Quantitative Adenosine Stress CMR with Spiral Pulse Sequences

描述（由申请人提供）：这个职业发展奖项目的目标是发展迈克尔萨莱诺医学博士，博士的研究技能，成为一个独立的研究人员参与以病人为导向的研究领域的心血管成像。临床研究中的必要指导将由其临床导师Christopher克雷默博士提供，工程指导将由其共同导师克雷格迈耶博士提供。他的职业生涯将通过一个咨询委员会进一步丰富，该委员会包括心肌灌注成像快速脉冲序列开发、灌注定量以及临床试验统计设计和分析方面的专家。弗吉尼亚大学将为萨莱诺博士成为一名独立的研究者提供理想的资源组合。该职业发展计划包括设计，执行和分析多中心成像试验所需的教学培训，这将有助于他在心血管成像领域的长期成功。这项培训将导致统计学硕士学位，集中在生物统计学和临床试验。 萨莱诺博士的最终计划是利用他在心血管成像方面独特的工程和临床专业知识的跨学科组合，将新的CMR技术转化为临床实践。他在这一奋进中取得成功的可能性将显着增加他的临床研究技能的进一步发展，他的教学培训和导师互动，从这个职业发展奖。 腺苷负荷灌注CMR正在成为一种有前途的冠状动脉疾病的评价模式，与其他成像技术相比具有多个优势，包括缺乏电离辐射，高空间分辨率，以及能够准确量化心肌灌注和缺血负荷。当前CMR首过灌注技术受到“暗边”伪影的限制，其可能被误认为真正的灌注异常，导致视觉分析的假阳性研究，并且可能妨碍定量方法对心肌灌注的准确定量。此外，这些技术在其时间分辨率、空间分辨率和心室覆盖方面仍然有限。我们假设螺旋脉冲序列对这些伪影具有鲁棒性，同时具有提供具有高时间和空间分辨率的完整心室灌注定量的效率。此外，我们假设这些技术将产生一个强大的腺苷应激CMR的临床协议，将具有高特异性。 本课题的具体目标是：（1）开发基于螺旋灌注脉冲序列的心肌灌注绝对定量方法。(2)使用螺旋轨迹评价腺苷负荷CMR，以定性和定量评估中等可能性CAD患者的心肌灌注，以确定使用FFR作为功能金标准的灵敏度和特异性。 由于在美国每年进行的超过100万次心脏导管插入术中有近40%没有显示出阻塞性CAD，因此提高无创压力测试技术的准确性可以显著降低患者接受昂贵且通常不必要的侵入性手术所导致的医疗保健成本。改进的技术还将减少对可疑研究的重复测试，并减少错误诊断的数量。因此，该项目有可能减少医疗保健支出，同时改善患者护理。

DESCRIPTION (provided by applicant): The goal of this career development award project is to develop the research skills of Michael Salerno MD, PhD to become an independent investigator involved in patient-oriented research in the field of cardiovascular imaging. The necessary mentorship in clinical investigation will be provided by his clinical mentor, Dr. Christopher Kramer MD and engineering mentorship will be provided by his co-mentor Dr. Craig Meyer. His career will be further enriched by an advisory committee which includes experts in the development of rapid pulse sequences for myocardial perfusion imaging, quantification of perfusion, and the statistical design and analysis of clinical trials. The University of Virginia wll provide the ideal combination of resources necessary for Dr. Salerno to become an independent investigator. This career development proposal includes didactic training necessary to design, perform and analyze multi-center imaging trials which will be instrumental to his long term success in the field of cardiovascular imaging. This training will lead to a Masters degree in Statistics with a concentration in biostatistics and clinical trials. Dr. Salerno's ultimate plan t to utilize his unique interdisciplinary combination of engineering and clinical expertise in cardiovascular imaging to translate new CMR techniques into clinical practice. His likelihood for success in this endeavor will be significantly increased by further development of his clinical research skills by both his didactic training and mentorship interactions resulting from this caree development award. Adenosine stress perfusion CMR is becoming a promising modality for the evaluation of coronary artery disease with multiple advantages as compared to other imaging techniques including a lack of ionizing radiation, high-spatial resolution, and the ability to accurately quantify myocardial perfusion and ischemic burden. Current CMR first pass perfusion techniques are limited by "dark-rim" artifacts which may be mistaken for true perfusion abnormalities resulting in false positive studies with visual analysis, and may impede accurate quantification of myocardial perfusion for quantitative methods. Furthermore, these techniques are still limited in their temporal resolution, spatial resolution and ventricular coverage. We hypothesize that spiral pulse sequences will be robust to these artifacts, while having the efficiency to provide full ventricular perfusion quantification with high temporal and spatial resolution. Additionally, we hypothesize that these techniques will result in a robust clinical protocol for adenosine stress CMR which will have high specificity. The specific aims of this project are: (1) To develop spiral based-perfusion pulse sequences to perform absolute quantification of myocardial perfusion with whole heart coverage. (2) To evaluate adenosine stress CMR using spiral trajectories for both qualitative and quantitative assessment of myocardial perfusion in patients with an intermediate probability of CAD to determine the sensitivity and specificity using FFR as a functional gold standard. As nearly 40% of the greater than 1 million heart catheterizations which are performed annually in the US do not demonstrate obstructive CAD, improving the accuracy of non-invasive stress testing techniques could significantly reduce health care costs resulting from patients undergoing expensive and often unnecessary invasive procedures. Improved techniques would also reduce repeated testing for equivocal studies and reduce the number of incorrect diagnoses. Thus, this project has the potential to reduce health care expenditures while improving patient care.