Anatomic Optical Coherence Tomography for Quantitative Bronchoscopy

描述（由申请人提供）：儿童通常患有上气道结构异常，导致呼吸不足和从简单的阻塞性睡眠呼吸暂停到迫在眉睫的危及生命的气道阻塞等问题。在许多情况下，动态气道塌陷明显导致气道阻塞，但缺乏定量评估动态气道的方法。动态气道的定量成像和计算建模不仅有助于气道阻塞的诊断，还有助于医疗和手术决策，并可用于预测建模和后续治疗计划。目前用于气道定量成像的临床方法，包括MRI和CT，存在一些局限性。婴儿和幼儿可能需要长时间的镇静或麻醉，这对气道阻塞的患者来说是相当危险的。就CT而言，存在与电离辐射暴露有关的风险。这些方法也不容易提供实时成像来研究气道动力学。气道内窥镜（喉镜和支气管镜）是评估气道阻塞的金标准，广泛用于提供定性诊断信息。我们建议通过开发一种基于解剖光学相干断层扫描（aOCT）的技术，通过标准支气管镜传递，来满足定量、实时、动态上呼吸道成像的需求。从这项新技术中获得的数据将可用于气道的三维计算模型，计算流体动力学（CFD）建模将在此基础上进行。我们的第一个具体目标将是验证acoct作为CT的功能等效替代品，用于为CFD创建3D虚拟气道几何形状。我们的假设是，通过支气管镜aOCT获得的上气道管腔几何形状可以预测等效气流阻力，就像通过CT获得的一样。作为该目的的一个探索性方面，我们将对成人尸体肺进行成像，以评估从隆突到主干、节段和较小支气管的定量成像能力。我们的第二个具体目标是将技术进步纳入aOCT系统，以实现动态，实时（3+1）维成像，以捕获活体猪模型的呼吸循环阶段。我们的第三个特定目标将是通过同时收集猪在体内的原位压力和aOCT成像数据来进行气道壁的弹性成像，以在自主呼吸和气道正压变化的情况下进行。这些数据将为模拟流固耦合（FSI）的CFD计算提供动态柔性气道模型。这些临床前验证、技术进步以及与阻塞性气道疾病生理参数的关联将使aOCT技术快速转化为临床气道成像。

DESCRIPTION (provided by applicant): Children commonly suffer from structural abnormalities of the upper airway that result in insufficient respiration and problems ranging from simple obstructive sleep apnea to imminent, life-threatening airway obstruction. In many cases dynamic airway collapse significantly contributes to airway obstruction, but methods for quantitative assessment of the dynamic airway are lacking. Quantitative imaging and computational modeling of the dynamic airway could prove very beneficial not only for the diagnosis of airway obstruction but also for aiding in medical and surgical decision-making, and could be utilized for predictive modeling and subsequent treatment planning. Current clinical methods for quantitative airway imaging, including MRI and CT, suffer from several limitations. Infants and young children may need to be sedated or anesthetized for long scan times, which can be quite hazardous for patients with airway obstruction. In the case of CT, there are risks associated with ionizing radiation exposure. These methods also do not readily offer real-time imaging to study airway dynamics. Airway endoscopy (laryngoscopy and bronchoscopy) is the gold standard for the evaluation of airway obstruction and is widely used to provide qualitative diagnostic information. We propose to address the need for quantitative, real-time, dynamic upper airway imaging by developing a technology based upon anatomic Optical Coherence Tomography (aOCT) delivered via standard bronchoscopes. The data acquired from this new technology will be manipulatable into 3D computational models of the airway upon which computational fluid dynamic (CFD) modeling will be performed. Our first Specific Aim will be to validate aOCT as a functionally equivalent substitute for CT for creating 3D virtual airway geometries for CFD. Our hypothesis is that the upper airway luminal geometries obtained by bronchoscopic aOCT can predict equivalent air flow resistance as that obtained by CT in cadaveric pigs. As an exploratory aspect of this Aim, we will perform imaging of adult human cadaveric lungs to evaluate the capability for quantitative imaging beyond the carina into the main stem, segmental, and smaller bronchi. Our second Specific Aim will be to incorporate technological advances into the aOCT system to enable dynamic, real-time (3+1) dimensional imaging to capture phases of the respiratory cycle in an in vivo pig model. Our third Specific Aim will be to perform elastography of the airway wall by collecting simultaneous in situ pressure and aOCT imaging data of pigs in vivo to during spontaneous respiration and while under variable positive airway pressure. This data will inform a dynamic flexible airway model for CFD computations that model the fluid-structure interaction (FSI). These pre-clinical steps of validation, technological advancement, and association with physiologic parameters of obstructive airway diseases will position the aOCT technology for rapid translation to clinical airway imaging.