3D MRI Characterization of High-Risk Carotid Artery Plaques without Contrast Media

无需造影剂的高风险颈动脉斑块的 3D MRI 表征

• 批准号: 8973293
• 负责人: Debiao Li
• 金额: $ 43.75万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-20 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8973293
• 关键词: Arterial Fatty Streak; Atherosclerosis; Blood; Caliber; Cardiovascular Diseases; Cardiovascular system; Carotid Arteries; Carotid Artery Plaques; Carotid Atherosclerotic Disease; Complex; Contrast Media; Cost Savings; Data; Deglutition; Detection; Development; Diffusion Magnetic Resonance Imaging; Event; Fibrosis; Future; Gadolinium; Goals; Hemorrhage; High Prevalence; Histopathology; Image; Kidney Failure; LDL Cholesterol Lipoproteins; Life Style; Lipids; Magnetic Resonance Imaging; Measures; Medical; Methods; Morphologic artifacts; Motion; Necrosis; Patients; Pattern; Physiologic pulse; Probability; Protocols documentation; Protons; Recovery; Resolution; Risk; Rupture; Scheme; Signal Transduction; Slide; Specimen; Stroke; T2 weighted imaging; Techniques; Testing; Time; Tissues; Transient Ischemic Attack; Treatment outcome; Validation; Weight; base; calcification; contrast imaging; cost; data acquisition; density; gadolinium oxide; high risk; imaging modality; improved; outcome forecast; public health relevance; response

 DESCRIPTION (provided by applicant): The broad, long-term objective of the application is to improve the prognosis of patients with carotid atherosclerosis. We will develop and validate a fast and non-contrast-agent-enhanced 3D MRI technique to identify carotid atherosclerotic plaques that have a high probability of causing neurovascular events such as stroke or transient ischemic attack. Major features of high-risk carotid plaques include the presence of intra- plaque hemorrhage (IPH), calcification (CA), a large lipid-rich necrotic core (LRNC), and thin fibrous cap (FC). MRI is used extensively to characterize carotid artery plaques based on tissue signal patterns on multi- contrast-weighted images (T1-, T2-weighted imaging and time-of-flight) and contrast-agent-enhanced imaging. However, the conventional protocol has a number of major limitations, including: (1) Relatively low through- plane resolution (2-3 mm) with 2D techniques, potentially reducing the accuracy of plaque characterization due to the partial volume effect, 2) relatively long total image acquisition time (> 20 min), 3) image artifacts caused by swallowing during data acquisition, 4) complex plaque characterization using separate T1-, T2-, proton- density-weighted, time-of-flight, and contrast-agent-enhanced images, resulting in potential errors due to image misregistration between separate acquisitions, and most importantly, 5) the requirement of gadolinium-based- contrast-agent-enhanced imaging for LRNC characterization. As a result, patients with renal insufficiency will not be able to undergo this examination due to the risk of developing nephrogenic systemic fibrosis. Therefore, MRI techniques without gadolinium-based contrast media could be vitally important for patients with renal insufficiency, who also have high prevalence for cardiovascular disease. The goal of the application is to develop a new MRI technique and test the hypothesis that it reduces data acquisition time by a factor of 3 while without the need for contrast media as compared to the conventional protocol. Specific aims are: Aim 1: To develop the non-contrast-agent-enhanced, multi-contrast-weighted atherosclerosis characterization (NCE-MATCH) technique Aim 2: To validate high-risk carotid plaque features detected by NCE-MATCH using histopathology Aim 3: To verify that NCE-MATCH can detect atherosclerotic lipid depletion during lipid lowering therapy If successfully developed, the technique will be able to identify patients who are prone to future neurovascular events so life style changes or medical therapies can be initiated to reduce the risks. It will als provide a measure for evaluating the response to lipid lowering therapy, which is predictive of reduced risk. Compared to the conventional protocol, NCE-MATCH will allow imaging of patients with renal insufficiency due to its ability to avoid contrast agents. It also has the potential for considerable cost savings due to shorter imaging time and non-contrast-agent-enhanced imaging.

 描述（由申请人提供）：该申请的广泛、长期目标是改善颈动脉粥样硬化患者的预后。我们将开发并验证一种快速且非造影剂增强的 3D MRI 技术，以识别很可能引起中风或短暂性脑缺血发作等神经血管事件的颈动脉粥样硬化斑块。高危颈动脉斑块的主要特征包括斑块内出血（IPH）、钙化（CA）、大的富含脂质的坏死核心（LRNC）和薄纤维帽（FC）。 MRI 广泛用于根据多对比加权图像（T1、T2 加权成像和飞行时间）和造影剂增强成像上的组织信号模式来表征颈动脉斑块。然而，传统协议有许多主要限制，包括：(1) 2D 技术的平面分辨率相对较低 (2-3 mm)，由于部分体积效应，可能会降低斑块表征的准确性，2) 总图像采集时间相对较长 (> 20 分钟)，3) 数据采集过程中吞咽引起的图像伪影，4) 使用单独的 T1-、T2- 进行复杂的斑块表征， 质子密度加权、飞行时间和造影剂增强图像，由于单独采集之间的图像重合失调而导致潜在的错误，最重要的是，5) LRNC 表征需要基于钆的造影剂增强成像。因此，肾功能不全的患者将无法接受这项检查，因为存在发生肾源性系统性纤维化的风险。因此，不使用钆对比剂的 MRI 技术对于肾功能不全患者至关重要，这些患者心血管疾病的患病率也很高。该应用程序的目标是开发一种新的 MRI 技术并测试这样的假设：与传统协议相比，该技术将数据采集时间缩短了 3 倍，同时无需造影剂。具体目标是： 目标 1：开发非造影剂增强、多对比加权动脉粥样硬化表征 (NCE-MATCH) 技术 目标 2：利用组织病理学验证 NCE-MATCH 检测到的高风险颈动脉斑块特征 目标 3：验证 NCE-MATCH 可以在降脂治疗期间检测动脉粥样硬化脂质消耗 如果开发成功， 技术将能够识别未来容易发生神经血管事件的患者，因此可以开始改变生活方式或进行药物治疗以降低风险。它还将提供一种评估降脂治疗反应的方法，这可以预测风险的降低。与传统方案相比，NCE-MATCH 由于能够避免使用造影剂，因此可以对肾功能不全患者进行成像。由于更短的成像时间和非造影剂增强成像，它还有可能节省大量成本。