Hemodynamic and inflammatory imaging in evaluation of abdominal aortic aneurysms

血流动力学和炎症成像评估腹主动脉瘤

基本信息

批准号：
9411005
负责人：
Michael Douglas Hope
金额：
$ 39.14万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-01-01 至 2019-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9411005
关键词：
Abdominal Aortic Aneurysm Anatomy Aneurysm Aortic Diseases Aortitis Blood Vessels Blood flow Caliber Central Artery Cessation of life Clinical Computer Simulation Contrast Media Data Descriptor Dimensions Disease Disease Progression Early Intervention Evaluation Functional Imaging Goals Growth Hematological Disease Image Imaging Techniques Inflammation Inflammatory Intervention Knowledge Life Magnetic Resonance Imaging Measurement Metabolic Motivation Operative Surgical Procedures Outcome Pathologic Patient risk Patients Pattern Phase Population Process Property Regimen Reporting Resources Risk Risk Assessment Rupture Ruptured Abdominal Aortic Aneurysm Series Site Stress Stretching Time Vascular Diseases base experience ferumoxytol hemodynamics improved improved outcome innovation macrophage older men patient stratification public health relevance rapid growth screening shear stress surveillance imaging vascular abnormality

项目摘要

DESCRIPTION (provided by applicant): Abdominal aortic aneurysms (AAA) are common and can be life-threatening if they progress to rupture. They have been reported in 5% of older men and account for over 15,000 deaths per year. Basic vessel dimensions are currently the primary imaging measurement used clinically to risk-stratify patients. But there is more to the story than dimensions. Wall stress estimated with computational modeling may better predict growth and rupture than diameters. Growth is often not continuous, and instead marked by periods of rapid growth followed by quiescence. Small series report that unrelated surgical procedures can precipitate AAA rupture. These findings suggest that episodic and heterogeneous inflammatory processes in concert with adverse hemodynamics are important for the progression of AAA disease. The complexity of aortic disease is more fully revealed with new functional imaging techniques than with conventional anatomic analysis alone. While AAA has been extensively studied, the mechanisms of disease progression have not been fully elucidated. If better understood, the management of patients with small AAAs (< 5.5cm) could be significantly improved. Many of these aneurysms can be followed safely with a long screening interval of 2-3 years, but some may progress to rupture. Identifying this subset would greatly streamline the surveillance imaging of the millions of patients with AAA. On the other hand, the majority of AAAs never rupture, and identifying low risk patients could help better manage resources and subject only those patients at truly elevated risk to intervention. Aortic wall inflammation can be evaluated with the MRI contrast agent ferumoxytol, which has macrophage- selective properties on delayed imaging. MRI also offers a unique and comprehensive assessment of aortic hemodynamics. Blood flow imaging with time-resolved, 3D phase-contrast MRI (4D Flow) allows quantification of key secondary vascular parameters including turbulence and wall shear stress (WSS). Cine Displacement Encoding with Stimulated Echos (DENSE) can quantify regional stretch differences experienced by the vessel wall. Computational modeling based on MRI volumetric data can be used to calculate wall stress. The goal of our study is to uncover important inflammatory changes and adverse hemodynamics that are not addressed with current imaging, and use them to predict disease progression. We seek to meaningfully advance the assessment of risk in patients who do not meet current intervention thresholds and improve outcomes by refining surveillance imaging regimens and decisions regarding early intervention for AAAs.

描述（由申请人提供）：腹部主动脉瘤（AAA）很常见，如果它们发展到破裂，可能会威胁生命。据报道，在5％的老年男性中，他们每年占15,000多人的死亡。基本的血管尺寸目前是用于风险分层患者的主要成像测量。但是，故事不仅仅是维度。用计算建模估计的壁应力可能比直径更好地预测生长和破裂。生长通常不是连续的，而是以快速生长的周期和静止为标志。小型报告表明，无关的手术程序会导致AAA破裂。这些发现表明，与不良血液动力学一致的偶发性和异质炎症过程对于AAA疾病的发展很重要。与单独的传统解剖分析相比，使用新功能成像技术可以更充分地揭示主动脉疾病的复杂性。尽管已经对AAA进行了广泛的研究，但疾病进展的机制尚未完全阐明。如果更好地理解，则可以显着改善小型AAA（<5.5厘米）患者的管理。这些动脉瘤中的许多可以安全地遵循2 - 3年的长期筛查间隔，但有些可能会破裂。确定该子集将大大简化数百万AAA患者的监视成像。另一方面，大多数AAAS永远不会破裂，识别低风险患者可以帮助更好地管理资源，并只接受那些真正升高干预风险的患者。主动脉壁发炎可能是用MRI对比剂铁氧毒醇评估，该毒剂在延迟成像上具有巨噬细胞选择性。 MRI还对主动脉血流动力学进行了独特而全面的评估。血流与时间分辨的3D相对比度MRI（4D流）允许量化关键的次要血管参数，包括湍流和壁剪应力（WSS）。用刺激的Echos（致密）编码的Cine位移可以量化容器壁经历的区域拉伸差异。基于MRI容量数据的计算建模可用于计算壁应力。我们研究的目的是发现重要的炎症性变化和不使用当前成像来解决的不良血液动力学，并使用它们来预测疾病进展。我们试图通过完善监视成像方案和有关AAAS早期干预的决策来有意义地提高不符合当前干预阈值并改善预后的患者的风险评估。

项目成果

期刊论文数量（11）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Patient-specific finite element analysis of ascending thoracic aortic aneurysm.

升胸主动脉瘤的患者特异性有限元分析。

DOI：
发表时间：
2014
期刊：
The Journal of heart valve disease
影响因子：
0
作者：
Wisneski,AndrewD;Mookhoek,Aart;Chitsaz,Sam;Hope,MichaelD;Guccione,JuliusM;Ge,Liang;Tseng,ElaineE
通讯作者：
Tseng,ElaineE

Vascular inflammation in a growing iliac artery aneurysm.

不断生长的髂动脉瘤中的血管炎症。

DOI：
10.1097/rlu.0000000000000731
发表时间：
2015
期刊：
Clinical nuclear medicine
影响因子：
10.6
作者：
Hope,MichaelD;Gasper,WarrenJ;Rapp,Joseph;Owens,ChristopherD;Haraldsson,Henrik;Saloner,David
通讯作者：
Saloner,David

Prevalence and significance of incidentally noted dilation of the ascending aorta on routine chest computed tomography in older patients.