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EVALUATION OF ENDOBRONCHIAL INTERVENTIONS FOR COPD VIA CT AND 3HE MRI

通过 CT 和 3HE MRI 评估 COPD 的支气管内干预措施

基本信息

批准号：
8691020
负责人：
JASON C WOODS
金额：
$ 21.34万
依托单位：
CINCINNATI CHILDRENS HOSP MED CTR
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-08-15 至 2014-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8691020
关键词：
EVALUATION ENDOBRONCHIAL INTERVENTIONS COPD VIA

项目摘要

DESCRIPTION (provided by applicant): Our overall goal is to identify CT and MR-imaging techniques that will best guide and inform the two minimally-invasive surgical therapies for COPD which are under development around the world: endobronchial stent-supported conduits from conducting airways to emphysematous parenchyma, and endobronchial one-way exit valves to effect volume reduction in severely emphysematous lung regions. Both proposed interventions show great promise at reducing dyspnea in patients with severe emphysema, for which there is no therapeutic treatment option other than lung transplantation and, for a few, lung volume reduction surgery. Despite the great promise, there is no currently identified method for identification of target regions for the intervention or for efficacy prediction. The work proposed here will be performed in human lungs removed at transplant for advanced COPD for two reasons: human emphysema is not well replicated in any animal model, and interventional placement can be at random locations, allowing a range of functional results without regard to patient outcomes and allowing testing of the underlying assumptions about regional collateral ventilation and regional lung function. Though the imaging procedures proposed here are all ex vivo, they can be and have been employed in vivo. By correlating lung functional improvements after intervention with quantitative 3He MRI and CT results (pre- and post-intervention), we will be able to demonstrate the utility of pulmonary imaging techniques to (i) guide the endoscopic installation of valves or stents in a given lung and (ii) predict the functional improvement outcomes for a given intervention. This proposal aims to make a significant step forward toward effective and predictable endoscopic treatment of emphysema, through a combined effort at two sites (Washington University and the University of Pennsylvania / University of Virginia) that are world leaders in thoracic imaging and treatment of severe COPD. PUBLIC HEALTH RELEVANCE: Chronic obstructive pulmonary disease (COPD) affects between 11 and 24 million Americans and is a major cause of suffering and premature death. Two minimally- invasive surgical procedures are under development to treat severe COPD and show great promise but results vary significantly among patients. We propose new imaging methods via CT and MRI to test these interventions, to eventually improve patient selection, choice of lung target areas in individuals, and reliable prediction of success of these procedures in individual patients.

描述（由申请人提供）：我们的总体目标是确定CT和MR成像技术，这些技术将最好地指导和告知世界各地正在开发的两种COPD微创手术疗法：从传导气道到肺气肿实质的支气管内支架支持导管，以及在严重肺气肿肺区域实现减容的支气管内单向出口阀。这两种拟议的干预措施在减少严重肺气肿患者的呼吸困难方面显示出很大的希望，对于这些患者，除了肺移植和少数肺减容手术外，没有其他治疗选择。尽管有很大的希望，目前还没有确定的方法来识别目标区域的干预或疗效预测。本文提出的工作将在移植晚期COPD时取出的人肺中进行，原因有两个：人肺气肿在任何动物模型中都不能很好地复制，介入放置可以在随机位置，允许一系列功能结果而不考虑患者结局，并允许测试有关区域侧支通气和区域肺功能的基本假设。虽然这里提出的成像程序都是离体的，但它们可以并且已经在体内使用。通过将介入后肺功能改善与定量3 He MRI和CT结果（介入前和介入后）相关联，我们将能够证明肺部成像技术的实用性，以（i）引导在给定肺部中内窥镜下安装瓣膜或支架，以及（ii）预测给定介入的功能改善结局。该提案旨在通过两个中心（华盛顿大学和宾夕法尼亚大学/弗吉尼亚大学）的联合努力，朝着有效和可预测的肺气肿内镜治疗迈出重要一步，这两个中心在胸部成像和重度COPD治疗方面处于世界领先地位。公共卫生相关性：慢性阻塞性肺疾病（COPD）影响着1100万至2400万美国人，是痛苦和过早死亡的主要原因。两种微创外科手术正在开发中，用于治疗严重的COPD，并显示出很大的希望，但结果在患者之间差异很大。我们提出了新的成像方法，通过CT和MRI来测试这些干预措施，最终改善患者的选择，个人肺靶区的选择，并可靠地预测这些程序在个体患者中的成功。