Identifying CT Imaging Biomarkers Associated with Prognosis of Pulmonary Embolism

识别与肺栓塞预后相关的 CT 成像生物标志物

• 批准号: 8117504
• 负责人: KYONGTAE T BAE
• 金额: $ 69.3万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-26 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8117504
• 关键词: Acute; Admission activity; Anatomy; Angiography; Anticoagulants; Archives; Biological Markers; Blood Vessels; Caliber; Cessation of life; Characteristics; Clinical; Clinical Management; Clinical Treatment; Clinical Trials; Coagulation Process; Comorbidity; Complex; Cost Control; Data; Databases; Deep Vein Thrombosis; Deposition; Diagnosis; Diagnostic; Diagnostic Imaging; Disease; Embolism; Enrollment; Goals; Health; Health Care Costs; Health system; Image; Incidence; Interobserver Variability; Intraobserver Variability; Left ventricular structure; Lung; Measurement; Measures; Medical; Medical center; Modeling; Outcome; Patients; Pennsylvania; Performance; Personal Satisfaction; Prevention therapy; Prophylactic treatment; Pulmonary Embolism; Pulmonary Emphysema; Radiology Specialty; Records; Recurrence; Research; Resolution; Retrieval; Risk; Risk Assessment; Role; Scanning; Source; Speed; Structure; System; Techniques; Testing; Thromboembolism; United States; Universities; Veins; Venous; Washington; Work; X-Ray Computed Tomography; abstracting; cohort; coronary artery calcification; design; disability; follow-up; hospital readmission; image processing; improved; indexing; innovation; insight; outcome forecast; patient population; prognostic; programs; prospective; public health relevance; tool

DESCRIPTION (provided by applicant): Identifying CT Imaging Biomarkers Associated with Prognosis of Pulmonary Embolism Abstract Venous thromboembolism (VTE), which clinically manifests as deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common but elusive illness that can cause significant disability and death if not promptly diagnosed and effectively treated. The annual incidence of VTE in the United States is estimated at 1 per 1000. Death occurs in approximately 12% of PE cases within 1 month of diagnosis. At present, clinical management of VTE and PE is hampered by gaps in our understanding of pathogenic mechanisms, the wide variety in patient populations, and incomplete understanding of the long term risks of recurrence and death. Given the complex presentation and risk associated with these conditions, proper risk assessment and subsequent prophylaxis for all at-risk patients is crucial. While clinical prediction rules have been recently developed to associate short-term risks and to stratify patients with acute PE, there is a dearth of objective biomarkers that can be related to the long-term prognosis of the disease. In addition to clinical information, clot burden is known to be strongly associated with clinical outcome of recurrent VTE. The quantification of clot burden requires imaging. CT Pulmonary Angiography (CTPA) has been established as a reference imaging standard in the diagnosis of PE. In addition to its role as a superb diagnostic tool, CTPA contains a wealth of information including characteristics of the clot that may be used as biomarkers associated with prognosis of PE. The work proposed in this application takes advantage of widely available CTPA imaging biomarker data and extends and advances clinical PE risk prediction model to include long term (2-year) survival as well as the clinically important outcome of recurrence. The primary objective of this proposal is to develop and identify CTPA imaging biomarkers that are associated with short-term and long-term prognoses of patients who were positively diagnosed for PE by CT. The rationale for this proposal is that CT imaging is a rich source of imaging biomarkers that may be associated with prognosis of PE. This information will help advance our understanding of the risk and recurrence of PE and provide a new insight to prognosis and clinical management and treatment of PE. This proposed research is innovative in that we have developed new CT imaging biomarkers and designed a clinical trial to assess and validate the prognostic values of these biomarkers. Our central hypothesis is that CT imaging biomarkers are associated with the risk of death and recurrence in patients with PE. The specific aims of this proposal are: (1) to quantify and characterize pulmonary emboli (volume and distribution) and comorbid cardiovasculopulmonary findings from CT images of patients who were positively diagnosed for PE by CT; (2) to identify CT imaging biomarkers that are associated with the prognosis of patients who were positively diagnosed for PE by CT, and to develop risk prediction tools for death and recurrence; and (3) to prospectively validate the risk prediction tool, and identify whether the change in CT imaging biomarkers of PE after initiation of therapy improve the predictive ability for recurrence and death. Public Health Relevance: The work proposed in this application takes advantage of widely available CTPA imaging biomarker data and extends and advances clinical PE risk prediction model to include long term (2-year) survival as well as the clinically important outcome of recurrence. We believe the proposed study is timely and will provide a new insight to prognosis and clinical management and treatment of PE.

描述（由申请人提供）： 静脉血栓栓塞症（Venous thromboembolism，VTE）是一种常见的肺栓塞性疾病，临床表现为深静脉血栓形成（Deep Vein Thromboembolism，DVT）和肺栓塞（Pulmonary Embolism，PE），如果不及时诊断和有效治疗，可导致严重残疾和死亡。在美国，VTE的年发病率估计为1/1000。大约12%的PE病例在诊断后1个月内死亡。目前，VTE和PE的临床管理受到我们对致病机制理解的差距、患者人群的广泛多样性以及对复发和死亡的长期风险的不完全理解的阻碍。鉴于这些疾病的复杂表现和风险，对所有高危患者进行适当的风险评估和后续预防至关重要。虽然最近已经开发了临床预测规则来关联短期风险并对急性PE患者进行分层，但缺乏与疾病长期预后相关的客观生物标志物。除临床信息外，已知凝块负荷与复发性VTE的临床结局密切相关。凝块负荷的定量需要成像。CT肺血管造影（CTPA）已被确立为诊断PE的参考影像学标准。除了作为一种极好的诊断工具外，CTPA还包含丰富的信息，包括可用作与PE预后相关的生物标志物的凝块特征。本申请中提出的工作利用了广泛可用的CTPA成像生物标志物数据，并扩展和推进了临床PE风险预测模型，以包括长期（2年）生存以及复发的临床重要结局。本提案的主要目的是开发和鉴定与经CT确诊为PE的患者的短期和长期复发相关的CTPA成像生物标志物。该建议的基本原理是CT成像是可能与PE预后相关的成像生物标志物的丰富来源。这些信息将有助于我们进一步了解PE的风险和复发，并为PE的预后和临床管理和治疗提供新的见解。这项拟议的研究是创新的，因为我们开发了新的CT成像生物标志物，并设计了一项临床试验来评估和验证这些生物标志物的预后价值。我们的中心假设是CT成像生物标志物与PE患者的死亡和复发风险相关。该建议的具体目标是：（1）量化和表征肺栓塞（2）鉴定与通过CT确诊为PE的患者的预后相关的CT成像生物标志物，并开发死亡和复发的风险预测工具;以及（3）前瞻性验证风险预测工具，并确定治疗开始后PE的CT成像生物标志物的变化是否提高复发和死亡的预测能力。公共卫生相关性：本申请中提出的工作利用了广泛可用的CTPA成像生物标志物数据，并扩展和推进了临床PE风险预测模型，以包括长期（2年）生存以及复发的临床重要结局。我们相信这项研究是及时的，将为PE的预后和临床管理和治疗提供新的见解。