Non-Contrast Magnetic Resonance Angiography of Peripheral Vascular Disease

周围血管疾病的非对比磁共振血管造影

• 批准号: 8206849
• 负责人: Robert R. Edelman
• 金额: $ 48.36万
• 依托单位: NORTHSHORE UNIVERSITY HEALTHSYSTEM
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-03-01 至 2013-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8206849
• 关键词: Affect; Angiography; Arrhythmia; Arteries; Atrial Fibrillation; Blood; Blood Vessels; Blood flow; Caliber; Cardiac; Cardiovascular system; Cine Magnetic Resonance Imaging; Clinical; Clinical Trials; Contrast Media; Dependence; Diagnosis; Diagnostic Imaging; Disease; Exercise; Fatty acid glycerol esters; Fibrosis; Goals; Health; Image; Impaired Renal Function; Kidney; Knowledge; Location; Magnetic Resonance Angiography; Methodology; Methods; Modeling; Morbidity - disease rate; Morphologic artifacts; Motion; Patients; Pattern; Pelvis; Peripheral; Peripheral Vascular Diseases; Physiologic pulse; Procedures; Pulsatile Flow; Recovery; Reporting; Resolution; Risk; Signal Transduction; Slice; Techniques; Technology; Testing; Thick; Time; Tissues; United States; base; cost; data acquisition; diagnostic accuracy; heart rhythm; image reconstruction; improved; mortality; new technology; novel strategies; patient safety; research study; simulation

DESCRIPTION (provided by applicant): Peripheral vascular disease (PVD) affects 8 million people in the United States, causes significant morbidity, and is associated with cardiovascular mortality. Given that many patients with PVD also suffer from impaired renal function, one must exercise caution in using CE-MRA because of concerns about the risks of nephrogenic systemic fibrosis (NSF), a serious and potentially lethal disorder. Recently, non-enhanced MRA techniques have been proposed to eliminate the risk of NSF. The overall goal of this proposal is to implement a methodology for non-contrast peripheral MRA that is insensitive to the timing of peak systolic flow; moreover, the technology should be fast, insensitive to patient motion, and accurate. For this purpose, we have implemented a novel approach consisting of a fat suppressed, single shot 2D saturation-recovery trueFISP (SR-TFI) pulse sequence. Although this approach for non-contrast MRA has not been previously reported, our initial clinical trials demonstrate excellent results even in the presence of severe PVD. The method does not require prior knowledge of flow patterns and eliminates the need for cine MRI to determine the timing of peak flow velocity, a requirement for FBI. Moreover, the method is less sensitive to patient motion than FBI and has proven robust for imaging of the pelvic arteries. For the small subset of patients in whom it is not possible to synchronize the data acquisition to the cardiac cycle (e.g. due to atrial fibrillation or other cardiac arrhythmias), we propose the use of ungated Ghost MRA. Ghost MRA uses the ghost artifacts generated by pulsatile flow to create an MRA with no signal contribution from background tissues. Our specific aims are: Specific Aim 1: To optimize multi-station flow-insensitive SR-TFI of the peripheral arteries with a total acquisition time < 10 minutes using spatial resolution on the order of 1-2 mm3. Specific Aim 2: To implement multi-station flow-dependent (Ghost) MRA of the peripheral arteries with an image acquisition time < 5 minutes per station using spatial resolution on the order of 1 mm. Specific Aim 3: Evaluate non-contrast MRA in comparison with CE-MRA and/or x-ray DSA in patients PUBLIC HEALTH RELEVANCE: We have developed a set of novel technologies that will largely eliminate the need to administer contrast agents during magnetic resonance angiography in order to diagnose peripheral vascular disease. This study will result in better image quality, greater diagnostic accuracy, lower procedure cost, and enhanced patient safety.

描述（由申请人提供）：外周血管疾病（PVD）影响美国800万人，导致显著的发病率，并与心血管死亡率相关。鉴于许多PVD患者也患有肾功能受损，由于担心肾源性系统性纤维化（NSF）的风险，因此必须谨慎使用CE-MRA，NSF是一种严重且可能致命的疾病。最近，有人提出了非增强MRA技术来消除NSF的风险。本提案的总体目标是实施一种对收缩期峰值血流时间不敏感的非造影外周MRA方法;此外，该技术应快速、对患者运动不敏感且准确。为此，我们已经实现了一种新的方法，包括脂肪抑制，单次拍摄的2D饱和恢复真FISP（SR-TFI）脉冲序列。虽然这种方法的非对比MRA以前没有报道，我们的初步临床试验表明，即使在严重的PVD的存在下，良好的结果。该方法不需要事先了解流动模式，并消除了电影MRI的需要，以确定峰值流速的时间，FBI的要求。此外，该方法对患者运动的敏感性低于FBI，并且已经证明对于盆腔动脉的成像是稳健的。对于不可能将数据采集与心动周期同步的一小部分患者（例如，由于房颤或其他心律失常），我们建议使用非门控Ghost MRA。Ghost MRA使用脉动流产生的Ghost伪影来创建没有来自背景组织的信号贡献的MRA。 我们的具体目标是：具体目标1：优化外周动脉的多站流量不敏感SR-TFI，总采集时间< 10分钟，空间分辨率约为1-2 mm 3。 具体目标二：在空间分辨率为1 mm的情况下，实现外周动脉的多站流量依赖（Ghost）MRA，每个站的图像采集时间< 5分钟。具体目标3：与患者的CE-MRA和/或X射线DSA相比，评价非造影MRA 公共卫生相关性：我们已经开发了一套新的技术，将在很大程度上消除磁共振血管造影术期间管理造影剂，以诊断外周血管疾病的需要。该研究将带来更好的图像质量、更高的诊断准确性、更低的手术成本和更高的患者安全性。