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，以 基于有效技术开发和临床疗效评价 一种特定的成像模式：磁共振血管成像(MRA)和 多普勒超声(DUS)对肾脏的检测和评价 血管疾病。 这项提议的目标是提供必要的支持， 格里斯特博士将制定一项独立研究计划，旨在 新影像技术的发展及其临床评价 技术。虽然申请人打算继续他的工作 涉及新的磁共振成像技术的开发，主要强调 这项建议是为了培养进行临床治疗所需的技能。 功效研究。这些技能将通过组合获得 在威斯康星大学的教学课程中，应用 建议的研究计划的技术，以及由 申请人的保荐人和学术顾问。 发展这些技能的研究计划包括两个阶段。 在第一阶段，将使用该模型来评估 肾脏MRA和DUS检查的技术优势和诊断准确性。 在第二阶段，成像研究将作为重点 制定评估这些技术的临床疗效的策略。 在第二阶段，我们的具体目标是确定DUS的价值 以及用于预测功能意义的定量磁共振技术 快速进展性肾功能衰竭患者的狭窄 肾血管疾病是一种可疑的病因。 为了评估第一个目标，磁共振血管成像将在 在我们的医院使用几种新的MRA技术的患者组(n=22) 实验室。在确定最佳筛查技术后，MRA和 DU研究将在一大批被提及的患者中进行 常规动脉造影术对动脉粥样硬化血管的评价 其他地方的疾病。MRA、DUS和DUS的盲法前瞻性比较 常规动脉造影术将在100名患者中使用 将常规动脉造影术作为金标准的共识读数。 为了评估狭窄的功能意义，一组 146名进展迅速的肾功能衰竭患者将接受评估。 使用MRA和DUS技术。肾功能衰竭的黄金标准 因肾动脉狭窄将根据临床情况建立 血运重建治疗的随访和反应。成像数据 将与患者期间获得的大量临床数据相关联 管理层。对疾病和疾病存在的共识确定 患者的结果将由包括放射科医生的小组来执行， 肾内科医生和参与病人护理的血管外科医生。 研究建议促进了一个跨学科的环境 申请者可以解决复杂的基础科学和临床问题 在有经验的临床指导下与肾血管疾病相关 和基础科学的联合赞助商。

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.