MR ANGIOGRAPHY AND ULTRASOUND IN RENOVASCULAR DISEASE

在这项工作中，申请人建议发展必要的技能， 有效的技术开发和临床疗效评价 在特定的成像模型上：磁共振血管造影（MRA）和 多普勒超声（DUS）用于检测和评价肾脏 血管疾病 这项建议的目的是提供必要的支助， 博士Grist培养一个独立的研究计划，旨在 新成像的开发和后续临床评价 技术. 虽然申请人打算继续他的工作 涉及新的MR成像技术的发展， 这项建议是为了发展必要的技能， 功效研究。 这些技能将通过结合 在威斯康星州大学的教学课程中， 技术，以拟议的研究计划，并指导由 申请人的赞助商和学术顾问。 发展这些技能的研究计划包括两个阶段。 在第一阶段，将使用该模型评估 肾MRA和DUS检查技术优点和诊断准确性。 在第二阶段，成像研究将作为重点 制定策略以评估技术的临床疗效。 在第二阶段，我们的具体目标是确定DUS的价值 和定量MR技术来预测功能意义 快速进展性肾衰竭患者的狭窄率， 肾血管疾病是一种可疑的病因。 为了评价第一个目标，将在 一组患者（n=22）在我们的研究中使用了几种新的MRA技术。 实验室 在确定最佳筛选技术后，MRA和 DUS研究将在大量患者中进行， 常规动脉造影评价动脉粥样硬化血管 疾病在别处 MRA、DUS和 将在100名患者中使用 常规动脉造影的一致阅读作为金标准。 为了评估狭窄的功能意义，一组 将对146例快速进展性肾衰竭患者进行评价 使用MRA和DUS技术。 肾衰竭的金标准 由于肾动脉狭窄，将根据临床 随访和对血运重建治疗的反应。 成像数据 将与患者治疗期间采集的大量临床数据相关 管理 对疾病存在的一致确定， 患者结果将由包括放射科医师的小组进行， 参与患者护理的肾病学家和血管外科医生。 该研究计划促进了跨学科的环境， 申请人可以解决复杂的基础科学和临床问题 在经验丰富的临床医生的指导下， 和基础科学共同赞助。

In this work, the applicant proposes to develop the skills necessary for effective technology development and clinical efficacy evaluation based on a specific imaging model: Magnetic Resonance Angiography (MRA) and Doppler Ultrasound (DUS) for the detection and evaluation of renal vascular disease. The objective of this proposal is to provide the support necessary for Dr. Grist to cultivate an independent research program aimed at the development and subsequent clinical evaluation of new imaging technologies. Although the applicant intends to continue his work involving development of new MR imaging techniques, a major emphasis of this proposal is to develop the skills necessary to perform clinical efficacy studies. These skills will be acquired through a combination of didactic courses at the University of Wisconsin, application of the techniques to the proposed research program, and mentorship by the applicant's sponsors and academic advisor. The research plan for developing these skills encompasses two phases. In the first phase the model will be used in order to assess the technical merit and diagnostic accuracy of renal MRA and DUS studies. In the second phase, the imaging studies will be used as a focal point to develop strategies to evaluate clinical efficacy of the techniques. In the second phase, we specifically aim to determine the value of DUS and quantitative MR techniques for predicting the functional significance of stenoses in patients with rapidly progressive renal failure where renovascular disease is a suspected etiology. To evaluate the first objective, MR angiograms will be obtained in a group of patients (n=22) using several new MRA techniques in our laboratory. After an optimal screening technique is identified, MRA and DUS studies will be performed in a large group of patients referred to conventional arteriography for evaluation of atherosclerotic vascular disease elsewhere. A blinded, prospective comparison of MRA, DUS and conventional arteriography will be performed in 100 patients using a consensus reading of the conventional arteriogram as the gold standard. In order to evaluate the functional significance of stenoses, a group of 146 patients with rapidly progressive renal failure will be evaluated using the MRA and DUS techniques. The gold standard for renal failure due to renal artery stenoses will be established based on clinical follow-up and response to revascularization therapy. The imaging data will be correlated with extensive clinical data acquired during patient management. A consensus determination of the presence of disease and patient outcome will be performed by a panel including the radiologist, nephrologist, and vascular surgeon involved in the care of the patient. The research proposal facilitates an interdisciplinary environment in which the applicant may address complex basic science and clinical issues related to renovascular disease with the guidance of experienced clinical and basic science co-sponsors.