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

描述(申请人提供)：我们的总体目标是确定CT和MR成像技术，以最好地指导和告知世界各地正在开发的两种治疗COPD的微创手术疗法：支气管腔内支架支撑的导管从导气管到肺气肿实质，以及支气管腔内单向出口阀，以在严重肺气肿区域实现容量减少。这两种拟议的干预措施都显示出在减少严重肺气肿患者呼吸困难方面的巨大希望，对于严重肺气肿患者，除了肺移植和少数人的肺减容手术外，没有其他治疗选择。尽管前景看好，但目前还没有确定的方法来确定干预或疗效预测的靶区。由于两个原因：人类肺气肿在任何动物模型中都不能很好地复制，以及介入性放置可以在随机位置进行，允许在不考虑患者预后的情况下获得一系列功能结果，以及允许测试关于区域侧支通气量和区域肺功能的基本假设。虽然这里提出的成像程序都是体外的，但它们可以并已经在体内使用。通过将干预后的肺功能改善与定量的3He MRI和CT结果(干预前后)相关联，我们将能够证明肺部成像技术的有效性，以(I)指导在给定肺内的内窥镜瓣膜或支架的安装，以及(Ii)预测给定干预的功能改善结果。这项提议旨在通过在两个地点(华盛顿大学和宾夕法尼亚大学/弗吉尼亚大学)的共同努力，朝着有效和可预测的内窥镜治疗肺气肿迈进一大步。这两个地点在严重COPD的胸部成像和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。两种治疗重度COPD的微创外科手术正在开发中，并显示出巨大的前景，但结果在患者之间存在显着差异。我们通过CT和MRI提出了新的成像方法来测试这些干预措施，以最终改善患者的选择，个体肺靶区的选择，并可靠地预测这些手术在个体患者中的成功。

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.