Development and Early Clinical Evaluation of Noninvasive MRI Measurement of ICP

无创 MRI 测量 ICP 的开发和早期临床评估

• 批准号: 7872132
• 负责人: NOAM ALPERIN
• 金额: $ 38.53万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-08-08 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7872132
• 关键词: Animal Model; Biomedical Engineering; Blood; Brain; Brain Edema; Cerebellar tonsil; Cerebrovascular Circulation; Clinical; Computer Simulation; Development; Diagnosis; Diagnostic; Disease; Functional disorder; Goals; Individual; Intracranial Pressure; Magnetic Resonance Imaging; Measurement; Measures; Methods; Monitor; Neurologic; Patients; Play; Radiology Specialty; Reproducibility; Risk; Role; Sampling; Scanning; Scheme; Spinal Canal; Techniques; Testing; Time; Validation; Weight; Work; base; blood flow measurement; brain tissue; cerebrospinal fluid flow; clinically relevant; data acquisition; healthy volunteer; improved; malformation; nervous system disorder; neurosurgery; nonhuman primate; novel; novel diagnostics; pressure; research clinical testing; tool

DESCRIPTION (provided by applicant): This bioengineering-radiology-neurosurgery partnership aims to further develop and test the clinical utility of a novel method for non-invasive measurement of intracranial compliance (ICC) and intracranial pressure (ICP). These important neurophysiologic parameters are measured using dynamic magnetic resonance imaging (MRI) of blood and cerebrospinal fluid (CSF) flows to and from the brain. The feasibility of this new technique is demonstrated using phantoms, computer simulations, non-human primate animal model, healthy volunteers, and small number of patients. Noninvasive quantification of these parameters is potentially important for improved diagnosis and treatment of several neurological problems. In this proposal we aim to demonstrate the potential clinical utility of a noninvasive ICC measurement to study a relatively common and poorly understood neurological problem, Chiari Malformations (CM) (associated with downward displacement of the cerebellar tonsils into the spinal canal). Some evidence suggests that ICC plays an important role in the pathophysiology of this disorder. However, because of increased risk of brain herniation associated with invasive ICC measurements in these patients, intracranial compliance has not been measured previously. Noninvasive ICC measurement in CM may help explain the pathophysiology and will potentially improve the diagnosis and treatment of this debilitating disorder. Moreover, since MRI is already used to diagnose CM, it would be practical to add the additional scan to obtain the ICC measurement noninvasively. While intracranial compliance quantifies the ability of the intracranial compartment to accommodate increase in volume (e.g., brain swelling) without a large increase in pressure, it is ICP that is more widely used clinically. Our MRI-based measurement of ICP relies on the inverse relationship between ICC and ICP. We propose further validations of a strong linear correlation we found between MR-ICP and invasively measured ICP in 9 patients. The proposed validations are an essential step before the method can become clinically acceptable and the potentially high diagnostic value of a noninvasive MR-ICP can be assessed in other neurological problems. The developmental components of the proposal aim at improving the MRI data acquisition scheme and at shortening overall scan time, primarily for increased measurement reliability by multiple sampling of ICP and for allowing dynamic measurements of ICP. The proposed developmental work also aims to improve measurements of total cerebral blood flow (tCBF), a byproduct of the MR-ICP measurement, by normalizing for the subject's total brain tissues volumes and weights. Preliminary results demonstrated lesser inter-individual variability of the normalized tCBF measurement.

描述（由申请人提供）：这一生物工程-放射学-神经外科合作伙伴关系旨在进一步开发和测试一种无创测量颅内顺应性（ICC）和颅内压（ICP）的新方法的临床实用性。这些重要的神经生理学参数是使用流入和流出大脑的血液和脑脊液 (CSF) 的动态磁共振成像 (MRI) 来测量的。这项新技术的可行性通过模型、计算机模拟、非人类灵长类动物模型、健康志愿者和少量患者得到了证明。这些参数的无创量化对于改善几种神经系统问题的诊断和治疗具有潜在的重要意义。在本提案中，我们旨在证明无创 ICC 测量的潜在临床效用，以研究相对常见且知之甚少的神经系统问题，Chiari 畸形 (CM)（与小脑扁桃体向下移位到椎管内相关）。一些证据表明 ICC 在这种疾病的病理生理学中发挥着重要作用。然而，由于这些患者的侵入性 ICC 测量导致脑疝风险增加，因此之前尚未测量颅内顺应性。 CM 中的无创 ICC 测量可能有助于解释病理生理学，并有可能改善这种使人衰弱的疾病的诊断和治疗。此外，由于 MRI 已用于诊断 CM，因此添加额外的扫描以无创地获取 ICC 测量结果是可行的。虽然颅内顺应性量化了颅内室在压力不大幅增加的情况下适应体积增加（例如脑肿胀）的能力，但临床上应用更广泛的是ICP。我们基于 MRI 的 ICP 测量依赖于 ICC 和 ICP 之间的反比关系。我们建议进一步验证我们在 9 名患者中发现的 MR-ICP 和侵入性测量的 ICP 之间的强线性相关性。所提出的验证是该方法变得临床可接受之前的一个重要步骤，并且可以评估无创 MR-ICP 在其他神经系统问题中的潜在高诊断价值。该提案的开发部分旨在改进 MRI 数据采集方案并缩短总体扫描时间，主要是通过 ICP 多次采样来提高测量可靠性，并允许动态测量 ICP。拟议的开发工作还旨在通过标准化受试者的总脑组织体积和重量来改进总脑血流量（tCBF）的测量，总脑血流量（tCBF）是 MR-ICP 测量的副产品。初步结果表明标准化 tCBF 测量值的个体间变异较小。