Dual-Venc 5D flow for Assessment of Congenital Heart Disease in Pediatrics

Dual-Venc 5D 流程用于评估儿科先天性心脏病

• 批准号: 10679809
• 负责人: Elizabeth Weiss
• 金额: $ 4.34万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10679809
• 关键词: 3-Dimensional; 4D MRI; Acceleration; Address; Adult; Age; Anesthesia procedures; Arteries; Blood flow; Body Size; Breathing; Bypass; Cardiac; Case Study; Cessation of life; Child; Childhood; Circulation; Clinical; Complex; Complication; Data; Development; Diagnostic Imaging; Disease Progression; Doppler Echocardiography; Echocardiography; Electrocardiogram; Environment; Failure; Fontan Procedure; General Anesthesia; Goals; Heart; Heart Rate; Heart Transplantation; Imaging Techniques; Individual; Infant; Legal patent; Life; Live Birth; Lung; Magnetic Resonance Imaging; Measurement; Measures; Methods; Monitor; Noise; Operative Surgical Procedures; Patient Monitoring; Patients; Pattern; Pediatrics; Phase; Physicians; Physiology; Population; Procedures; Prospective Studies; Pulmonary Circulation; Pulmonary Vascular Resistance; Pulmonary artery structure; Pulsatile Flow; Radial; Reproducibility; Resolution; Respiration; Route; Running; Sampling; Scanning; Secondary to; Series; Single ventricle congenital heart disease; Techniques; Testing; Time; United States; Validation; Veins; Venous; Viscosity; Work; analysis pipeline; cardiac magnetic resonance imaging; cohort; congenital heart disorder; data acquisition; diagnostic tool; expiration; flexibility; heart function; hemodynamics; image reconstruction; imaging modality; improved; in vivo; middle age; novel; palliation; pediatric patients; pressure; reconstruction; recruit; respiratory; standard of care; temporal measurement; tool

Project Abstract/Summary Congenital heart disease (CHO) afflicts up to 2% of live births in the United States. Among the most severe CHO is single ventricle disease (SVD) where infants are born with only one sufficiently functional ventricle. SVD often requires a series of surgeries that is completed with the Fontan procedure. This results in a circulation that bypasses a right-heart-driven pulmonary circulation, instead, routing systemic venous return directly to the pulmonary arteries. While it is a life-saving procedure, a common complication later in life is failing Fontan physiology which often results in heart transplant, initiation of palliation, or death. Despite regular monitoring of these patients, the underlying mechanisms leading to Fontan failure are poorly understood. Several modes of Fontan failure are hypothesized to be secondary to changes in 3D blood flow dynamics inside the Fontan connection. Current standard-of care imaging methods (echocardiography and 2D phase contrast MRI) capture only 1D hemodynamics and have substantial user variability. 4D flow MRI, a technique pioneered by our lab, was developed to address these challenges, and enable volumetric, 3D velocity measurement over the cardiac cycle. While this technique has been used to study Fontan hemodynamics, among other CHDs, it is not optimal for thorough, life-long monitoring. 4D flow has long, unpredictable scan times which are not amenable to small children requiring anesthesia during cardiac MRI studies. Additionally, 4D flow has a limited velocity dynamic range, lacks flexible reconstruction for different temporal and spatial resolution, and does not capture respiratory driven flow, a hemodynamic feature known to be important in the Fontan connection. To address these limitations, we have developed a method termed 5D flow MRI, a free-running technique with flexible, compressed sensing reconstruction that captures 3D velocities along the cardiac and respiratory cycles. The first aim of this proposal is to develop an under 10 minutes dual-velocity encode (venc) 5D flow method along with a streamlined processing and analysis pipeline. This will enable accurate, simultaneous measurement of flow in veins and arteries while remaining sufficiently short for patients requiring general anesthesia. The second aim of this proposal is to validate this method and to optimize the reconstruction and acquisition parameters. This will be crucial for understanding the reliability of the metrics compared to clinical standards and to ensure that respiratory resolved flow is accurate. The third aim of this proposal is to apply the developed sequence in a cohort of patients with the Fontan connection. I hypothesize that: 1. Dual-venc 5D flow will be faster and simpler than clinically standard acquisitions, 2. Respiratory resolved flow measurements reveal additional hemodynamic information, 3. Voxel-wise parameters derived from 5D flow, such as respiratory driven peak velocities, correlate with pulmonary vascular resistance, an invasive measurement.

项目摘要/摘要 在美国，先天性心脏病（CHO）困扰着多达2%的活产婴儿。其中最严重的CHO是单心室疾病（SVD），婴儿出生时只有一个功能充分的心室。SVD通常需要一系列的手术，这些手术是用Fontan手术完成的。这导致循环绕过右心驱动的肺循环，而是将体静脉回流直接引导至肺动脉。虽然这是一种挽救生命的手术，但在以后的生活中常见的并发症是Fontan生理功能衰竭，这通常会导致心脏移植，开始姑息治疗或死亡。尽管定期监测这些患者，导致Fontan失败的潜在机制知之甚少。 Fontan失效的几种模式被假设为继发于Fontan连接内的3D血流动力学变化。目前的标准护理成像方法（超声心动图和2D相位对比MRI）仅捕获1D血流动力学，并且具有很大的用户可变性。4D flow MRI是我们实验室开创的一项技术，旨在解决这些挑战，并实现心动周期内的体积，3D速度测量。虽然该技术已被用于研究Fontan血流动力学，但在其他CHD中，它并不是彻底的终身监测的最佳选择。4D Flow具有较长且不可预测的扫描时间，不适合在心脏MRI研究期间需要麻醉的幼儿。此外，4D血流具有有限的速度动态范围，缺乏针对不同时间和空间分辨率的灵活重建，并且不能捕获呼吸驱动的血流，这是已知在Fontan连接中很重要的血流动力学特征。为了解决这些局限性，我们开发了一种称为5D流动MRI的方法，这是一种自由运行的技术，具有灵活的压缩感知重建，可以捕获沿着心脏和呼吸周期的3D速度。 本提案的第一个目标是开发一种10分钟以下的双速编码（venc）5D流方法，沿着并提供流线型处理和分析管道。这将能够准确、同时测量静脉和动脉中的流量，同时对于需要全身麻醉的患者保持足够短的时间。该建议的第二个目的是验证该方法并优化重建和采集参数。这对于理解与临床标准相比的度量的可靠性以及确保呼吸分辨流量是准确的至关重要。该提案的第三个目的是将开发的序列应用于Fontan连接的患者队列。我假设：1。Dual-venc 5D血流将比临床标准采集更快、更简单，2.呼吸分辨流量测量揭示了额外的血液动力学信息，3。从5D流导出的逐体素参数（诸如呼吸驱动的峰值速度）与肺血管阻力（侵入性测量）相关。