Identifying CT Imaging Biomarkers Associated with Prognosis of Pulmonary Embolism

识别与肺栓塞预后相关的 CT 成像生物标志物

• 批准号: 8311726
• 负责人: KYONGTAE T BAE
• 金额: $ 69.26万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-26 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8311726
• 关键词: Acute; Admission activity; Anatomy; Angiography; Anticoagulants; Archives; Biological Markers; Blood Vessels; Caliber; Cessation of life; Characteristics; Clinical; Clinical Management; Clinical Treatment; Clinical Trials; Coagulation Process; Comorbidity; Complex; Cost Control; Data; Databases; Deep Vein Thrombosis; Deposition; Diagnosis; Diagnostic; Diagnostic Imaging; Disease; Embolism; Enrollment; Goals; Health; Health Care Costs; Health system; Image; Incidence; Interobserver Variability; Intraobserver Variability; Left ventricular structure; Lung; Measurement; Measures; Medical; Medical center; Modeling; Outcome; Patients; Pennsylvania; Performance; Personal Satisfaction; Prevention therapy; Prophylactic treatment; Pulmonary Embolism; Pulmonary Emphysema; Radiology Specialty; Records; Recurrence; Research; Resolution; Retrieval; Risk; Risk Assessment; Role; Scanning; Source; Speed; Structure; System; Techniques; Testing; Thromboembolism; United States; Universities; Veins; Venous; Washington; Work; X-Ray Computed Tomography; abstracting; cohort; coronary artery calcification; design; disability; follow-up; hospital readmission; image processing; improved; indexing; innovation; insight; outcome forecast; patient population; prognostic; programs; prospective; public health relevance; tool

DESCRIPTION (provided by applicant): Identifying CT Imaging Biomarkers Associated with Prognosis of Pulmonary Embolism Abstract Venous thromboembolism (VTE), which clinically manifests as deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common but elusive illness that can cause significant disability and death if not promptly diagnosed and effectively treated. The annual incidence of VTE in the United States is estimated at 1 per 1000. Death occurs in approximately 12% of PE cases within 1 month of diagnosis. At present, clinical management of VTE and PE is hampered by gaps in our understanding of pathogenic mechanisms, the wide variety in patient populations, and incomplete understanding of the long term risks of recurrence and death. Given the complex presentation and risk associated with these conditions, proper risk assessment and subsequent prophylaxis for all at-risk patients is crucial. While clinical prediction rules have been recently developed to associate short-term risks and to stratify patients with acute PE, there is a dearth of objective biomarkers that can be related to the long-term prognosis of the disease. In addition to clinical information, clot burden is known to be strongly associated with clinical outcome of recurrent VTE. The quantification of clot burden requires imaging. CT Pulmonary Angiography (CTPA) has been established as a reference imaging standard in the diagnosis of PE. In addition to its role as a superb diagnostic tool, CTPA contains a wealth of information including characteristics of the clot that may be used as biomarkers associated with prognosis of PE. The work proposed in this application takes advantage of widely available CTPA imaging biomarker data and extends and advances clinical PE risk prediction model to include long term (2-year) survival as well as the clinically important outcome of recurrence. The primary objective of this proposal is to develop and identify CTPA imaging biomarkers that are associated with short-term and long-term prognoses of patients who were positively diagnosed for PE by CT. The rationale for this proposal is that CT imaging is a rich source of imaging biomarkers that may be associated with prognosis of PE. This information will help advance our understanding of the risk and recurrence of PE and provide a new insight to prognosis and clinical management and treatment of PE. This proposed research is innovative in that we have developed new CT imaging biomarkers and designed a clinical trial to assess and validate the prognostic values of these biomarkers. Our central hypothesis is that CT imaging biomarkers are associated with the risk of death and recurrence in patients with PE. The specific aims of this proposal are: (1) to quantify and characterize pulmonary emboli (volume and distribution) and comorbid cardiovasculopulmonary findings from CT images of patients who were positively diagnosed for PE by CT; (2) to identify CT imaging biomarkers that are associated with the prognosis of patients who were positively diagnosed for PE by CT, and to develop risk prediction tools for death and recurrence; and (3) to prospectively validate the risk prediction tool, and identify whether the change in CT imaging biomarkers of PE after initiation of therapy improve the predictive ability for recurrence and death. Public Health Relevance: The work proposed in this application takes advantage of widely available CTPA imaging biomarker data and extends and advances clinical PE risk prediction model to include long term (2-year) survival as well as the clinically important outcome of recurrence. We believe the proposed study is timely and will provide a new insight to prognosis and clinical management and treatment of PE.

描述(由申请人提供)： 摘要静脉血栓栓塞症(VTE)，临床表现为深静脉血栓形成(DVT)和肺栓塞(PE)，是一种常见但难以捉摸的疾病，如不及时诊断和有效治疗，可导致严重的残疾和死亡。据估计，美国每年的VTE发病率为千分之一。约12%的PE病例在确诊后1个月内死亡。目前，VTE和PE的临床管理受到以下因素的阻碍：我们对发病机制的了解存在差距，患者群体的种类繁多，以及对复发和死亡的长期风险认识不完全。考虑到与这些情况相关的复杂表现和风险，对所有高危患者进行适当的风险评估和随后的预防是至关重要的。虽然最近开发了临床预测规则来关联短期风险并将患者与急性PE分层，但缺乏与疾病长期预后相关的客观生物标志物。除了临床信息外，已知血栓负荷与复发性静脉血栓栓塞症的临床结果密切相关。血块负荷的量化需要成像。CT肺血管造影(CTPA)已被确立为诊断PE的参考影像标准。除了作为一种极好的诊断工具的作用外，CTPA还包含丰富的信息，包括血栓的特征，这些特征可能被用作与PE预后相关的生物标志物。本申请中提出的工作利用了广泛可用的CTPA成像生物标记物数据，并扩展和改进了临床PE风险预测模型，以包括长期(2年)生存以及临床上重要的复发结果。这项建议的主要目标是开发和识别CTPA成像生物标记物，这些标记物与CT阳性PE患者的短期和长期预后相关。这一建议的基本原理是，CT成像是一个丰富的成像生物标志物来源，可能与PE的预后相关。这些信息将有助于提高我们对PE的风险和复发的认识，并为PE的预后和临床管理治疗提供新的视角。这项拟议的研究具有创新性，因为我们开发了新的CT成像生物标记物，并设计了一项临床试验来评估和验证这些生物标记物的预后价值。我们的中心假设是CT成像生物标记物与PE患者的死亡和复发风险有关。这一建议的具体目的是：(1)量化和表征经CT确诊为PE的患者的CT图像中的肺血栓(体积和分布)及其合并心血管病变；(2)确定与CT确诊为PE患者的预后相关的CT成像生物标志物，并开发死亡和复发的风险预测工具；(3)前瞻性验证风险预测工具，并确定开始治疗后PE的CT成像生物标志物的变化是否提高了预测复发和死亡的能力。公共卫生相关性：本申请中提出的工作利用了广泛可用的CTPA成像生物标记物数据，并扩展和改进了临床PE风险预测模型，以包括长期(2年)生存以及临床上重要的复发结果。我们相信，这项研究是及时的，将为PE的预后和临床管理和治疗提供新的见解。

项目成果

The rate of resolution of clot burden measured by pulmonary CT angiography in patients with acute pulmonary embolism.

• DOI: 10.2214/ajr.12.8624
• 发表时间: 2013-04
• 期刊: AJR. American journal of roentgenology
• 作者: Aghayev A;Furlan A;Patil A;Gumus S;Jeon KN;Park B;Bae KT
• 通讯作者: Bae KT

Accuracy and reproducibility of blood clot burden quantification with pulmonary CT angiography.

肺 CT 血管造影血凝块负荷定量的准确性和可重复性。

• DOI: 10.2214/ajr.10.4603
• 发表时间: 2011
• 期刊: AJR. American journal of roentgenology
• 作者: Furlan,Alessandro;Patil,Amol;Park,Bumwoo;Chang,Chung-ChouH;Roberts,MarkS;Bae,KyongtaeT
• 通讯作者: Bae,KyongtaeT