Rapid Real-Time Cardiovascular MRI for Detecting Coronary Artery Disease

项目概要/摘要：冠状动脉疾病（CAD）是美国疾病和死亡的主要原因。 我们无创性心脏成像在诊断、危险分层和指导治疗方面起着至关重要的作用 已知或疑似CAD患者的决策。然而，目前的成像策略的局限性是 有据可查在之前的一项研究中，近40万名没有已知心脏病的患者接受了 在积极的预试验后进行选择性心导管插入术（主要是负荷超声心动图和核 灌注成像），其中约60%被发现没有阻塞性CAD。根据最近的 根据AHA指南，辐射风险是选择诊断测试时的重要考虑因素。确实有 未满足的临床需求是推进无辐射诊断成像测试，以准确诊断功能性 严重梗阻性CAD。 由于没有一个单一的测试是100%准确的，一种提高准确性的经济有效的方法是执行一个 在单一模式下进行全面评估。在可用的心脏成像模式中，MRI是 可以说是最通用的，能够全面评估CAD，包括心脏功能， 灌注、冠状动脉血管造影和活力，而不需要电离辐射。尽管作出了重大的 从基础研究和临床试验的成功，甚至经过几十年的进步，心脏MRI 继续受到以下因素的阻碍：（i）检查时间长（约60-90分钟），（ii）操作复杂性，例如呼吸- 保持要求，和（iii）心律失常患者的不良表现。为了克服这些障碍， 我们将开发一种快速（15分钟）、实时（心律失常和运动不敏感）的心血管MRI方案， 可以在自由呼吸期间进行，同时产生与标准临床诊断相当的诊断准确性。 MRI方案（60-90分钟）。 本申请的中心假设是快速（15分钟）MRI方案可产生诊断准确性 与标准临床MRI方案相当。支持测试我们的中央的具体目标 假设是：（1）开发快速图像采集和重建方法， 简化了检测CAD的单一方案;（2）评价快速和标准之间的一致性 核磁共振结果。这项研究利用了西北大学现有的广泛的临床和研究资源 （每年约200次心脏负荷MRI扫描;心血管成像研究）。快速自由呼吸核磁共振 协议是MRI技术向前迈出的重要一步，因为它将大大提高扫描效率， 简化扫描操作，减少专业知识和资源有限的成像中心的财务负担 提供心血管MRI作为常规临床服务。成功的3年R 01应用将产生 进行旨在验证快速MRI诊断准确性的更新申请所需的初步数据 在多个研究中心的不同人群中进行导管X射线血管造影的方案。

Project Summary/Abstract: Coronary artery disease (CAD) is a leading cause of sickness and death in the US. Noninvasive cardiac imaging plays a vital role in diagnosing, risk stratifying, and guiding treatment decisions in patients with known or suspected CAD. However, the limitations of current imaging strategies are well documented. In a previous study of nearly 400,000 patients without known heart disease undergoing elective cardiac catheterization following a positive pre-test (mostly stress echocardiography and nuclear perfusion imaging), approximately 60% of them were found to not have obstructive CAD. According to recent AHA guidelines, radiation risk is an important consideration when choosing a diagnostic test. Indeed, there is an unmet clinical need to advance radiation-free diagnostic imaging tests for accurate diagnosis of functionally significant obstructive CAD. Since no single test is 100% accurate, one cost-effective approach to increase accuracy is to perform a comprehensive assessment within a single modality. Among available cardiac imaging modalities, MRI is arguably the most versatile and capable of a comprehensive evaluation of CAD, including cardiac function, perfusion, coronary angiography, and viability, while not requiring ionizing radiation. Despite substantial successes from both basic research and clinical trials, and even after decades of advancements, cardiac MRI continues to be hampered by (i) long exam times (~ 60-90 min), (ii) complexities in operation such as breath- holding requirements, and (iii) poor performance in patients with arrhythmias. To overcome these obstacles, we will develop a rapid (15 min), real-time (arrhythmia and motion insensitive) cardiovascular MRI protocol that can be performed during free breathing, while producing diagnostic accuracy comparable to a standard clinical MRI protocol (60-90 min). The central hypothesis of this application is that a rapid (15-min) MRI protocol produces diagnostic accuracy comparable to a standard clinical MRI protocol. The specific objectives in support of testing our central hypothesis are: (1) to develop rapid image acquisition and reconstruction methods that will be integrated into a single protocol streamlined for detecting CAD and (2) to evaluate the agreement between rapid and standard MRI results. This study leverages extensive clinical and research resources existing at Northwestern University (~200 cardiac stress MRI scans per year; cardiovascular imaging research). A rapid, free-breathing MRI protocol is a major step forward in MRI technology, because it will dramatically increase scan efficiency, simplify scan operation, and reduce financial burdens for imaging centers with limited expertise and resources to offer cardiovascular MRI as a routine clinical service. Success of this 3-year R01 application will yield preliminary data needed to pursue a renewal application aimed at validating diagnostic accuracy of a rapid MRI protocol against catheter X-ray angiography in a diverse population at multiple sites.