Novel Cardiac MRI techniques for the diagnosis of coronary artery disease compared to PET imaging and Invasive Coronary Angiography.

冠状动脉疾病（CAD）是英国第二大最常见的死亡原因，早期识别患有CAD的患者非常重要，这样可以在心脏病发作之前开始预防。广泛的测试被用于检测CAD。冠状动脉造影在NHS中是常规使用的，如果没有额外的血流测量，我们就不知道CAD有多重要。心脏扫描可用于检测重要的CAD，包括使用放射性染料的扫描，超声波或心脏MRI (CMR)，通过简单地查看计算机控制台上的图像来解释。这种视觉解释通常是准确的，但即使是训练有素的个人，扫描记者也可能在他们的解释上有所不同，特别是在CAD如此广泛的情况下，测试可能看起来正常。我们可以通过心脏扫描来测量心脏的血流，而最好的方法是使用正电子发射断层扫描（PET）。在识别心脏病方面，这比目测检查更好，可以帮助预测心脏病发作和其他健康危害的风险，并帮助医生决定哪些患者需要进行心脏手术。不幸的是，PET扫描是昂贵的（每次扫描超过2000英镑），不广泛使用，并使用潜在的有害电离辐射。CMR可以用来测量心脏的血流量。与PET相比，它的主要优势在于更便宜（约500英镑），更容易获得，而且不使用有害辐射，更安全。在之前的研究中（最大的一项是在伦敦国王学院进行的），用PET和CMR进行的血流测量进行了比较，发现两者相似，但并不完全一致。这项研究有一些重要的局限性，因为患者使用单独的CMR和PET扫描仪，在不同的日期和单独的分析进行扫描。因此，PET和CMR的血流测量还没有结论性的比较。技术进步-我们很荣幸拥有“混合PET- mr扫描仪”，这是英国第二台能够同时进行PET和CMR扫描的扫描仪。该扫描仪使我们能够在PET和CMR的同时进行心脏血流测量，因此可以对测试进行真正的正面比较。这将帮助我们更确定CMR在测量心脏血流方面是否和PET一样好。我们已经开发了一种测量心脏血流的新方法，在动物和血流模型研究中非常准确，但我们需要在人类身上进行测试。-使用CMR测量血流既麻烦又耗时，即使是专家也可能需要几个小时。我们已经开发了一种自动化软件来执行这一操作，可用于NHS护理点的常规临床诊断。AIMI的目的是测试CMR是否可以成为PET的更便宜、更广泛和更安全的替代品。如果被证明具有可比性，自动化CMR工具可以很容易地转化为英国各地的临床实践，以增强CAD的诊断。我将使用一种新型混合PET- mr扫描仪和新型CMR技术在心脏病患者中比较PET和CMR测量的血流。我们将比较新型CMR的血流测量结果与冠状动脉造影的结果。方法：10名无心脏病的健康志愿者将接受PET- mr扫描，同时使用PET和CMR测量血流。这将使我们能够在人类身上测试这种方法。-77名计划进行血管造影的患者将对心脏进行PET-MR扫描。我们将比较血流测量与CMR， PET和冠心病与冠状动脉造影的存在。我们希望能更好地了解心脏的血流情况，并测试这种CMR工具是否与PET和血管造影一样好。这将有助于患者，因为CMR是安全的，无创的，不使用辐射。这个工具可以帮助医生更好地治疗病人，指导医生哪些病人需要药物、支架或心脏手术。

Coronary artery disease (CAD) is the second most common cause of death in the UK and it is very important to identify patients who have CAD early so that prevention can be started before a heart attack occurs. A wide range of tests are used to detect CAD. Coronary angiography is routinely used in the NHS, and without extra flow measurements, we do not know how important CAD is. Heart scans can be used to detect important CAD including a scan that uses radioactive dye, ultrasound or cardiac MRI (CMR) which are interpreted by simply looking at images on a computer console. This visual interpretation is generally accurate but even with well trained individuals, scan reporters can differ in their interpretation especially in cases where there is such widespread CAD that the test may be appear normal. We can measure the heart's blood flow with heart scans and the best method to do this is with Positron Emission Tomography (PET). This is better than visual inspection in identifying heart disease, can help with predicting the risk of a heart attack and other health hazards and help doctors decide which patients to treat with heart surgery. Unfortunately PET scanning is expensive (over £2,000 per scan), not available widely and uses potential harmful ionising radiation.CMR can be used to measure the heart's blood flow. It has a major advantage over PET because it is much cheaper (around £500), more widely available and is safer as no harmful radiation is used. In previous research studies (the largest one performed at King's College London), blood flow measurements with PET and CMR were compared and found to be similar but not to agree perfectly. This study had some important limitations, as patients were scanned using separate CMR and PET scanners, on different days and separate analysis. Therefore, there has yet to be a conclusive comparison of PET and CMR blood flow measurements.ADVANCES IN TECHNOLOGY- We are privileged to have a 'hybrid PET-MR scanner', only the second one in the UK, which is able to perform PET and CMR scans at the same time. This scanner allows us to perform heart blood flow measurements at exactly the same time with PET and CMR and therefore allows a true head on comparison of the tests. This will help us to determine with more certainty if CMR is as good as PET for measuring the heart's blood flow. - We have developed a new method to measure the heart's blood flow which is very accurate in animal and flow model studies but we need to test this in humans.- Measuring blood flow is cumbersome and time-consuming with CMR and can take several hours even for an expert. We have developed an automated software to perform this which may be used for routine clinical diagnosis at point of care in the NHS.AIMI aim to test if CMR can be a cheaper, more widely available and safer alternative to PET. If proven to be comparable, automated CMR tools can be readily translated to clinical practice across the UK to enhance diagnosis of CAD. I will compare blood flow measured with PET and CMR using a novel hybrid PET-MR scanner and novel CMR techniques in patients with heart disease. We will compare blood flow measurements with novel CMR with findings with coronary angiography. METHODS-10 healthy volunteers without heart disease will undergo a PET-MR scan to measure blood flow with PET and CMR at the same time. This will allow us to test the method in humans.-77 patients who are scheduled for an angiogram will have a PET-MR scan of their heart . We will compare blood flow measurements with CMR, PET and presence of CAD with coronary angiography.We hope to get a better understanding of the heart's blood flow and test if this CMR tool is as good as PET and angiography. This will be helpful to patients as CMR is safe, non-invasive and does not use radiation. This tool may help doctors treat patients better by guiding doctors on which patients needs medications, stents or heart surgery.