Prediction and assessment of COPD lung volume reduction outcomes with polarized MRI

使用偏振 MRI 预测和评估 COPD 肺减容结果

• 批准号: 9051246
• 负责人: RAHIM R RIZI
• 金额: $ 75.7万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2020-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9051246
• 关键词: Ablation; Address; Affect; Air; Alveolar; Animals; Area; Attenuated; Chronic Obstructive Airway Disease; Clinical; Communities; Data; Decision Making; Defect; Development; Devices; Diffusion; Disease; Dyspnea; Effectiveness; Elastases; Ensure; Environmental air flow; Evaluation; Excision; Exertion; Future; Gases; Goals; Health; High Prevalence; High Resolution Computed Tomography; Image; Intervention; Longitudinal Studies; Lung; Lung Volume Reductions; Lung diseases; Lung volume reduction surgery; Magnetic Resonance Imaging; Maps; Measures; Medical; Methods; Modeling; Morbidity - disease rate; Nature; Operative Surgical Procedures; Oryctolagus cuniculus; Outcome; Oxygen; Palliative Care; Patients; Pattern; Performance; Perfusion; Phase; Physical Capacity; Physiological; Procedures; Public Health; Pulmonary Emphysema; Pulmonary Function Test/Forced Expiratory Volume 1; Pulmonary function tests; Research; Resected; Respiratory physiology; Smoke; Smoker; Smoking; Spirometry; Staging; Symptoms; Techniques; Technology; Therapeutic; Thick; Tissues; Uncertainty; United States; X-Ray Computed Tomography; base; cohort; cost; disability; exercise capacity; improved; individual patient; innovation; mortality; public health relevance; pulmonary function; response; years lived with disability

 DESCRIPTION (provided by applicant): Chronic obstructive pulmonary disease (COPD) is an increasingly urgent public health concern on both the national and global levels. Not only is the disorder a major cause of mortality, but the dyspnea, reduced capacity for physical exertion, and periodic exacerbations that it causes result in tremendous disability and cost. Treatment options for established COPD remain limited in number, diversity, and effectiveness. However, in recent years, significant innovation has been accomplished in the field of lung volume reduction (LVR), which seeks to enhance global lung function through the removal, occlusion, or obliteration of hyperinflated, emphysematous regions. While LVR has traditionally been implemented through surgical resection, the development of less invasive bronchoscopic techniques (BLVR) is ongoing and represents an extremely promising arena of COPD therapy. This application proposes to develop a hyperpolarized 129Xe magnetic resonance imaging (HP 129Xe MRI) approach for planning BLVR intervention and assessing its pulmonary effects. The core problem faced by all LVR approaches is that they have demonstrated highly variable outcomes; it consequently remains unclear exactly what types of patient will benefit most from this therapy and why. Clinicians currently base their decisions of whether to carry out LVR and which regions to target using high-resolution computed tomography (HRCT) to measure the extent of emphysema and its distribution. While HRCT is highly capable of accurately assessing these features, it does not provide the functional information necessary to gain a comprehensive understanding of an individual patient's regional pulmonary status. We thus posit that the incorporation of functional parameters obtained with HP 129Xe MRI will allow for more informed decision-making in regards to which patients should undergo LVR and how the procedure should be tailored according to the lung health of the particular patient. In applying HP 129Xe MRI to this medical area of need, a corollary goal will be achieved: the refinement of this hyperpolarized technique such that it can extract pulmonary information with the sensitivity of the more well-established HP 3He MRI approach. 3He has become drastically more expensive in recent years due to its scarcity, and the hyperpolarized community recognizes that a shift to the much less expensive and more easily obtainable 129Xe is necessary to ensure the translational applicability of this important technology. We seek here to use Xe to derive three lung parameters-specific ventilation (SV), alveolar oxygen tension (pAO2), 129 and apparent diffusion coefficient (ADC)-with approximately the same sensitivity and efficiency that we have previously attained using 3He. This development will enhance the clinical future of hyperpolarized MRI not only in the area of LVR, but also in the non-invasive assessment of COPD and lung diseases more broadly.

 描述(申请人提供)：慢性阻塞性肺疾病(COPD)在国家和全球层面上都是一个日益紧迫的公共卫生问题。这种疾病不仅是死亡的主要原因，而且呼吸困难、体力活动能力下降以及由此导致的周期性恶化都会导致巨大的残疾和成本。已确诊的COPD的治疗选择在数量、多样性和有效性方面仍然有限。然而，近年来，肺减容术(LVR)领域取得了重大创新，它寻求通过移除、闭塞或闭塞过度膨胀的肺气肿区域来增强全球肺功能。虽然传统上肺减容术是通过手术切除实施的，但侵入性较小的支气管镜技术(BLVR)的发展正在进行中，代表着COPD治疗的一个非常有前途的领域。本申请建议开发一种超极化129Xe磁共振成像(HP 129Xe MRI)方法，用于计划BLVR干预和评估其对肺的影响。所有LVR方法面临的核心问题是，它们显示了高度不同的结果；因此，目前尚不清楚哪种类型的患者将从这种治疗中受益最多，以及为什么。目前，临床医生使用高分辨率计算机断层扫描(HRCT)来测量肺气肿的程度及其分布，以决定是否进行LVR以及针对哪些区域。虽然HRCT能够高度准确地评估这些特征，但它不能提供全面了解单个患者的区域肺状况所需的功能信息。因此，我们认为，结合HP 129Xe MRI获得的功能参数将允许就哪些患者应该接受LVR以及如何根据特定患者的肺部健康情况做出更明智的决策。在将HP 129Xe MRI应用于这一医疗需求领域时，将实现一个必然的目标：改进这种超极化技术，使其能够以更成熟的HP 3He MRI方法的灵敏度提取肺部信息。3近年来，由于129Xe的稀缺性，它的价格急剧上升，而两极分化的社区认识到，为了确保这项重要技术的翻译适用性，有必要转向成本低得多、更容易获得的129Xe。在这里，我们寻求使用Xe来推导三个肺参数--比通气量(SV)、肺泡氧分压(PAO2)、129和表观弥散系数(ADC)--其灵敏度和效率与我们以前使用3He获得的大致相同。这一进展将增强超极化MRI的临床前景，不仅在LVR领域，而且在更广泛的COPD和肺部疾病的无创性评估中。