Quantitative susceptibility mapping for stroke risk prediction of vulnerable carotid plaques

用于预测易损颈动脉斑块中风风险的定量敏感性图

• 批准号: 10446087
• 负责人: Ajay Gupta
• 金额: $ 69.78万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-15 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10446087
• 关键词: Age; Algorithms; Area; Arterial Fatty Streak; Blood; Carotid Artery Plaques; Carotid Endarterectomy; Carotid Stenosis; Carotid stent; Clinical; Contrast Media; Data; Detection; Development; Diagnosis; Discrimination; Erythrocytes; Evaluation; Extravasation; Fingerprint; Gold; Hemoglobin; Hemorrhage; Hemosiderin; Histopathology; Image; Imaging Device; Individual; Inflammation; Ipsilateral; Iron; Ischemic Stroke; Lead; Magnetic Resonance Imaging; Magnetism; Measures; Medical; Methemoglobin; Motion; Noise; Outcome; Outcomes Research; Oxidative Stress; Patients; Phase; Physiologic pulse; Predisposition; Prevention Research; Property; Protocols documentation; ROC Curve; Reproducibility; Research; Risk; Rupture; Sampling; Scanning; Schedule; Signal Transduction; Stenosis; Stroke; Stroke prevention; Testing; Thrombus; Time; Tissues; Vascular Diseases; X-Ray Computed Tomography; base; calcification; cell injury; clinical imaging; clinical risk; diagnostic accuracy; efficacy evaluation; ex vivo imaging; experience; high risk; image reconstruction; imaging modality; improved; in vivo imaging; non-invasive imaging; novel strategies; patient stratification; personalized medicine; reconstruction; risk prediction; risk stratification; secondary outcome; stroke risk; superparamagnetism; thromboembolic stroke

Our main objective is to use quantitative susceptibility mapping (QSM) in establishing reliable noninvasive MRI for identification and risk stratification of unstable carotid atherosclerotic plaques. Currently, decisions about carotid revascularization to prevent stroke, such as carotid endarterectomy or carotid artery stenting, are based on whether there is ?50% carotid artery stenosis. However, this strategy uses only one feature of vulnerable plaque and frequently misclassifies patients. Using imaging to identify other features of rupture-prone carotid plaques with high risk for thromboembolic stroke, in combination with stenosis assessment, proves to be a more effective approach for risk evaluation. Of these features, intraplaque hemorrhage (IPH) is associated with a 4 to 6-fold higher risk of stroke, while calcification is associated with a 50% lower stroke risk. In the conventional approach, IPH and calcification are defined as hyperintensity and hypointensity, respectively, in a plaque region on the T1-weighted (T1w) image acquired as part of the multi-contrast MRI (mcMRI) protocol. However, T1w hyperintensity only captures the transient methemoglobin phase of hemorrhage. In the ensuing hemosiderin phase, IPH appears hypointense due to the strong susceptibility-induced dephasing effects of the superparamagnetic hemosiderin (susceptibility>150 ppm), which can be misinterpreted as calcification, although calcification is strongly diamagnetic (-2.3 ppm). The key scientific premise of this proposal is that QSM can reliably resolve T1w hypointensity into IPH hemosiderin versus calcification based on their different magnetic property, and therefore will significantly improve imaging characterization and risk stratification of patients with atherosclerotic carotid plaques. We have pioneered QSM development and demonstrated the exquisite sensitivity of QSM for hemorrhage and calcification in carotid plaque. In this project, we will further improve the utility of carotid plaque QSM for routine clinical imaging by developing a multi-contrast QSM (mcQSM) approach which can provide not only QSM but also traditional mcMRI contrasts in 5 min scan time. We will develop a nonlinear QSM reconstruction algorithm which is robust against noise and motion and can separate co-existing IPH and calcification to improve IPH detection in calcified vessels. We will then establish the improvement in diagnostic accuracy of mcQSM over mcMRI for detecting IPH and calcification in patients who are scheduled for carotid endarterectomy. Finally, we will test the hypothesis that mcQSM will provide significantly higher discrimination for stroke than mcMRI. A successful outcome of this proposal will make carotid plaque QSM ready for widespread and routine clinical use in the emerging era of personalized medicine to reduce the individual and societal burden of stroke.

我们的主要目标是使用定量敏感性制图（QSM）建立可靠的无创MRI