Time-efficient accurate 3D myocardium scar quantification using RAPID imaging

描述（由申请人提供）：冠心病（CHD）仍然是美国的头号死因。大多数冠心病患者出现严重的临床症状，包括心肌梗死（MI），并且首次发作后MI的复发率显著增加。心肌梗死后心肌瘢痕的准确检测和定量对于临床诊断至关重要，因为它与心脏功能密切相关，被证明是治疗预后的预测指标，并被广泛用作治疗评估的生物标志物。当前MI瘢痕检测的金标准是使用基于磁共振（MR）的相敏反转恢复（PSIR）技术，其可以在反转脉冲之后恢复自旋磁化的极性。由于已经发现3D扫描提供比2D扫描更高的量化和检测准确性，PSIR技术仍然面临两个主要挑战以完全使其自身适应临床上可行的D技术：1）低时间效率。因为PSIR技术需要额外的完全采样参考扫描来恢复磁化方向，因此与非PSIR LGE扫描相比，扫描时间加倍。因此，尽管3D PSIR可以潜在地提供改进的检测和量化精度，但它们仅在研究环境中进行了探索。2)疤痕和明亮的血池之间的对比度很差。尽管PSIR重建确保了疤痕/组织的强对比度，但通常明亮的血池信号仍然是量化疤痕的混淆因素，特别是对于细微的内膜下疤痕。我们的长期目标是开发一种MR成像技术，作为常规临床实践中心肌瘢痕检测/量化的一线诊断工具。新设计的RAPID重建不需要PS重建的第二次采集，将用于提高时间效率，并将与专用血液抑制技术相结合，以提高疤痕/血液对比度。新技术的准确性也将在临床环境中得到验证。通过成功实现这两个目标，我们希望开发和验证一种时间效率高的临床导向的3D可行性成像技术，可以显着提高目前的MI检测/量化的准确性。

DESCRIPTION (provided by applicant): Coronary Heart Disease (CHD) remains the No.1 cause of death in the United States. The majority patients with CHD develop serious clinical symptoms, including myocardial infarction (MI), and the recurrence rate of MI becomes significantly increased after the initial attack. The accurate detection and quantification of myocardial scarring post-MI is critical for clinical diagnosis because it has been strongly associated with cardiac function, proven to be a predictive indicator for treatment prognosis, and is widely used as a biomarker for treatment evaluation. The current gold standard of MI scarring detection is to use magnetic resonance (MR) based Phase Sensitive Inversion Recovery (PSIR) technique, which can restore the polarity of the spin magnetization after inversion pulses. As 3D scans have been found to provide higher quantification and detection accuracy than 2D scans, the PSIR technique still faces two major challenges to fully adapt itself into a clinically viable D technique: 1) Low time-efficiency. Because the PSIR technique requires an extra fully sampled reference scan to restore the magnetization orientation, thus doubling scan time compared to non-PSIR LGE scans. As a result, although 3D PSIR can potentially provide improved detection and quantification accuracy, they have only been explored in research environments. 2) Poor contrast between the scar and bright blood pool. Although the PSIR reconstruction ensures strong scar/tissue contrast, the usually bright blood pool signal remains a confounding factor in quantifying scars, esp. for a subtle subendocardial scar. Our long-term goal is to develop an MR imaging technique as first-line diagnostic tool for myocardial scar detection/quantification in regular clinical practice. A newly designed RAPID reconstruction that does not require the 2nd acquisition for PS reconstruction will be used to improve the time efficiency and it will be combined with dedicated blood suppression techniques to improve the scar/blood contrast. The accuracy of the new techniques will also be validated in a clinical environment. By successfully achieving both aims, we expect to develop and validate a time-efficient clinically orientated 3D viability imaging technique that can significantly improve the current MI detection/quantification accuracy.