工具共同提供了一种基于CMR图像的策略来帮助 告知病人的手术计划，并最终预测手术结果。我们将扩大我们的多中心 协作以汇集数据并实现更大规模的研究。该项目的完成将导致临床 部署新的MRI脉冲序列、图像采集和重建策略以及实验 以及计算建模方法。

Project Summary Congenital heart disease (CHD) is the most common defect affecting approximately 1% of live births. Initially developed and optimized for adults, cardiac magnetic resonance imaging (CMR) is increasingly used in pediatric CHD patients to complement echocardiography and invasive angiography for anatomical and functional evaluation of the heart and blood vessels. For children, the non-invasiveness, unrestricted field of view, and absence of ionizing radiation make MRI an attractive imaging modality because many will need sequential imaging and long-term follow-up evaluations. However, current CMR for very young children requires general anesthesia and invasive intubation for acquisition of images that are of acceptable diagnostic quality. In the past 5 years, we pioneered ferumoxytol-enhanced CMR techniques that provide unprecedented image quality and diagnostic value; this technique has changed how CMR for pediatric CHD is clinically performed at our center. Our diagnostic application of ferumoxytol obviates any concerns about gadolinium accumulation in biologic tissues, In this renewal R01, we aim to develop next-generation CMR that can be performed without invasive intubation, and potentially with reduced anesthesia/sedation exposure. We further propose to build upon our improved CMR framework to develop advanced anatomical and hemodynamic modeling techniques for complex CHD. Together, these tools provide a CMR image-based strategy to help inform the patient's surgical plan and to ultimately predict surgical outcome. We will expand our multi-center collaborations to pool data and enable larger scale studies. Completion of the project will result in clinical deployment of new MRI pulse sequences, image acquisition and reconstruction strategies, and experimental and computational modeling methods.