Improved MRI guidance of pediatric catheterization via autonomous multi-beat data synthesis

项目摘要 心血管导管插入术是一种微创方法，用于测量血液动力学和治疗 异常，如血管狭窄。传统上，X射线透视引导导管插入术，但它使用 电离辐射，并且即使使用外源性造影剂也遭受差的软组织对比。 这在儿童中是有问题的，因为他们特别容易受到辐射，经常需要重复 评估，并且可能具有难以导航的复杂解剖结构。MRI引导提供了一种非- 电离替代品，可以改善软组织对比度和增强评价。除了引导 15年前的首次人体研究表明，MRI可以引导心脏 介入治疗，如缩窄血管成形术。然而，从那时起，临床应用受到以下因素的限制： MRI安全介入器械和2）在手术期间可用的实时MRI图像质量相对较差 程序. MRI安全设备的数量正在增加，低场MRI已成为一种新的方法， 显著降低器件发热。然而，实时图像质量差仍然是一个重大障碍。尽管 并行成像和加速图像重建，图像质量受到MRI有限集的限制 可用于单次实时采集中的图像重建的样本。 解决方案：该提案旨在利用多拍信息来改善实时MRI图像 儿科干预期间的质量。目标是通过增加可用于 图像重建和通过突出显示搏动之间运动来改善设备可视化。中央 假设在介入环境中，多拍信息将改善实时MRI图像质量 和设备可视化，从而提高操作员的信心和性能。为了验证这个假设， 多心搏对介入图像质量的影响（目标1）、对器械可视化的影响（目标2）和临床 评估其在儿科患者中的效用（目标3）。该提案得到了一个团队的支持， 心脏病专家在MRI引导的干预和先前的研究经验，开发一个封闭的， 循环MRI数据收集技术，可稳健地识别相似的心跳。该平台最初是 设计用于不同的应用-改善心律失常成人的非介入性MRI成像。在这里， 它适合于在新的患者群体（儿科）中探索新的成像范例（介入成像 患者）的PI。这项工作有望建立一种新的方法，用于实时MRI引导心血管 通过解决目前限制图像引导置信度的领域进行干预：解剖结构和器械不良 视觉化成功不仅可以改善MRI对儿童心血管介入治疗的指导， 还为心血管和非心血管（活检，引流， 热疗法）程序。

Project Summary Cardiovascular catheterization is a minimally-invasive approach to measure hemodynamics and treat abnormalities, such as vascular stenosis. Conventionally, X-ray fluoroscopy guides catheterizations, but it uses ionizing radiation and suffers from poor soft tissue contrast even with the use of exogenous contrast agents. This is problematic in children as they are particularly susceptible to radiation, often require repeat assessments, and can have complex anatomy that is difficult to navigate. MRI guidance provides a non- ionizing alternative that can improve soft tissue contrast and enhance evaluations. In addition to guiding diagnostic catheterization, first-in-human studies 15 years ago demonstrated that MRI could guide cardiac interventions such as coarctation angioplasty. However, clinical adoption since then has been limited by 1) few MRI-safe interventional devices and 2) the relatively poor real-time MRI image quality available during procedures. The number of MRI-safe devices is increasing, and low-field MRI has emerged as a new way to significantly reduce device heating. Yet, poor real-time image quality remains a significant barrier. Despite parallel imaging and accelerated image reconstructions, image quality is constrained by the limited set of MRI samples available for image reconstruction in a single-shot, real-time acquisition. The solution: This proposal aims to leverage multi-beat information to improve real-time MRI image quality during pediatric interventions. The goal is to improve image quality by increasing data available for image reconstruction and improve device visualization by highlighting motion between beats. The central hypothesis is that, in the interventional setting, multi-beat information will improve real-time MRI image quality and device visualization, leading to improved operator confidence and performance. To test this hypothesis, multi-beat’s impact on interventional image quality (Aim 1), impact on device visualization (Aim 2), and clinical utility in pediatric patients (Aim 3) are evaluated. The proposal is supported by a team that includes pediatric cardiologists at the forefront of MRI-guided interventions and prior research experience developing a closed- loop MRI data collection technique which robustly identifies similar heartbeats. The platform was originally designed for a different application – improving non-interventional MRI imaging of adults with arrythmia. Here, it is adapted to explore a new imaging paradigm (interventional imaging) in a new patient population (pediatric patients) for the PI. The work is expected to establish a new approach for real-time MRI-guided cardiovascular interventions by addressing the areas that currently limit image guided confidence: poor anatomic and device visualization. Success would not only improve MRI guidance of cardiovascular interventions in children but also create new opportunities for MRI guidance of cardiovascular and non-cardiovascular (biopsy, drainage, thermal therapy) procedures for adults.