Rapid Pediatric Cardiovascular MRI without Contrast Agent or Anesthesia

项目摘要/摘要：先天性心脏病（CHD）是最常见的出生缺陷类型， 占美国活产婴儿的近1%。即使在矫正或姑息手术和/或 在儿童期及以后的干预措施中，经常监测，包括成像是必要的。 心血管MRI是诊断儿童CHD的极好工具。MRI具有明显的优势， 因为它不涉及电离辐射。MRI提供了更清晰的可视化， 心血管解剖比超声心动图。尽管MRI比其他成像方式具有这些优势， 仅占儿科心脏诊断测试的2%。这种利用率不足的原因是扫描时间较长 （通常60-90分钟）和必要的钆基造影剂（GBCA）和一般 麻醉（GA），这两者都增加了健康风险和医疗保健成本。作为直接回应，我们将开发和 评估快速心血管MRI和磁共振血管造影（MRA）方法， GA或GBCA给药。 这一建议的科学前提是基于最先进的欠采样策略，如压缩 感测（CS）、径向k空间采样和同时多切片（SMS）激励，非常适合于 加速心血管MRI和MRA脉冲序列。我们将协同联合收割机， 开发“冻结”生理和患者运动的2D动态MRI方法的欠采样策略 和具有呼吸运动自导航的3D MRA方法。本申请的具体目标是： (1)开发快速图像采集和重建方法，将其集成到单一协议中 用于对未给予GA或GBCA的儿科患者进行成像，以及（2）测试15分钟方案是否 （目标1）在CHD患者中产生高诊断性能。 这项研究利用了Ann & Robert H现有的广泛临床和研究资源。Lurie儿童 芝加哥医院（每年约1，000次心血管MRI扫描）和西北大学（心血管 成像研究）。快速、自由呼吸的MRI协议是MRI技术的一个重大进步，因为它 具有消除GA和GBCA管理的潜力，同时显著提高扫描效率。 消除GA和GBCA管理将降低相关风险以及医疗保健成本， 从而产生了更大的兴趣，将儿科患者转诊到“更安全”的心血管MRI。更快的扫描将 降低运营成本，并为成像中心采用心血管MRI提供经济激励， 临床实践此R21应用程序旨在生成未来R 01所需的初步数据 应用程序旨在比较我们的新（快速，无GA，无GBCA）和标准之间的有效性， 不同儿科人群的心血管MRI护理（慢、GA、GBCA）方案。

Project Summary/Abstract: Congenital heart disease (CHD) is the most common type of birth defect, accounting for nearly 1% of live births in the US. Even after corrective or palliative surgeries and/or interventions, frequent monitoring, including imaging, is necessary during childhood and beyond. Cardiovascular MRI is an excellent diagnostic tool for children with CHD. MRI offers a clear advantage over computed tomography because it does not involve ionizing radiation. MRI provides clearer visualization of cardiovascular anatomy than echocardiography. Despite these advantages over other imaging modalities, MRI accounts for only 2% of pediatric cardiac diagnostic tests. This underutilization is due to long scan times (typically 60-90 min) and requisite administration of a gadolinium-based contrast agent (GBCA) and general anesthesia (GA), both of which add health risk and healthcare cost. In direct response, we will develop and evaluate rapid cardiovascular MRI and magnetic resonance angiography (MRA) methods that do not require GA or GBCA administration. The scientific premise of this proposal is based on cutting-edge undersampling strategies such as compressed sensing (CS), radial k-space sampling, and simultaneous multi-slice (SMS) excitation which are well-suited for accelerating cardiovascular MRI and MRA pulse sequences. We will synergistically combine these undersampling strategies to develop 2D dynamic MRI methods that “freeze” physiologic and patient motion and 3D MRA methods with self-navigation of respiratory motion. The specific objectives of this application are: (1) to develop rapid image acquisition and reconstruction methods that will be integrated into a single protocol for imaging pediatric patients without GA or GBCA administration and (2) to test whether a 15-min protocol (objective 1) produces high diagnostic performance in patients with CHD. This study leverages extensive clinical and research resources existing at Ann & Robert H. Lurie Children’s Hospital of Chicago (~1,000 cardiovascular MRI scans per year) and Northwestern University (cardiovascular imaging research). A rapid, free-breathing MRI protocol is a major step forward in MRI technology, because it has the potential to eliminate GA and GBCA administration, while dramatically increasing scan efficiency. Elimination of GA and GBCA administration will reduce associated risks, as well as healthcare costs, and thereby generate greater interest in referring pediatric patients for “safer” cardiovascular MRI. A faster scan will reduce operational cost and provide a financial incentive for imaging centers to adopt cardiovascular MRI into clinical practice. This R21 application is designed to yield preliminary data needed to pursue a future R01 application aimed at comparing the effectiveness between our new (fast, no GA, no GBCA) and standard-of- care (slow, GA, GBCA) cardiovascular MRI protocols in a diverse pediatric population.