Quantitative Adenosine Stress CMR with Spiral Pulse Sequences

螺旋脉冲序列定量腺苷应激 CMR

• 批准号: 8466371
• 负责人: Michael Salerno
• 金额: $ 14.65万
• 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/8466371
• 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(申请人提供)：这个职业发展奖项目的目标是发展Michael Salerno医学博士的研究技能，成为一名独立的研究员，参与心血管成像领域以患者为导向的研究。临床研究的必要指导将由他的临床导师克里斯托弗·克莱默博士和医学博士提供，工程指导将由他的共同导师克雷格·迈耶博士提供。一个顾问委员会将进一步丰富他的职业生涯，该委员会包括开发用于心肌灌注成像的快速脉冲序列、定量灌注以及临床试验的统计设计和分析的专家。弗吉尼亚大学将提供萨勒诺博士成为独立研究员所需的理想资源组合。这项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。这一培训将导致获得统计学硕士学位，重点是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跨学科工程和临床专业知识组合，将新的CMR技术转化为临床实践。他的临床研究技能的进一步发展将大大增加他在这一努力中取得成功的可能性，他的教学培训和导师互动都将因此而获得CAREE发展奖。与其他成像技术相比，腺苷负荷灌注CMR具有多方面的优点，包括缺乏电离辐射、高空间分辨率以及准确量化心肌灌注和缺血负荷等，正成为评价冠状动脉疾病的一种有前途的方法。目前的CMR首过灌注技术受到“暗边缘”伪影的限制，这些伪影可能被误认为真正的灌注异常，从而导致视觉分析的假阳性研究，并可能阻碍定量方法对心肌灌注的准确定量。此外，这些技术在时间分辨率、空间分辨率和脑室覆盖率方面仍然受到限制。我们假设螺旋脉冲序列对这些伪影是稳健的，同时具有提供高时间和空间分辨率的全脑室灌注定量的效率。此外，我们假设这些技术将导致一个强大的腺苷应激CMR的临床方案，它将具有高度的特异性。该项目的具体目标是：(1)开发基于螺旋的灌注脉冲序列，在全心脏覆盖范围内执行心肌灌注的绝对定量。(2)用螺旋运动轨迹评价腺苷负荷CMR对中度冠心病患者心肌血流灌注的定性和定量评价，以FFR作为功能金标准，确定其敏感性和特异性。由于美国每年进行的100多万次心脏插管手术中有近40%没有显示出梗阻性冠心病，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是不必要的侵入性手术而产生的医疗成本。改进的技术还将减少对可疑研究的重复测试，并减少错误诊断的数量。因此，这个项目有可能在改善病人护理的同时减少医疗支出。