4D DSA and 4D Fluoroscopy: Validation of Diagnostic and Therapeutic Capabilities

4D DSA 和 4D 透视：诊断和治疗能力的验证

• 批准号: 8608595
• 负责人: Charles A. Mistretta
• 金额: $ 60.3万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-02-01 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8608595
• 关键词: Acceleration; Agreement; Algorithms; Angiography; Animals; Area; Arteries; Blood Vessels; Clinical; Computer software; Contrast Media; Devices; Diagnostic; Dose; Engineering; Evaluation; Fluoroscopy; Gadolinium; Human; Image; Imagery; Injection of therapeutic agent; Intervention; Intra-Arterial Injections; Intravenous; Laboratories; Maps; Measurement; Medical Imaging; Methods; Modality; Movement; Operative Surgical Procedures; Patients; Phase; Positioning Attribute; Procedures; Process; Radiology Specialty; Reporting; Research; Research Design; Resolution; Retrospective Studies; Roentgen Rays; Safety; Savings; Series; System; Techniques; Therapeutic; Time; Translations; Validation; Veins; Work; arm; base; clinical practice; digital imaging; gadolinium oxide; image reconstruction; intravenous injection; pre-clinical; pressure; public health relevance; reconstruction; simulation; tool; virtual

DESCRIPTION (provided by applicant): In 1980 when DSA was introduced there was initial enthusiasm that the technique would, for the first time, enable the ability to perform angiographic procedures, on a wide spread basis, using an intravenous injection of contrast medium. Unfortunately, this enthusiasm rather quickly dissipated as it became evident that because of the overlap of arteries and veins on any single projection, multiple acquisitions were required for adequate diagnostic evaluations (each of these was associated with a very significant contrast medium dose as well as additional x-ray exposure). Quickly, the use of the real time digital imaging capabilities was adapted for use with intra-arterial contrast injections. Conventional DSA provides 2D images at variable frame rates (a time series). Similarly, X-ray fluoroscopy offers a 2D display at high frame rates. Over the last 3 decades, DSA has been used primarily in conjunction with intra-arterial injections for diagnostic purposes while other angiographic modalities such as CTA and MRA have been used in connection with intravenous injections. Although current 3D rotational DSA does provide a 3D reconstruction, the images contain no temporal information, and although vessel overlap can be overcome to some extent through the use of rotational views, the combination of arteries and veins in the reconstructed volume often makes optimal visualization difficult. Because of the geometrical constraints that limit positioning of the C-arm gantries fluoroscopy implemented using C-arm systems often cannot provide optimal views for delivery and deployment (working views) of interventional devices. This not only impairs the safety of some interventions but also often results in an inability to offer patients endovascular treatment, requiring that they undergo more invasive traditional surgical interventions. During the past several years we have developed MRA techniques involving sub-Nyquist acquisition and constrained reconstruction that permit acceleration factors up to 1000. These have removed the traditional tradeoffs between spatial and temporal resolution and have provided contrast-enhanced MRA techniques using as little as 1 cc of intravenous gadolinium and phase contrast techniques that have facilitated new applications such as non-invasive measurement of vascular pressure gradients 1-4. The principles of constrained reconstruction have also been extended to other areas of medical imaging where significant dose reductions or SNR increases have been reported 5-7. Many of these principles can be applied to X-ray DSA to greatly increase the rate at which 3D time resolved volumes can be obtained. We have recently developed a C-arm based 4D DSA method that provides a series of fully time resolved 3D DSA volumes (4D-DSA) at frame rates of up to 30/s with higher temporal and spatial resolution than current MRA and CTA techniques. We also have developed a 4D Fluoroscopy method that permits fluoroscopic viewing of virtual roadmaps at any desired angle without a need to reposition the C-arm gantries. The purpose of the proposed research is to validate these techniques and to bring them to a point where they are ready for wide spread dissemination and clinical usage.

描述（由申请人提供）：1980 年，当 DSA 被引入时，人们最初热情地认为该技术将首次能够使用静脉注射造影剂在广泛的基础上进行血管造影手术。不幸的是，这种热情很快就消散了，因为很明显，由于任何单个投影上动脉和静脉的重叠，需要多次采集才能进行充分的诊断评估（每一次采集都与非常显着的造影剂剂量以及额外的 X 射线暴露相关）。很快，实时数字成像功能的使用就适应了动脉内造影剂注射。 传统 DSA 以可变帧速率（时间序列）提供 2D 图像。同样，X 射线透视提供高帧速率的 2D 显示。在过去 30 年中，DSA 主要与动脉内注射结合用于诊断目的，而其他血管造影方法（例如 CTA 和 MRA）已与静脉注射结合使用。尽管当前的 3D 旋转 DSA 确实提供了 3D 重建，但图像不包含时间信息，并且尽管可以通过使用旋转视图在一定程度上克服血管重叠，但重建体积中动脉和静脉的组合通常使最佳可视化变得困难。由于几何限制限制了使用 C 形臂系统实施的 C 形臂机架荧光检查的定位，因此通常无法提供介入设备的输送和部署（工作视图）的最佳视图。这不仅损害了某些干预措施的安全性，而且常常导致无法为患者提供血管内治疗，从而要求他们接受更具侵入性的传统手术干预措施。在过去的几年中，我们开发了涉及亚奈奎斯特采集和约束重建的 MRA 技术，允许高达 1000 的加速因子。这些技术消除了空间和时间分辨率之间的传统权衡，并提供了使用少至 1 cc 静脉注射钆的对比增强 MRA 技术和相位对比技术，促进了新应用，例如非侵入性测量 血管压力梯度1-4。约束重建的原理也已扩展到医学成像的其他领域，据报道，这些领域的剂量显着减少或信噪比增加 5-7。其中许多原理可应用于 X 射线 DSA，以大大提高获得 3D 时间分辨体积的速率。我们最近开发了一种基于 C 形臂的 4D DSA 方法，该方法以高达 30/s 的帧速率提供一系列完全时间分辨的 3D DSA 体积 (4D-DSA)，具有比当前 MRA 和 CTA 技术更高的时间和空间分辨率。我们还开发了一种 4D 荧光检查方法，允许以任何所需角度荧光检查虚拟路线图，而无需重新定位 C 形臂机架。拟议研究的目的是验证这些技术，并使它们能够广泛传播和临床使用。