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Accurate quantification of kidney function with non-sedated motion-compensated pediatric MRI

使用非镇静运动补偿小儿 MRI 准确量化肾功能

基本信息

批准号：
10230988
负责人：
Sila Kurugol
金额：
$ 26.55万
依托单位：
BOSTON CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-06 至 2023-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10230988
关键词：
Address Adoption Age-Months Agreement Anatomy Anesthesia procedures Child Childhood Chronic Kidney Insufficiency Clinical Computer Analysis Computer software Data Development Diagnosis Diagnostic Dialysis procedure Discipline of Nuclear Medicine Disease Dose Drainage procedure Ethics Failure Free Will Functional Imaging Gadolinium Glomerular Filtration Rate Hospitalization Hydronephrosis Image Imaging Techniques Impairment Infection Injections Ionizing radiation Kidney Kidney Function Tests Kidney Transplantation Lead Left Liquid substance Lower urinary tract Magnetic Resonance Imaging Maps Measurement Measures Methods Modeling Monitor Motion Neonatal Nephrectomy Newborn Infant Nuclear Obstruction Oncology Operative Surgical Procedures Pain Patient imaging Patient observation Patients Pentetic Acid Pharmaceutical Preparations Physiological Play Protocols documentation Public Health Radiation Reference Standards Renal function Renal pelvis Reproducibility Resolution Role Scanning Sedation procedure Severities Sleep Structure Techniques Testing Time Tracer Ultrasonography Unnecessary Surgery Ureter Ureteropelvic junction obstruction Urine Urology analysis pipeline automated algorithm automated analysis base bulk motion care costs clinical decision-making clinical practice contrast enhanced deep neural network functional decline heart motion image processing image reconstruction imaging approach improved innovation kidney imaging kinetic model neonate neural network algorithm novel pharmacokinetic model renal artery respiratory response spatiotemporal temporal measurement translational impact urologic

项目摘要

Project Summary: Ureteropelvic junction obstruction (UPJO) is an impairment of urine flow from the renal pelvis into the proximal ureter and is the most common cause of hydronephrosis in neonates. This disorder is detected in up to 7% of all maternal ultrasound scans, and an estimated 10% of these newborns have hydronephrosis, which, if left untreated, may result in early failure of functional renal development in these patients. Current methods of assessing kidney function in neonates and children are less than optimal, however. While the current reference standard, nuclear renography (MAG3), yields some useful diagnostic information; it is invasive, slow, provides low resolution, does not offer anatomic detail, and delivers potentially harmful ionizing radiation. Thus, there is an urgent, unmet need to develop a method for functional imaging of kidneys that is non-invasive, safe, accurate, reproducible and radiation-free. The primary objective of this exploratory, two-year study, therefore, is two-fold: first, to develop advanced methods of motion-compensated, high spatial and temporal resolution magnetic resonance imaging (MRI) for the improved quantification of the glomerular filtration rate (GFR), an important marker of renal function; and second, to demonstrate the superiority of this method over the current reference standard, nuclear renography (MAG3). Our application in response to PAR-18-743 is specifically aimed at developing, and evaluating motion-robust, high spatiotemporal resolution dynamic contrast-enhanced MRI (DCE-MRI) for quantifying GFR (MR-GFR) as well as creating new automated analysis software to enable the robust and reproducible assessment of differential renal function in newborns eliminating need for sedation, and in older children. Our method will overcome the technical challenges of current DCE-MRI techniques providing high temporal resolution to capture fast arterial input function dynamics required for accurate computation of GFR, compensate for unavoidable respiratory and bulk motion to reconstruct high quality images and will provide robust, fast, automated post processing techniques for accurate GFR computation. As a non-invasive, motion-robust, radiation-free imaging technique that can depict renal structures at much higher resolution, MR-GFR will offer, for the first time, a level of diagnostic information that is unattainable with MAG3. The critical importance of understanding the extent and severity of UPJO (and resulting hydronephrosis) cannot be understated; for in the absence of this information, children who stand to benefit from immediate surgery might be overlooked or delayed in receiving treatment; and those who might benefit from a more conservative approach (i.e., watching waiting) might receive an unnecessary surgical intervention. Indeed, this novel imaging approach is expected to substantially improve clinical decision-making. The successful completion of our aims will enable 1) assessment of renal function accurately; 2) predicting the likelihood of functional decline; and 3) determining whether surgery is indicated. DCE-MRI is expected to have rapid translational impact for several diseases effecting kidney function once it is introduced into clinical practice.

项目概要：肾盂输尿管连接部梗阻（UPJO）是一种尿流从肾盂进入近端输尿管的障碍。是新生儿肾积水的最常见原因。这种疾病在高达7%的所有产妇的超声波扫描，估计其中10%的新生儿患有肾积水，如果留下，未经治疗，可能导致这些患者的功能性肾发育早期衰竭。的当前方法然而，评估新生儿和儿童的肾功能不是最佳的。虽然目前的参考标准的核肾造影（MAG 3）可提供一些有用的诊断信息;它是侵入性的，缓慢的，低分辨率，不能提供解剖细节，并提供潜在有害的电离辐射。因此，迫切的、未满足的需要是开发一种用于肾的功能成像的方法，该方法是非侵入性的，安全的，准确、可重复和无辐射。因此，这项为期两年的探索性研究的主要目标是，是双重的：首先，发展先进的运动补偿方法，高空间和时间分辨率磁共振成像（MRI）用于改善肾小球滤过率（GFR）的定量，肾功能的重要标志物;第二，证明该方法优于当前方法参考标准，核肾图（MAG 3）。我们针对PAR-18-743的申请具体如下：旨在开发和评估运动鲁棒、高时空分辨率的动态对比度增强 MRI（DCE-MRI）用于定量GFR（MR-GFR），并创建新的自动分析软件，对新生儿不同肾功能的可靠和可重复评估消除了镇静的需要，以及年龄较大的儿童。我们的方法将克服当前DCE-MRI技术的技术挑战提供高的时间分辨率以捕获精确测量所需的快速动脉输入功能动态，计算GFR，补偿不可避免的呼吸和整体运动，以重建高质量图像，并将提供强大的，快速的，自动后处理技术，准确的GFR计算。作为一种无创、运动稳健、无辐射的成像技术，可以在更高的温度下描绘肾脏结构，随着分辨率的提高，MR-GFR将首次提供MAG 3无法达到的诊断信息水平。了解UPJO的范围和严重程度（以及由此导致的肾积水）的至关重要性不能低估;因为在没有这些信息的情况下，儿童谁站在受益于立即手术可能会被忽视或延迟接受治疗;那些可能受益于更多保守方法（即，观察等待）可能接受不必要的外科手术干预。这确新的成像方法有望大大改善临床决策。成功完成我们的目标将能够：1）准确评估肾功能; 2）预测功能衰退; 3）确定是否需要手术。DCE-MRI有望快速一旦将其引入临床实践，对影响肾功能的几种疾病的转化影响。