Novel Myocardial Perfusion Stress Test using Arterial Spin Labeling

使用动脉旋转标记的新型心肌灌注压力测试

• 批准号: 9124428
• 负责人: Krishna S Nayak
• 金额: $ 43.28万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9124428
• 关键词: Accounting; Address; American; Angiography; Animal Model; Animals; Aorta; Blood; Blood flow; Brain; Calibration; Cardiac; Cardiac health; Cardiology; Cardiovascular system; Chronic Kidney Failure; Clinical; Contrast Media; Coronary; Coronary Angiography; Coronary Arteriosclerosis; Coronary Stenosis; Coronary artery; Detection; Diagnostic; Diastole; Dose; End stage renal failure; Engineering; Evaluation; Family suidae; Gadolinium; General Population; Goals; Growth; Heart; Heart Diseases; Human; Image; Intravenous; Ionizing radiation; Kidney; Kidney Failure; Label; Left; Left ventricular structure; Liver; Magnetic Resonance Imaging; Measurement; Measures; Methods; Modeling; Morphologic artifacts; Motion; Motivation; Myocardial Ischemia; Myocardial perfusion; Myocardial tissue; Noise; Operative Surgical Procedures; Patient Recruitments; Patients; Performance; Perfusion; Photons; Physiologic pulse; Positron-Emission Tomography; Prevalence; Pulsatile Flow; Radiation; Radioisotopes; Regional Perfusion; Renal function; Reproducibility; Research; Risk; Role; Safety; Scanning; Schedule; Scheme; Severities; Signal Transduction; Slice; Source; Spin Labels; Stress; Stress Tests; Students; Subgroup; Systole; Techniques; Technology; Testing; Thallium Myocardial Perfusion Imaging Stress Test; Time; Tissues; United States; Variant; Vasodilation; Ventricular; Work; X-Ray Computed Tomography; base; cardiovascular imaging; clinically relevant; cost; experience; gadolinium oxide; heart motion; high risk; imaging modality; innovation; interest; method development; mortality; novel; patient subsets; public health relevance; radiofrequency; research clinical testing; research study; screening; skills; training project

 DESCRIPTION (provided by applicant): This project will develop a new ultra-safe technique for myocardial perfusion stress testing in humans. Rationale: A growing number of patients in the United States require frequent cardiovascular assessment, to determine the presence and significance of coronary artery disease (CAD). Non-invasive myocardial perfusion stress testing is a method of choice, but we are not able to use current tests as frequently as we would like in these patients due to ionizing radiation and/or risks associated with contrast agents. Our proposed technique will not require any ionizing radiation or any potentially toxic contrast agents, and could therefore be performed repeatedly with no incremental risk to the patient. Innovation: We will utilize arterial spin labeled magnetic resonance imaging (ASL-MRI), an established technology for measuring brain perfusion in humans and myocardial perfusion in small animals. To our knowledge, its application to clinical myocardial perfusion imaging and stress testing is novel. Current methods for human cardiac ASL are able to detect increases in blood flow due to vasodilation, but provide only single slice coverage and barely adequate measurement variability (per-segment variations of roughly 0.16 mL-blood / g-tissue / min). We will address these limitations by developing and optimizing innovative new labeling schemes that enable evaluation of all 17 left ventricular segments, while taking into account cardiac motion, pulsatile flow, and potential sources of artifact. We will also integrate several new MRI technologies, for the first time, into the cardiac ASL experiment: simultaneous multi-slice imaging, background suppression, and blood pool suppression. Approach: The new test will be developed and experimentally optimized in a porcine model of CAD. We will first develop and optimize a labeling method that is compatible with whole-heart spatial coverage and maximizes the strength of the ASL signal. We will then develop and optimize an imaging method that interrogates all 17 left ventricular segments and maximizes the ASL temporal signal-to-noise ratio. After this is completed, we will perform a clinical evaluation of the optimized ASL-MRI stress test in patients with suspected CAD, and will compare the new test with both single-photon emitted computed tomography (SPECT) and invasive coronary angiography with fractional flow reserve (FFR). We will determine test-retest reproducibility of the new test in a subset of the patients. This study will enable whole-heart ASL-MRI stress testing, optimize and validate its ability to measure myocardial perfusion reserve, and enhance its feasibility as a firs-line test for CAD screening. Broader Impact: The proposed myocardial perfusion stress test could have a broader role for screening of patients with suspected CAD, due to its safety and its potential for simplicity and low cost. The technical work, particularly the labeling and imaging schemes, are likely to have implications for kidney and liver ASL-MRI. Finally, this work will provide training projects for postdoctoral, graduate, and undergraduate engineering students and clinical fellows interested in advanced cardiovascular imaging.

 描述（由适用提供）：该项目将开发一种针对人类心肌灌注应力测试的新的超安全技术。理由：美国越来越多的患者需要经常进行心血管评估，以确定冠状动脉疾病（CAD）的存在和重要性。非侵入性心肌灌注应力测试是一种首选方法，但是由于电离辐射和/或与对比剂相关的风险，我们无法像这些患者那样频繁地使用当前测试。我们提出的技术将不需要任何电离辐射或任何潜在的毒性对比剂，因此可以反复进行，而不会对患者进行增量风险。创新：我们将利用文物标记为磁共振成像（ASL-MRI），这是一种既定的技术，用于测量人类的脑灌注和小动物的心肌灌注。据我们所知，它将其应用于临床心肌灌注成像和压力测试是新颖的。人类心脏ASL的当前方法能够检测到由于血管舒张而导致的血流增加，但仅提供单个切片覆盖率，几乎没有足够的测量可变性（每段的变化约为0.16 mL-llood / g-tissue / min）。我们将通过开发和优化创新的新标签方案来解决这些局限性，这些方案能够评估所有17个左心室段，同时考​​虑到心脏运动，脉动流动和潜在的人工制品来源。我们还将首次将几种新的MRI技术集成到心脏ASL实验中：同时进行多板胶成像，背景抑制和抑制血液池。方法：新测试将在CAD的猪模型中开发并实验优化。我们将首先开发并优化与全心空间覆盖兼容并最大化ASL信号强度的标记方法。然后，我们将开发并优化一种成像方法，该方法询问所有17个左心室段，并最大化ASL临时信噪比。完成此操作后，我们将对可疑CAD的患者进行优化的ASL-MRI应力测试进行临床评估，并将新测试与单光子发射的计算机断层扫描（SPECT）和浸润性冠状动脉造影与分数流动储备（FFR）进行比较。我们将在患者的一部分中确定新测试的重现测试重现性。这项研究将使全心ASL-MRI应力测试，优化和验证其测量心肌灌注储备的能力，并提高其作为CAD筛选的第一线测试的可行性。更广泛的影响：拟议的心肌灌注压力测试可能在筛查可疑CAD的患者的安全性和低成本的潜力上具有更广泛的作用。技术工作，尤其是标签和成像方案，可能对肾脏和肝脏ASL-MRI具有影响。最后，这项工作将为博士后，研究生和本科工程专业的学生以及对高级心血管成像感兴趣的临床研究员提供培训项目。