Early to late gadolinium enhancement cardiac MRI in ischemic and non-ischemic cardiomyopathies

 描述（由申请人提供）：在心力衰竭（HF）患者中，准确区分缺血性和各种非缺血性心肌病（NICM）对于适当指导治疗至关重要。晚期钆增强（LGE）MRI是描述心肌瘢痕和纤维化的理想非侵入性成像方法，但由于需要多次屏气和区分各种形式NICM的特异性有限，因此不太适合HF患者。虽然LGE MRI基于在单个注射后时间对造影剂浓度的静态分析，但造影剂摄取和洗脱实际上是一个时间动态过程，其模式取决于特定的病理条件而变化。如果准确捕获，则对比动力学可以改善组织表征，特别是用于区分与不同病因相关联的NICM。该项目的最终目标是开发所谓的早期到晚期钆增强（ELGE）MRI方法，该方法可捕获造影剂摄取和随时间推移的洗脱，并利用所得动力学信息区分各种NICM。为了实现这一目标，我们将首先开发呼吸运动校正的3D LGE成像方法，该方法能够在自由呼吸期间覆盖整个心脏。这将通过集成新的MRI组件来实现，例如3D螺旋堆叠采集、外部体积抑制磁化准备和基于1D投影的运动估计器。然后，通过在注射后1分钟至40分钟之间重复自由呼吸扫描，在NICM患者中进行ELGE测量。ELGE时间曲线参数化后，将建立分类规则以区分心肌炎、扩张型心肌病和结节病，从而证明更大规模的临床研究是合理的。

 DESCRIPTION (provided by applicant): In patients with heart failure (HF), accurate differentiation among ischemic and various non-ischemic cardiomyopathies (NICMs) is essential for appropriate guidance of therapies. Late gadolinium enhancement (LGE) MRI is an ideal non-invasive imaging method for depicting myocardial scarring and fibrosis, but is not well suitable for HF patients due to the requirement of many breath-holds and limited specificity to distinguish various forms of NICM. While LGE MRI is based on static analysis of the concentration of contrast agent at a single post-injection time, contrast uptake and washout is actually a temporally dynamic process, the pattern of which varies depending on specific pathological conditions. If accurately captured, the contrast kinetics may improve the tissue characterization particularly for differentiating NICMs that are associated with different etiologies. The ultimate goal of this project is to develop so-called early-to-late gadolinium enhancement (ELGE) MRI methods which capture contrast uptake and wash-out over time and to utilize the resultant kinetics information for differentiating various NICMs. Towards this goal, we will first develop respiratory motion corrected 3D LGE imaging methods which enable whole heart coverage during free-breathing. This will be achieved by integrating novel MRI components such as 3D stack-of-spirals acquisition, outer volume suppression magnetization preparation and 1D projection-based motion estimator. Then, ELGE measurement will be done in NICM patients by repeating the free-breathing scan between 1min through 40 min post injection. After parameterization of ELGE time curves, classification rules will be established to distinguish myocarditis, dilated cardiomyopathy and sarcoidosis that justify a larger clinical study.