4D Flow MRI for characterization of brain arteriovenous malformations

4D Flow MRI 用于表征脑动静脉畸形

• 批准号: 10189688
• 负责人: Maria Aristova
• 金额: $ 5.1万
• 依托单位: NORTHWESTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-06-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10189688
• 关键词: 3-Dimensional; 3D Print; 4D MRI; Acceleration; Address; Adult; Age; Agreement; Aneurysm; Arteries; Arteriovenous malformation; Biological; Biological Models; Blood Flow Velocity; Blood Pressure; Blood Vessels; Blood flow; Brain; Brain hemorrhage; Caliber; Cardiac; Catheters; Cerebrovascular Circulation; Cerebrovascular system; Clinical; Collaborations; Complex; Contralateral; Custom; Data; Data Analyses; Data Collection; Development; Digital Subtraction Angiography; Dimensions; Drops; Ensure; Evaluation; Exposure to; Feedback; Future; Geometry; Goals; Graph; Hemorrhage; Hospitals; Image; In Vitro; Individual; Investigation; Lesion; MRI Scans; Magnetic Resonance Imaging; Measurement; Measures; Methods; Modeling; Morphology; Network-based; Operative Surgical Procedures; Pathologic; Patient Schedules; Patients; Physicians; Physiological; Physiology; Pilot Projects; Property; Pulsatile Flow; Pump; Radiation; Reproducibility; Resolution; Risk; Risk Estimate; Rupture; Sampling; Scanning; Seizures; Subarachnoid Hemorrhage; Techniques; Testing; Therapeutic Embolization; Time; Validation; Venous; Visualization; Work; base; brain arteriovenous malformations; cerebrovascular; computerized data processing; data analysis pipeline; design; feeding; fluid flow; healthy volunteer; hemodynamics; image processing; imaging approach; imaging modality; improved; in vitro testing; in vivo; malformation; neurovascular; performance tests; pressure; recruit; risk stratification; sex; tool

Project Summary Cerebral arteriovenous malformation (AVM) is a congenital cerebrovascular malformation that predisposes to vascular aneurysm, hemorrhagic stroke, and seizures. This typically occurs between ages 10 – 40, making AVM an unpredictable, potentially devastating condition in young, previously asymptomatic patients. The current clinical standard in AVM evaluation and surgical planning is to derive morphology and subjective flow parameters from digital subtraction angiography (DSA) – an effective but invasive technique that uses radiation and contrast. The goal of this project is to develop an optimized 4D flow MRI sequence for imaging AVM hemodynamics, in order to provide quantitative metrics of net flow, flow distribution, peak velocity, and pressure drop across the AVM, and to track these parameters throughout AVM treatment. 4D flow MRI is a method developed in the Markl lab to obtain temporally- and spatially-resolved three- dimensional flow velocity data from a contrast-free MRI scan. In adapting this approach for neurovascular imaging and AVM specifically, the aim is to reduce total imaging and processing time while increasing spatial resolution to account for small vessels, increasing dynamic range of measured velocities to accommodate AVM physiology, and maintaining clinical utility of flow images. This project will not only include advanced MRI sequence development, but also rely on close collaboration with clinicians to ensure that the sequence is optimized to provide types of information that can be clinically useful in AVM evaluation and treatment. The first aim is development of a sequence with an appropriate undersampling technique and data collection parameters, as well as a network-based, streamlined data processing method. Design criteria are chosen to enable both visualization of main feeding vessels of an AVM and evaluation of pulsatile flow within a cardiac cycle. The second specific aim is validation of the developed sequence and data processing method in vitro, with a model system with flow properties similar to actual AVMs, and in vivo, in healthy volunteers. Using an existing MRI-compatible flow pump with physiological flow profile and a custom 3D-printed flow chamber (MRI phantom), we will test the performance of the developed sequence and compare the resulting measurements to ground truth values calculated using the phantom geometry. Then, 10 healthy volunteers will be recruited for a test-retest reproducibility study to assess inter-study mean differences and limits of agreement. The third aim is validation of the developed sequence and data processing method in AVM patients, via a small pilot study. 10 adult AVM patients will be recruited at Northwestern Memorial Hospital. Patients will be scanned prior to first treatment as well as after each embolization step. Through feedback from collaborating physicians, the potential clinical utility of the new information obtained from the scan will be evaluated and optimized. Ultimately, the objective is to create a reliable imaging method for AVM to supplement information obtained from DSA, and to provide an accurate evaluation of AVM hemodynamics and changes throughout treatment.

项目概要 脑动静脉畸形（AVM）是一种先天性脑血管畸形，易导致 血管动脉瘤、出血性中风和癫痫发作。这种情况通常发生在 10 至 40 岁之间， 对于以前无症状的年轻患者来说，动静脉畸形是一种不可预测的、具有潜在破坏性的疾病。这 当前 AVM 评估和手术计划的临床标准是推导形态和主观流程 数字减影血管造影 (DSA) 的参数——一种使用辐射的有效但侵入性技术 和对比。该项目的目标是开发用于 AVM 成像的优化 4D 流 MRI 序列 血流动力学，以提供净流量、流量分布、峰值速度和 AVM 上的压降，并在整个 AVM 治疗过程中跟踪这些参数。 4D 流 MRI 是 Markl 实验室开发的一种方法，用于获取时间和空间分辨率的三 来自无对比 MRI 扫描的三维流速数据。将这种方法应用于神经血管 具体来说，目标是减少总成像和处理时间，同时增加空间 解决小血管的问题，增加测量速度的动态范围以适应 AVM 生理学，并维持血流图像的临床实用性。该项目不仅包括先进的核磁共振成像 序列开发，还要依靠与临床医生的密切合作来确保序列 优化以提供可在临床上用于 AVM 评估和治疗的信息类型。 第一个目标是开发具有适当欠采样技术和数据收集的序列 参数，以及基于网络的简化数据处理方法。选择设计标准 实现 AVM 主要供血血管的可视化和心脏内脉动血流的评估 循环。第二个具体目标是在体外验证开发的序列和数据处理方法， 使用具有与实际 AVM 类似的流动特性的模型系统，并在健康志愿者体内进行体内实验。使用 现有的 MRI 兼容流量泵，具有生理流量剖面和定制 3D 打印流量室（MRI 幻影），我们将测试开发序列的性能并比较结果测量 使用幻影几何计算的地面真实值。随后，将招募10名健康志愿者， 重测再现性研究，用于评估研究间的平均差异和一致性限制。第三个目标 通过一项小型试点研究，对 AVM 患者开发的序列和数据处理方法进行了验证。 西北纪念医院将招募 10 名成人 AVM 患者。患者将在术前接受扫描 第一次治疗以及每次栓塞步骤后。通过合作医生的反馈， 从扫描中获得的新信息的潜在临床效用将得到评估和优化。 最终的目标是为 AVM 创建一种可靠的成像方法来补充获得的信息 来自 DSA，并提供 AVM 血流动力学和整个治疗过程中变化的准确评估。

项目成果

Intracranial Blood Flow Quantification by Accelerated Dual-venc 4D Flow MRI: Comparison With Transcranial Doppler Ultrasound.

• DOI: 10.1002/jmri.28115
• 发表时间: 2022-10
• 期刊: JOURNAL OF MAGNETIC RESONANCE IMAGING
• 影响因子: 4.4
• 作者: Mahinrad, Simin;Tan, Can Ozan;Ma, Yue;Aristova, Maria;Milstead, Andrew L.;Lloyd-Jones, Donald;Schnell, Susanne;Markl, Michael;Sorond, Farzaneh A.
• 通讯作者: Sorond, Farzaneh A.