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: 10065215
• 负责人: Amy L Oldenburg
• 金额: $ 82.64万
• 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/10065215
• 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; Gold; Growth; Hypoxia; Image; Imaging technology; Infant; Infrastructure; Institution; Ionizing radiation; Lasers; Lead; 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; 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; base; 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; success; surgery outcome; tool; treatment planning; 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)是最常见的危及婴儿和儿童生命的呼吸道疾病之一 孩子们。目前的治疗方法是基于呼吸道内窥镜检查，它只提供定性的 信息。对于最严重的SGS级别的手术治疗失败接近50%，通常是由于 手术后新的、不可预测的位置出现呼吸道塌陷。如果有以下情况，治疗计划可以得到改进 有基于证据的、定量的、生理学的或解剖学的测量方法。 为了解决这一需求，我们提出了先进的解剖光学相干层析成像(AOCT)用于高分辨率成像。 分辨率，对呼吸道的高速成像。内窥镜AOCT和腔内压力导管将 同时用于为气道壁粘弹性(VE)模型提供信息。结合模拟手术 和计算流体动力学(CFD)，这构成了预测呼吸道塌陷的强大的新的临床工具 以及SGS儿童的气流阻力。我们的最终目标是开发一条AOCT信息渠道，以 建立组织VE模型，执行模拟手术，根据各种手术计划预测结果，最终， 减少治疗失败。这将利用北卡罗来纳大学的现有基础设施，包括虚拟儿科 用于模拟手术的呼吸道工作台、正常呼吸道的儿科呼吸道图谱和流体结构 气道壁VE、气道变形和气道变形之间动态相互作用的相互作用(FSI)建模 腔内压力，以准确建模和预测呼吸道塌陷。 我们的第一个目标是验证几何和压力相关的指标与儿童 可以从内窥镜aOCT获得先前使用CT建立的针对SGS的接受手术，从而 避免电离辐射暴露。我们的第二个目标是动态(4维、4维)的技术开发 AOCT成像用于量化气道壁VE，对照猪的电影CT进行验证。我们的最终目标是创建4D 使用aOCT建立患有SGS的儿童的呼吸道模型，包括VE特性，执行模拟手术以 预测患者特定的手术后结果，并将这些结果与手术后aOCT模型进行比较 术后常规监视内窥镜检查。除了开发一种新工具外，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衡量标准，并使对 无辐射暴露的动态呼吸道。我们的长期目标是：1)在临床上验证这一方法 多个机构；2)评估这些方法改善结果的能力；3)使用工具进行研究 其他呼吸道疾病，如儿童和成人的阻塞性睡眠呼吸暂停(约占总人口的10%)。