Novel Myocardial Perfusion Stress Test using Arterial Spin Labeling

使用动脉旋转标记的新型心肌灌注压力测试

• 批准号: 9751363
• 负责人: Krishna S Nayak
• 金额: $ 50.38万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9751363
• 关键词: Address; American; Angiography; Animal Model; Animals; Aorta; Blood; Blood flow; Brain; Calibration; Cardiac; Cardiac health; Cardiology; Cardiovascular system; Chronic Kidney Failure; Clinical; Contrast Media; Coronary; Coronary Angiography; Coronary Arteriosclerosis; Coronary Stenosis; Coronary artery; Detection; Diagnostic; Diastole; End stage renal failure; Engineering; Evaluation; Family suidae; Gadolinium; General Population; Goals; Growth; Heart; Heart Diseases; Human; Image; Intervention; Intravenous; Ionizing radiation; Ions; Kidney; Kidney Failure; Label; Left; Left ventricular structure; Liver; Magnetic Resonance Imaging; Measurement; Measures; Methods; Modeling; Morphologic artifacts; Motion; Motivation; Myocardial Ischemia; Myocardial perfusion; Myocardial tissue; Noise; Operative Surgical Procedures; Patient Recruitments; Patients; Performance; Perfusion; Photons; Physiologic pulse; Positron-Emission Tomography; Prevalence; Pulsatile Flow; Radiation Dose Unit; Radioisotopes; Regional Perfusion; Renal function; Reproducibility; Research; Risk; Role; Safety; Scanning; Schedule; Scheme; Severities; Signal Transduction; Slice; Source; Spin Labels; Stress; Stress Tests; Students; Subgroup; Supervision; Systole; Techniques; Technology; Testing; Thallium Myocardial Perfusion Imaging Stress Test; Time; Tissues; United States; Variant; Vasodilation; Ventricular; Work; X-Ray Computed Tomography; base; cardiovascular imaging; clinically relevant; cost; experience; experimental study; heart motion; high risk; imaging modality; innovation; interest; method development; mortality; novel; novel strategies; patient screening; patient subsets; perfusion imaging; public health relevance; radio frequency; research clinical testing; screening; skills; training project; undergraduate student

 DESCRIPTION (provided by applicant): This project will develop a new ultra-safe technique for myocardial perfusion stress testing in humans. Rationale: A growing number of patients in the United States require frequent cardiovascular assessment, to determine the presence and significance of coronary artery disease (CAD). Non-invasive myocardial perfusion stress testing is a method of choice, but we are not able to use current tests as frequently as we would like in these patients due to ionizing radiation and/or risks associated with contrast agents. Our proposed technique will not require any ionizing radiation or any potentially toxic contrast agents, and could therefore be performed repeatedly with no incremental risk to the patient. Innovation: We will utilize arterial spin labeled magnetic resonance imaging (ASL-MRI), an established technology for measuring brain perfusion in humans and myocardial perfusion in small animals. To our knowledge, its application to clinical myocardial perfusion imaging and stress testing is novel. Current methods for human cardiac ASL are able to detect increases in blood flow due to vasodilation, but provide only single slice coverage and barely adequate measurement variability (per-segment variations of roughly 0.16 mL-blood / g-tissue / min). We will address these limitations by developing and optimizing innovative new labeling schemes that enable evaluation of all 17 left ventricular segments, while taking into account cardiac motion, pulsatile flow, and potential sources of artifact. We will also integrate several new MRI technologies, for the first time, into the cardiac ASL experiment: simultaneous multi-slice imaging, background suppression, and blood pool suppression. Approach: The new test will be developed and experimentally optimized in a porcine model of CAD. We will first develop and optimize a labeling method that is compatible with whole-heart spatial coverage and maximizes the strength of the ASL signal. We will then develop and optimize an imaging method that interrogates all 17 left ventricular segments and maximizes the ASL temporal signal-to-noise ratio. After this is completed, we will perform a clinical evaluation of the optimized ASL-MRI stress test in patients with suspected CAD, and will compare the new test with both single-photon emitted computed tomography (SPECT) and invasive coronary angiography with fractional flow reserve (FFR). We will determine test-retest reproducibility of the new test in a subset of the patients. This study will enable whole-heart ASL-MRI stress testing, optimize and validate its ability to measure myocardial perfusion reserve, and enhance its feasibility as a firs-line test for CAD screening. Broader Impact: The proposed myocardial perfusion stress test could have a broader role for screening of patients with suspected CAD, due to its safety and its potential for simplicity and low cost. The technical work, particularly the labeling and imaging schemes, are likely to have implications for kidney and liver ASL-MRI. Finally, this work will provide training projects for postdoctoral, graduate, and undergraduate engineering students and clinical fellows interested in advanced cardiovascular imaging.

 描述（由申请人提供）：本项目将开发一种用于人体心肌灌注负荷试验的新的超安全技术。基本原理：在美国，越来越多的患者需要频繁的心血管评估，以确定冠状动脉疾病（CAD）的存在和意义。非侵入性心肌灌注负荷试验是一种可选择的方法，但由于电离辐射和/或造影剂相关风险，我们无法在这些患者中频繁使用当前的试验。我们提出的技术不需要任何电离辐射或任何潜在毒性的造影剂，因此可以重复进行，不会增加患者的风险。创新：我们将利用动脉自旋标记磁共振成像（ASL-MRI），这是一种用于测量人类脑灌注和小动物心肌灌注的成熟技术。据我们所知，其应用于临床心肌灌注成像和负荷试验是新颖的。目前用于人类心脏ASL的方法能够检测由于血管舒张引起的血流增加，但仅提供单个切片覆盖和几乎不充分的测量可变性（每段变化约为0.16 mL-血液/g-组织/ min）。我们将通过开发和优化创新的新标记方案来解决这些局限性，这些方案能够评价所有17个左心室节段，同时考虑心脏运动、脉动流和伪影的潜在来源。我们还将首次将几种新的MRI技术整合到心脏ASL实验中：同步多层成像，背景抑制和血池抑制。方法：将在CAD猪模型中开发并实验优化新试验。我们将首先开发和优化一种标记方法，该方法与全心脏空间覆盖兼容，并最大限度地提高ASL信号的强度。然后，我们将开发和优化一种成像方法，询问所有17个左心室段，并最大限度地提高ASL的时间信噪比。完成后，我们将在疑似CAD患者中对优化的ASL-MRI负荷试验进行临床评价，并将新试验与单光子发射计算机断层扫描（SPECT）和有创冠状动脉造影术（血流储备分数（FFR））进行比较。我们将在一部分患者中确定新检测的重复性。这项研究将实现全心脏ASL-MRI负荷测试，优化和验证其测量心肌灌注储备的能力，并增强其作为CAD筛查一线测试的可行性。更广泛的影响：由于其安全性和潜在的简单性和低成本，拟议的心肌灌注负荷试验可能在疑似CAD患者的筛查中发挥更广泛的作用。技术工作，特别是标记和成像方案，可能对肾脏和肝脏ASL-MRI产生影响。最后，这项工作将提供培训项目的博士后，研究生和本科生工程专业的学生和临床研究员感兴趣的先进的心血管成像。

项目成果

Demonstration of velocity selective myocardial arterial spin labeling perfusion imaging in humans.

• DOI: 10.1002/mrm.26994
• 发表时间: 2018-07
• 期刊: Magnetic resonance in medicine
• 影响因子: 3.3
• 作者: Jao TR;Nayak KS
• 通讯作者: Nayak KS

Analysis of physiological noise in quantitative cardiac magnetic resonance.

定量心脏磁共振中的生理噪声分析。

• DOI: 10.1371/journal.pone.0214566
• 发表时间: 2019
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Jao,Terrence;Nayak,Krishna
• 通讯作者: Nayak,Krishna

Myocardial blood flow is the dominant factor influencing cardiac magnetic resonance adenosine stress T2.

• DOI: 10.1002/nbm.4643
• 发表时间: 2022-03
• 期刊: NMR in biomedicine
• 影响因子: 2.9
• 作者: Weyers JJ;Ramanan V;Javed A;Barry J;Larsen M;Nayak K;Wright GA;Ghugre NR
• 通讯作者: Ghugre NR

Iterative correction of RF envelope distortion with GRATER-measured waveforms.

使用 GRATER 测量波形迭代校正 RF 包络失真。

• DOI: 10.1002/mrm.27930
• 发表时间: 2020
• 期刊: Magnetic resonance in medicine
• 影响因子: 3.3
• 作者: Landes,VanessaL;Nayak,KrishnaS
• 通讯作者: Nayak,KrishnaS

Contrast-optimal simultaneous multi-slice bSSFP cine cardiac imaging at 0.55 T.

0.55 T 下的对比度最佳同步多切片 bSSFP 电影心脏成像。

• DOI: 10.1002/mrm.29472
• 发表时间: 2023-02
• 期刊: MAGNETIC RESONANCE IN MEDICINE
• 影响因子: 3.3
• 作者: Tian, Ye;Cui, Sophia X.;Lim, Yongwan;Lee, Nam G.;Zhao, Ziwei;Nayak, Krishna S.
• 通讯作者: Nayak, Krishna S.