Clinically Translatable Cardiac Diffusion MR for Non-Contrast Characterization of

描述(由申请人提供)：长期目标是开发一种创新的、临床上可靠的、对心肌组织微结构变化敏感的心脏弥散磁共振序列。表征心肌组织微结构的能力将使人们能够独特地了解心血管疾病(CVD)的病理生理进展，如急性冠脉综合征、心肌炎和心肌病，这些疾病是美国发病率和死亡率的主要原因之一。传统的心脏磁共振成像(CMR)技术在显示心肌形态变化的同时提供了良好的软组织对比，具有临床价值。然而，用于心肌组织定征的有效CMR技术需要使用造影剂。对于肾系统受损的患者，如慢性肾脏疾病(CKD)，这些患者无法从这些基于造影剂的技术中受益。此外，25%的CKD患者患有严重的CVD，导致左心室肥厚(LVH)，并可直接受益于心肌组织纤维化的特征。因此，需要一种能够对心肌纤维化进行非对比剂量化的新的MR技术，我们相信这可以通过心脏弥散磁共振实现。在这项拟议的项目中，临床上可翻译的心脏 能够表征人类心肌纤维化的扩散磁共振技术将应用于肥厚型心肌病(HCM)患者，这些患者已知具有经对比增强CMR证实的高度纤维化。具体目标1解决了我们实验室开发的新建立的心脏弥散磁共振技术临床翻译的技术挑战，该技术要求更好的空间覆盖、空间分辨率和更短的扫描时间。特定目标2将把在特定目标1中开发的建议技术应用于肥厚性心肌病患者，以确定心肌纤维化的程度，并将其与经过验证的对比增强CMR方法进行比较。假设：心脏弥散磁共振成像的临床翻译需要重大的技术创新，而证明该技术对CKD+LVH患者的临床有效性的关键应用将是在不使用造影剂的情况下表征肥厚性心肌病患者的心肌纤维化。

DESCRIPTION (provided by applicant): The long-term objective is to develop an innovative and clinically robust cardiac diffusion MRI sequence that is sensitive to changes to myocardial tissue microstructure. The ability to characterize myocardial tissue microstructure will allow for unique insight to the pathophysiological progression of cardiovascular diseases (CVD) such as acute coronary syndrome, myocarditis, and cardiomyopathy, which are among the leading causes of morbidity and mortality of the US. Conventional cardiac MRI (CMR) techniques have shown to be clinically valuable in revealing morphological changes in the myocardium while providing excellent soft tissue contrast. However, validated CMR techniques used for myocardial tissue characterization require the use contrast agents. For patients with compromised renal systems such as those with Chronic Kidney Disease (CKD), these patients cannot benefit from these contrast-based techniques. Furthermore, 25% of CKD patients have a severe form of CVD that results in left ventricular hypertrophy (LVH) and can directly benefit from characterization of myocardial tissue fibrosis. Therefore, there is a need for a novel MR technique capable of non- contrast quantification of myocardial fibrosis, which we believe can be achieved with cardiac diffusion MRI. In this proposed project, a clinically translatable cardiac diffusion MR technique capable of myocardial fibrosis characterization of the human myocardium will be applied in hypertrophic cardiomyopathy patients (HCM) who are known to have high degree of fibrosis validated with contrast-enhanced CMR. Specific Aim 1 addresses the technical challenges of the clinical translation of a newly established cardiac diffusion MR technique developed by our lab, which requires better spatial coverage, spatial resolution, and shorter scan times. Specific Aim 2 will apply the proposed technique developed in Specific Aim 1 to HCM patients to characterize the extent of myocardial fibrosis and compare it with validated contrast-enhanced CMR methods. Hypothesis: Clinical translation of cardiac diffusion MRI requires major technical innovation, and a key application to demonstrate the technique's clinical utility for CKD+LVH patients would be to characterize myocardial fibrosis in HCM patients without the use of contrast agents.