Predicting the Need for Surgery in Pediatric Subglottic Stenosis using Airway Elastography Derived from Endoscopic OCT and Intraluminal Pressure Measurement

使用内窥镜 OCT 和腔内压力测量得出的气道弹性成像预测小儿声门下狭窄的手术需求

• 批准号: 10682427
• 负责人: Amy L Oldenburg
• 金额: $ 76.85万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10682427
• 关键词: 3-Dimensional; Achievement; Address; Adult; Affect; Air; Air Movements; Airway Disease; Anatomy; Atlases; Bronchoscopes; Bronchoscopy; Catheters; Cessation of life; Child; Childhood; Cine CT; Clinical; Data; Decision Making; Development; Disease; Endoscopy; Enrollment; Evaluation; Failure; Family suidae; Foundations; Four-dimensional; Geometry; Goals; Growth; Hypoxia; Image; Imaging technology; Infant; Infrastructure; Institution; Ionizing radiation; Lasers; Life; Liquid substance; Location; Measurement; Measures; Methods; Modeling; Morbidity - disease rate; Multicenter Studies; Obstructive Sleep Apnea; Operative Surgical Procedures; Optical Coherence Tomography; Outcome; Output; Patients; Pattern; Phase; Physiological; Population; Postoperative Period; Prediction of Response to Therapy; Property; Radiation; Radiation exposure; Resistance; Resolution; Respiration; Respiratory Insufficiency; Risk; Scanning; Signal Transduction; Speed; Stenosis; Structure; Surgical Models; Testing; Time; Tissue Model; Treatment Failure; Treatment outcome; Vision; airway obstruction; computational pipelines; deep learning; elastography; evidence base; experimental study; healing; imaging capabilities; imaging modality; improved; improved outcome; in vivo; novel; outcome prediction; pre-clinical; pressure; prospective; public health relevance; quantitative imaging; respiratory; respiratory imaging; success; surgery outcome; tool; treatment planning; ventilation; virtual; viscoelasticity

Project Abstract Subglottic stenosis (SGS) is one of the most common life-threatening airway disorders in infants and children. Current treatment methods are based on airway endoscopy, which provides only qualitative information. Surgical treatment failures for the most severe grades of SGS range toward 50%, often due to post-operative airway collapse in new, unpredicted locations. Treatment planning could be improved if evidence-based, quantitative, physiologic or anatomic metrics were available. To address this need, we propose to advance anatomic optical coherence tomography (aOCT) for high- resolution, high-speed imaging of the airway. Endoscopic aOCT and intraluminal pressure catheters will be used simultaneously to inform models of airway wall viscoelasticity (VE). In combination with simulated surgery and computational fluid dynamics (CFD), this constitutes a powerful new clinical tool to predict airway collapse and airflow resistance in children with SGS. Our ultimate goal is to develop an aOCT-informed pipeline to model tissue VE, perform simulated surgery, predict outcomes from a variety of surgical plans and, ultimately, reduce treatment failures. This will leverage existing infrastructure at UNC, including the Virtual Pediatric Airways Workbench for simulated surgery, the Pediatric Airway Atlas of normal airways, and fluid-structure interaction (FSI) modeling of the dynamic interplay between airway wall VE, airway deformation, and intraluminal pressure to accurately model and predict airway collapse. Our first Aim is to verify that geometric and pressure-related metrics that correlate with whether children receive surgery for SGS, previously established using CT, can be obtained from endoscopic aOCT, thereby avoiding ionizing radiation exposure. Our second Aim is technical development of dynamic (4 dimensional, 4D) aOCT imaging to quantify airway wall VE, validated against CINE CT in pigs. Our final Aim is to create 4D models of the airway in children with SGS including VE properties using aOCT, perform simulated surgery to predict patient-specific post-surgical outcomes, and compare these to post-surgical aOCT models created from routine post-operative surveillance endoscopies. In addition to the development of a new tool, these experiments will also provide new data on longitudinal changes in VE wall properties before and after surgery. Achievement of these goals will provide improved metrics for decision-making and enable evaluation of the dynamic airway without radiation exposure. Our long-term goals are to: 1) validate this approach clinically at multiple institutions; 2) evaluate the ability of these methods to improve outcomes; and 3) use the tool to study other airway diseases, such as obstructive sleep apnea (~10% of the population), in children and adults.

项目摘要 声门下狭窄 (SGS) 是婴儿和婴儿中最常见的危及生命的气道疾病之一 孩子们。目前的治疗方法基于气道内窥镜检查，仅提供定性治疗 信息。最严重 SGS 等级的手术治疗失败率接近 50%，通常是由于 术后气道在新的、不可预测的位置塌陷。治疗计划可以改进，如果 可以使用基于证据的、定量的、生理学或解剖学的指标。 为了满足这一需求，我们建议推进解剖光学相干断层扫描（aOCT），以实现高 高分辨率、高速气道成像。内窥镜 aOCT 和腔内压力导管将 同时用于了解气道壁粘弹性 (VE) 模型。结合模拟手术 和计算流体动力学 (CFD)，这构成了预测气道塌陷的强大新临床工具 和 SGS 儿童的气流阻力。我们的最终目标是开发一个基于 aOCT 的管道 建立组织 VE 模型，执行模拟手术，预测各种手术计划的结果，并最终 减少治疗失败。这将利用北卡罗来纳大学现有的基础设施，包括虚拟儿科 用于模拟手术的气道工作台、正常气道的儿科气道图谱和流体结构 气道壁 VE、气道变形和气道变形之间的动态相互作用 (FSI) 建模 腔内压力以准确建模和预测气道塌陷。 我们的第一个目标是验证与儿童是否 接受手术之前使用 CT 建立的 SGS 可以通过内窥镜 aOCT 获得，从而 避免电离辐射暴露。我们的第二个目标是动态（4维、4D）的技术开发 用于量化气道壁 VE 的 aOCT 成像，针对猪的 CINE CT 进行了验证。我们的最终目标是创造4D 使用 aOCT 建立 SGS 儿童气道模型，包括 VE 特性，进行模拟手术 预测患者特定的术后结果，并将其与以下创建的术后 aOCT 模型进行比较 常规术后监测内窥镜检查。除了开发新工具之外，这些 实验还将提供手术前后 VE 壁特性纵向变化的新数据。 这些目标的实现将为决策提供改进的指标，并能够评估 无辐射暴露的动态气道。我们的长期目标是：1）在临床上验证这种方法 多个机构； 2）评估这些方法改善结果的能力； 3）使用该工具进行学习 其他气道疾病，例如儿童和成人的阻塞性睡眠呼吸暂停（约占人口的 10%）。

项目成果

Anatomic Optical Coherence Tomography (aOCT) for Evaluation of the Internal Nasal Valve.

• DOI: 10.1002/lary.29979
• 发表时间: 2022-11
• 期刊: LARYNGOSCOPE
• 影响因子: 2.6
• 作者: Waters, Candace M.;Stepp, Wesley H.;Conduff, Joseph;Balakrishnan, Santosh;Bu, Ruofei;Oldenburg, Amy L.;Kimbell, Julia S.;Shockley, William W.;Clark, Joseph Madison
• 通讯作者: Clark, Joseph Madison

Sensing Inhalation Injury-Associated Changes in Airway Wall Compliance by Anatomic Optical Coherence Elastography.

• DOI: 10.1109/tbme.2020.3037288
• 发表时间: 2021-08
• 期刊: IEEE transactions on bio-medical engineering
• 作者: Bu R;Balakrishnan S;Iftimia N;Price H;Zdanski C;Mitran S;Oldenburg AL
• 通讯作者: Oldenburg AL