High-Resolution Lymphatic Mapping of the Upper Extremities with MRI

项目摘要 淋巴水肿是一种淋巴清除受损的情况，导致淋巴肿胀和肿胀。 这可能会对生活质量和医疗费用产生破坏性影响。最常见的原因是 美国的淋巴水肿是由癌症相关的手术引起的。淋巴水肿是进行性的，无法治愈。它不是 知道为什么一些患者会患淋巴水肿，而另一些患者则不会。对身体的研究表明， 淋巴解剖结构可能会因个体而异，据信这些变异可能会增加罹患 某些人会患上淋巴水肿。如果这是真的，可以采取措施防止淋巴水肿 发展的，例如在手术时搭桥的。然而，没有实际的方法来获得 在活体四肢内的完整淋巴解剖图。目前的成像技术受到以下限制 穿透深度、低分辨率、侵入性和局部覆盖。挑战是绘制淋巴管的图谱 直径为0.4-0.8毫米的通道，并从四肢的所有区域追溯到引流淋巴 节点。本方案的重点是开发一种新型的高分辨率磁共振(MR)。 淋巴造影术(HrMRL)在活人上肢淋巴测绘中的应用。HRMRL将是 快速自旋回波序列与定制的可变翻转角度、背景减去和 通过采用压缩传感和深度学习的欠采样加速。第一个目标将是建立 并使用幻影以迭代的方式优化这些组件，然后在10个健康的 受试者，目标是在目标时间内获得整个肢体的淋巴通道图 20分钟，适合临床使用。在第二个目标中，首先将使用hrmrl来获得完整的淋巴管。 曾接受吲哚青绿治疗的35名健康志愿者的上肢解剖图 (ICG)淋巴造影术，将作为黄金标准参考。然后，HrMRL将通过以下方式针对ICG进行验证 比较两张地图，并确定它们的一致程度。预计hrmrl还将解决其他 未被ICG发现的淋巴通道，使我们有机会创建更全面的地图并 描述新的通路，特别是深淋巴管。如果成功，hrMRL将是 在临床环境中立即产生影响，在那里它可以指导避免淋巴水肿发生的措施， 将淋巴水肿管理算法从一种支持和纠正疗法转变为一种 预防，目的是减少这种使人衰弱和代价高昂的疾病的发生率。

Project Summary Lymphedema is a condition in which the clearance of lymph is compromised, resulting in edema and swelling of limbs, with potentially devastating impact on quality of life and medical costs. The most common cause of lymphedema in the US is from cancer-related surgery. Lymphedema is progressive and has no cure. It is not known why some patients develop lymphedema while others do not. Studies of cadavers have shown that the lymphatic anatomy can vary across individuals, and it is believed that these variations may increase the risk for certain individuals to develop lymphedema. If this is true, steps may be taken to prevent lymphedema from developing, for example with a bypass at the time of surgery. However, there is no practical way to obtain a complete lymphatic anatomical map within an extremity in vivo. Current imaging techniques are limited by penetration depth, low resolution, invasiveness, and partial coverage. The challenge is to map lymphatic channels, with diameters of 0.4-0.8 mm, and to trace them from all regions of an extremity back to draining lymph nodes. This proposal focuses on the development of a novel high resolution magnetic resonance (MR) lymphography technique (hrMRL) for lymphatic mapping of the upper extremities in living people. hrMRL will be a combination of a fast spin echo sequence with tailored variable flip angles, background subtraction, and acceleration via undersampling with compressed sensing and deep learning. The first aim will be to construct and optimize each of these components in an iterative fashion using phantoms, followed by testing on 10 healthy subjects, with the goal of obtaining maps of the lymphatic channels of an entire extremity within a target time of 20 minutes, suitable for clinical adoption. In the second aim, hrMRL will first be used to obtain full lymphatic anatomic maps of the upper extremity of 35 healthy volunteers who previously underwent indocyanine green (ICG) lymphography, which will serve as a gold-standard reference. hrMRL will then be validated aginst ICG by comparing both maps and determining their degree of agreement. hrMRL is also expected to resolve additional lymphatic channels undetected by ICG, allowing us the opportunity to create more comprehensive maps and to characterize new pathways, in particular the deep lymphatic channels. If successful, hrMRL would be immediately impactful in the clinical setting, where it could guide measures to avoid onset of lymphedema, shifting the lymphedema management algorithm from one of supportive and corrective therapies to one of prevention, with the goal of reducing the incidence of this debilitating and costly disease.