Evaluation of Vascular Malformation Hemodynamics Using ASL Perfusion MRI

使用 ASL 灌注 MRI 评估血管畸形血流动力学

• 批准号: 7862628
• 负责人: RONALD L WOLF
• 金额: $ 19.88万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-15 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7862628
• 关键词: Angiography; Architecture; Arteries; Arteriovenous fistula; Arteriovenous malformation; Blood; Blood Vessels; Blood capillaries; Blood flow; Brain; Bypass; Cerebrovascular Circulation; Cessation of life; Complex; Data; Detection; Development; Digital Subtraction Angiography; Dural Arteriovenous Fistulas; Evaluation; Event; Excision; Goals; Gold; Hemorrhage; Image; Injury; Intracranial Hemorrhages; Label; Lead; Lesion; Magnetic Resonance Imaging; Measurement; Methodology; Methods; Morbidity - disease rate; Operative Surgical Procedures; Patients; Perfusion; Physiologic arteriovenous anastomosis; Pilot Projects; Shunt Device; Spin Labels; Techniques; Testing; Theft; Therapeutic Embolization; Tracer; Veins; Water; Work; brain tissue; capillary; hemodynamics; imaging modality; improved; malformation; mortality; novel; public health relevance

DESCRIPTION (provided by applicant): Arteriovenous malformation (AVM) and dural arteriovenous fistula (AVF) are vascular malformations with direct arteriovenous (AV) connections. Intracranial hemorrhage is the presenting event in 40-70% of patients, causing significant morbidity and mortality. Current noninvasive imaging methods like MR and CT angiography are inadequate for comprehensive evaluation of the complex vascular architecture and hemodynamics of these lesions, including effects on cerebral blood flow (CBF). Even digital subtraction angiography (DSA, the gold standard) is not capable of providing accurate quantitative assessment of blood flow or degree of shunt. In arterial spin labeled (ASL) perfusion MRI of the brain, magnetically labeled arterial blood water is used as a diffusible tracer. In preliminary studies, it was observed that labeled blood no longer behaves as a diffusible tracer in vessels associated with untreated AVMs, but as an intravascular tracer since it bypasses the capillaries. The effect is that not only are AVM and draining vessels conspicuously demonstrated, but also that measurement of label with rapid transit allows potential quantification of AV shunt. The goal of this proposal is to test the hypothesis that ASL can be used as a novel method to detect and quantify AV shunting in AVM or AVF, while simultaneously evaluating effects on brain perfusion. The first part of the proposal focuses on further development and optimization of the ASL perfusion MRI technique for use in this setting. In the second part of the proposal, patients with suspected AVM or AVF who are undergoing DSA will also be studied using the optimized ASL perfusion MRI technique in a pilot study to assess its accuracy. In the third part of the proposal, the information obtained in the pilot study will be further analyzed to determine whether AV shunting can be quantified, whether alterations in CBF related to an AVM or AVF can be detected, and whether changes in AV shunt or CBF can be detected in those patients undergoing surgical excision or embolization. PUBLIC HEALTH RELEVANCE: An arteriovenous malformation (AVM) is a vascular malformation in the brain with direct connections between arteries and veins such that blood bypasses brain tissue. A patient with an AVM may not be aware of it until the AVM causes hemorrhage into the brain, which is the first presentation in as many as 40-70% of patients and may lead to permanent injury or death. Current imaging methods are inadequate for comprehensive evaluation of these lesions, so the goal of this proposal is to test a new method called arterial spin labeled (ASL) perfusion MRI to improve detection and evaluation of AVMs as well as to assess effects on nearby brain tissue.

描述（由申请人提供）：动静脉畸形（AVM）和硬脑膜动静脉瘘（AVF）是具有直接动静脉（AV）连接的血管畸形。 40-70% 的患者会出现颅内出血，导致显着的发病率和死亡率。目前的无创成像方法，如 MR 和 CT 血管造影，不足以全面评估这些病变的复杂血管结构和血流动力学，包括对脑血流 (CBF) 的影响。即使是数字减影血管造影（DSA，金标准）也无法提供血流或分流程度的准确定量评估。在大脑动脉自旋标记 (ASL) 灌注 MRI 中，磁性标记的动脉血水被用作可扩散示踪剂。在初步研究中，观察到标记的血液不再充当与未经处理的动静脉畸形相关的血管中的扩散示踪剂，而是充当血管内示踪剂，因为它绕过了毛细血管。其效果是，不仅显着地显示了 AVM 和引流血管，而且通过快速传输的标记测量可以实现 AV 分流的潜在量化。该提案的目的是检验以下假设：ASL 可用作检测和量化 AVM 或 AVF 中 AV 分流的新方法，同时评估对脑灌注的影响。该提案的第一部分重点关注在此环境中使用的 ASL 灌注 MRI 技术的进一步开发和优化。在提案的第二部分中，正在接受 DSA 的疑似 AVM 或 AVF 患者也将在试点研究中使用优化的 ASL 灌注 MRI 技术进行研究，以评估其准确性。在该提案的第三部分中，将进一步分析试点研究中获得的信息，以确定是否可以量化 AV 分流，是否可以检测到与 AVM 或 AVF 相关的 CBF 变化，以及是否可以在接受手术切除或栓塞的患者中检测到 AV 分流或 CBF 的变化。公共卫生相关性：动静脉畸形 (AVM) 是大脑中的一种血管畸形，动脉和静脉之间有直接连接，导致血液绕过脑组织。患有 AVM 的患者可能直到 AVM 导致脑出血才意识到这一点，这是 40-70% 患者的首次症状，并可能导致永久性伤害或死亡。目前的成像方法不足以全面评估这些病变，因此该提案的目标是测试一种称为动脉自旋标记（ASL）灌注 MRI 的新方法，以改进 AVM 的检测和评估，并评估对附近脑组织的影响。