Quantitative Adenosine Stress CMR with Spiral Pulse Sequences

螺旋脉冲序列定量腺苷应激 CMR

• 批准号: 8279056
• 负责人: Michael Salerno
• 金额: $ 13.57万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8279056
• 关键词: Adenosine; Adverse event; Advisory Committees; Award; Biometry; Cardiac; Cardiac Catheterization Procedures; Chest Pain; Clinical; Clinical Engineering; Clinical Protocols; Clinical Research; Clinical Trials; Coronary Angiography; Coronary Arteriosclerosis; Coronary Stenosis; Data; Dependence; Development; Diagnosis; Disease; Doctor of Philosophy; Engineering; Evaluation; Exclusion; Goals; Gold; Health Care Costs; Health Expenditures; Heart; Image; Imaging Techniques; Intervention; Ionizing radiation; Ischemia; K-Series Research Career Programs; Lead; Left; Lesion; Magnetic Resonance; Master' s Degree; Measures; Mentors; Mentorship; Methodology; Methods; Modality; Morphologic artifacts; Motion; Myocardial; Myocardial Ischemia; Myocardial perfusion; Noise; Outcome; Patient Care; Patients; Perfusion; Perfusion Weighted MRI; Physiologic pulse; Probability; Procedures; Relative (related person); Research; Research Personnel; Resolution; Resources; Risk; Sensitivity and Specificity; Signal Transduction; Specificity; Stenosis; Stress; Stress Tests; Techniques; Testing; Training; Translating; Universities; Validation; Ventricular; Virginia; Visual; base; cardiovascular imaging; career; career development; clinical practice; data acquisition; design; image reconstruction; imaging modality; improved; innovation; patient oriented research; respiratory; single photon emission computed tomography; skills; statistics; success

DESCRIPTION (provided by applicant): The goal of this career development award project is to develop the research skills of Michael Salerno MD, PhD to become an independent investigator involved in patient-oriented research in the field of cardiovascular imaging. The necessary mentorship in clinical investigation will be provided by his clinical mentor, Dr. Christopher Kramer MD and engineering mentorship will be provided by his co-mentor Dr. Craig Meyer. His career will be further enriched by an advisory committee which includes experts in the development of rapid pulse sequences for myocardial perfusion imaging, quantification of perfusion, and the statistical design and analysis of clinical trials. The University of Virginia wll provide the ideal combination of resources necessary for Dr. Salerno to become an independent investigator. This career development proposal includes didactic training necessary to design, perform and analyze multi-center imaging trials which will be instrumental to his long term success in the field of cardiovascular imaging. This training will lead to a Masters degree in Statistics with a concentration in biostatistics and clinical trials. Dr. Salerno's ultimate plan t to utilize his unique interdisciplinary combination of engineering and clinical expertise in cardiovascular imaging to translate new CMR techniques into clinical practice. His likelihood for success in this endeavor will be significantly increased by further development of his clinical research skills by both his didactic training and mentorship interactions resulting from this caree development award. Adenosine stress perfusion CMR is becoming a promising modality for the evaluation of coronary artery disease with multiple advantages as compared to other imaging techniques including a lack of ionizing radiation, high-spatial resolution, and the ability to accurately quantify myocardial perfusion and ischemic burden. Current CMR first pass perfusion techniques are limited by "dark-rim" artifacts which may be mistaken for true perfusion abnormalities resulting in false positive studies with visual analysis, and may impede accurate quantification of myocardial perfusion for quantitative methods. Furthermore, these techniques are still limited in their temporal resolution, spatial resolution and ventricular coverage. We hypothesize that spiral pulse sequences will be robust to these artifacts, while having the efficiency to provide full ventricular perfusion quantification with high temporal and spatial resolution. Additionally, we hypothesize that these techniques will result in a robust clinical protocol for adenosine stress CMR which will have high specificity. The specific aims of this project are: (1) To develop spiral based-perfusion pulse sequences to perform absolute quantification of myocardial perfusion with whole heart coverage. (2) To evaluate adenosine stress CMR using spiral trajectories for both qualitative and quantitative assessment of myocardial perfusion in patients with an intermediate probability of CAD to determine the sensitivity and specificity using FFR as a functional gold standard. As nearly 40% of the greater than 1 million heart catheterizations which are performed annually in the US do not demonstrate obstructive CAD, improving the accuracy of non-invasive stress testing techniques could significantly reduce health care costs resulting from patients undergoing expensive and often unnecessary invasive procedures. Improved techniques would also reduce repeated testing for equivocal studies and reduce the number of incorrect diagnoses. Thus, this project has the potential to reduce health care expenditures while improving patient care.

描述（由申请人提供）：该职业发展奖励项目的目标是发展Michael Salerno医学博士的研究技能，使其成为一名独立的研究者，参与心血管成像领域以患者为导向的研究。临床研究方面的必要指导将由他的临床导师Christopher Kramer博士提供，工程指导将由他的共同导师Craig Meyer博士提供。他的职业生涯将进一步丰富的咨询委员会，其中包括专家在发展快速脉冲序列心肌灌注成像，灌注量化，统计设计和临床试验分析。弗吉尼亚大学将提供萨勒诺博士成为独立研究者所需的理想资源组合。这份职业发展建议包括设计、执行和分析多中心成像试验所需的教学培训，这将有助于他在心血管成像领域的长期成功。该培训将获得统计学硕士学位，主修生物统计学和临床试验。Salerno博士的最终计划是利用他在心血管成像方面独特的工程和临床专业知识的跨学科结合，将新的CMR技术转化为临床实践。他在这一努力中取得成功的可能性将大大增加他的临床研究技能的进一步发展，通过他的教学培训和导师互动产生的这个职业发展奖。与其他成像技术相比，腺苷应激灌注CMR正成为一种有前景的冠状动脉疾病评估方式，具有多种优势，包括缺乏电离辐射、高空间分辨率、能够准确量化心肌灌注和缺血负荷。目前的CMR第一次灌注技术受到“暗环”伪影的限制，这些伪影可能被误认为是真正的灌注异常，导致视觉分析的假阳性研究，并且可能妨碍定量方法准确量化心肌灌注。此外，这些技术在时间分辨率、空间分辨率和心室覆盖范围方面仍然有限。我们假设螺旋脉冲序列将对这些伪像具有鲁棒性，同时具有高时间和空间分辨率提供全心室灌注量化的效率。此外，我们假设这些技术将导致具有高特异性的腺苷应激CMR的强大临床方案。本课题的具体目的是：(1)发展螺旋灌注脉冲序列，实现全心覆盖心肌灌注的绝对定量。(2)采用螺旋轨迹评价腺苷应激CMR对冠心病中间概率患者心肌灌注的定性和定量评估，以FFR作为功能金标准确定其敏感性和特异性。在美国每年进行的超过100万例心导管手术中，有近40%没有出现阻塞性CAD，因此提高非侵入性压力测试技术的准确性可以显著降低因患者接受昂贵且往往不必要的侵入性手术而导致的医疗成本。改进的技术还将减少对模棱两可的研究的重复检测，并减少错误诊断的数量。因此，该项目有可能在改善病人护理的同时减少卫生保健支出。