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%的活产婴儿。最初 心脏磁共振成像（CMR）是为成人开发和优化的，越来越多地用于 儿童CHD患者，以补充超声心动图和侵入性血管造影术， 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， 由于MRI的视野和电离辐射的缺乏，使得MRI成为一种有吸引力的成像方式，因为许多人需要 连续成像和长期随访评价。然而，目前针对非常年幼儿童的CMR 需要全身麻醉和侵入性插管以获取具有可接受诊断性的图像 质量.在过去的5年里，我们开创了ferumoxytol增强CMR技术，提供了前所未有的 影像质量和诊断价值;这项技术改变了儿童CHD的CMR临床 在我们的中心。我们对ferumoxytol的诊断应用消除了对钆的任何担忧 在这次更新R 01中，我们的目标是开发下一代CMR， 在无创插管的情况下进行，并且可能减少麻醉/镇静暴露。我们进一步 我建议在我们改进的CMR框架的基础上开发先进的解剖学和血流动力学 复杂CHD的建模技术。这些工具共同提供了一种基于CMR映像的策略， 告知患者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 合作以汇集数据并进行更大规模的研究。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 和计算建模方法。

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.