Noninvasive Assessment of Liver Stiffness with Tagged MRI

使用标记 MRI 对肝硬化进行无创评估

• 批准号: 7977979
• 负责人: Leon Axel
• 金额: $ 21.13万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7977979
• 关键词: Alcoholic Hepatitis; Autopsy; Biopsy; Biopsy Specimen; Blinded; Cardiac; Cirrhosis; Clinical; Computer software; Development; Disease; Disease Progression; Evaluation; Exposure to; Fibrosis; Finite Element Analysis; Hepatitis C; Image; Image Analysis; Imagery; Lead; Life; Liver; Liver Cirrhosis; Liver Fibrosis; Liver diseases; Magnetic Resonance Imaging; Measures; Mechanics; Methods; Minor; Modeling; Modification; Motion; Operative Surgical Procedures; Palpation; Patient Care; Patients; Prevention; Primary carcinoma of the liver cells; Property; Public Health; Recruitment Activity; Research; Research Project Grants; Risk; Series; Severities; Software Tools; Staging; Symptoms; System; Testing; Time; Viral; base; clinical application; cost; effective therapy; heart motion; high risk; imaging modality; improved; liver biopsy; public health relevance; research clinical testing; tool

DESCRIPTION (provided by applicant): Liver disease is a major and growing public health concern. While many patients presenting with viral or alcoholic hepatitis will recover well, others will have significant progression of their disease (more than 50% of patients with exposure to hepatitis C become chronically infected), often initially without externally apparent symptoms. This can lead to the late development of frank liver cirrhosis, with its attendant potentially life-threatening complications, and an increased risk of developing hepatocellular carcinoma. While many patients can be successfully treated in the earlier stages of the disease, treatment is much less successful once full-blown cirrhosis has developed. However, the available treatments are not without their own cost and potential risks, and cannot be given routinely to all patients at their initial presentation. Thus, the ability to detect progression of liver disease at an earlier stage would enable more effective treatment and the prevention of later complications, while avoiding treatment of those patients who do not require it. Unfortunately, the currently available noninvasive means of detecting the early progression of the disease are limited in their accuracy, thus often leading to a need for repeated liver biopsies to follow those patients who are felt to be at a higher risk of developing cirrhosis. This proposed research is focused on the initial development and testing of a new method for the noninvasive evaluation of liver stiffness, based on tagged magnetic resonance imaging (tMRI), which is expected to provide a sensitive early marker for the development of liver fibrosis, an important hallmark of the progression toward cirrhosis. Cardiac motion produces transmitted motion in the liver that can be seen and measured with tMRI. Fibrosis of the liver has been seen to produce qualitative and quantitative changes in this liver motion in our initial results. The proposed research will develop improved tools to study the changes in this motion associated with liver fibrosis, and will correlate them with the degree of fibrosis as a means to validate the results. This new method for assessment of liver stiffness produces images that can be directly and intuitively understood; it can be implemented on conventional MRI systems, requiring only minor imaging software modification and the use of suitable software tools for analysis of the resulting images; and it can be rapidly carried out. These features all make it potentially suitable for incorporation in routine liver MRI evaluations when there is a question of possible increased liver stiffness. Thus, there is a significant potential for an important beneficial impact of this research on patient care. PUBLIC HEALTH RELEVANCE: Liver disease is an important and growing public health problem, with there frequently being clinically silent progression to the later serious complications of cirrhosis. However, conventional noninvasive methods of detecting liver fibrosis, a hallmark of developing cirrhosis, are unreliable, often resulting in the need for repeated liver biopsies (with their associated discomfort and risk) to follow patients at risk for progressive liver disease. The overall aim of this project is the development and evaluation of a new method for assessing the stiffness of the liver, specifically, the use of tagged magnetic resonance imaging (tMRI) to measure the motion and deformation induced in the liver by the motion of the heart; if successful, this could provide a way to avoid the need for biopsy in following many patients with liver disease.

描述（由申请人提供）：肝病是一个主要的和日益增长的公共卫生问题。虽然许多患有病毒性或酒精性肝炎的患者会恢复良好，但其他人的疾病会有显著的进展（超过50%的丙型肝炎患者会成为慢性感染），通常最初没有明显的外部症状。这可能导致肝硬化的晚期发展，伴随着潜在的危及生命的并发症，以及发展为肝细胞癌的风险增加。虽然许多患者可以在疾病的早期阶段成功治疗，但一旦发展为完全肝硬化，治疗就不那么成功了。然而，现有的治疗方法并非没有成本和潜在风险，并且不能在初始表现时常规给予所有患者。因此，在早期阶段检测肝病进展的能力将能够更有效地治疗和预防后期并发症，同时避免对那些不需要治疗的患者进行治疗。不幸的是，目前可用的检测疾病早期进展的非侵入性手段在其准确性方面是有限的，因此经常导致需要重复的肝活组织检查以跟踪那些感觉处于发展为肝硬化的较高风险的患者。这项拟议的研究重点是基于标记磁共振成像（tMRI）的非侵入性评估肝脏硬度的新方法的初步开发和测试，预计将为肝纤维化的发展提供敏感的早期标志物，这是肝硬化进展的重要标志。心脏运动在肝脏中产生可以用tMRI看到和测量的传输运动。在我们的初步结果中，已经看到肝脏纤维化在肝脏运动中产生质和量的变化。拟议的研究将开发改进的工具来研究与肝纤维化相关的这种运动的变化，并将其与纤维化程度相关联，作为验证结果的一种手段。这种用于评估肝脏硬度的新方法产生可以直接和直观地理解的图像;它可以在传统的MRI系统上实现，仅需要微小的成像软件修改和使用合适的软件工具来分析所得图像;并且可以快速进行。当存在可能增加肝脏硬度的问题时，这些特征都使其可能适合纳入常规肝脏MRI评价。因此，这项研究对患者护理有重要的有益影响。 公共卫生关系：肝病是一个重要的和日益增长的公共卫生问题，经常有临床沉默进展到肝硬化的后期严重并发症。然而，检测肝纤维化（发展中肝硬化的标志）的传统非侵入性方法是不可靠的，经常导致需要重复肝活检（伴随其相关的不适和风险）来随访有进展性肝病风险的患者。该项目的总体目标是开发和评价一种评估肝脏硬度的新方法，特别是使用标记磁共振成像（tMRI）来测量心脏运动引起的肝脏运动和变形;如果成功，这可以提供一种方法来避免对许多肝脏疾病患者进行活检。