Yan R01 Develops MR Imaging Technology for Improved Cerebral Revascularization Surgery Outcomes
Technology and Hardware Update | Lirong Yan, PhD
Cerebrovascular disease is one of the leading causes of death and disability worldwide. Surgical revascularization has become one of the most effective therapies for management of chronic cerebrovascular diseases including moyamoya disease, complex aneurysms, and selected carotid steno-occlusive disease. Surgical therapies are known to improve cerebral hemodynamics and reduce the risk of stroke. Dr. Lirong Yan, who started at Northwestern in April 2022, has been awarded a NINDS R01 that works to develop non-contrast, non-invasive MRI imaging to aid in pre- and post-revascularization surgery (7R01NS118019). As the need for surgery increases, so does the need for effective surgical planning. Surgeons need to know the best donor artery for bypass surgery. Imaging that quantifies blood flow significantly helps to answer the question of which artery is the best donor for at-risk territory. Currently, however, the choice of revascularization strategy highly relies on subjective interpretation of flow which is more variable, and thus patients are more at risk for post-operative complications. With this in mind, researchers like Dr. Yan are responding to the nuances of this clinical need.
“A segmented and quantitative characterization of cerebral hemodynamics pre- and post-revascularization is necessary to objectify flow requirements, standardize and improve patient care,” Yan says. “However, none of the existing clinical imaging modalities are able to provide high spatiotemporal resolution angiographic images with quantitative hemodynamic information from individual arterial segments without contrast agents.” The technology uses arterial spin labeling (ASL) to assess both vascular territories and perfusion from individual arteries quantitatively. Non-contrasted enhanced 4D MR angiography is employed to provide better delineation of dynamic flows with good time resolution. Furthermore, the non-contrast, non-invasive component to the imaging increases patient comfort and post- operative health. “Compared to the gold standard of digital subtraction angiography,” Dr. Yan says, “this provides a non-contrast option and is completely non-invasive.” This project also proposes an advanced image acquisition method and advanced image reconstruction algorithms to facilitate its clinical use.
Efforts to Standardize Protocols Across NM Increases Patient Flexibility of Care
Clinical Update | Bradley Allen, MD, Chief of Cardiovascular and Thoracic Imaging
Over the past six months, a dedicated group has worked to standardize MR and CT protocols across Northwestern Medicine. As NM continues to grow and integrate with other hospitals, standardizing protocols is a critical next step to offering our patients the best care and to creating more efficient workflows for our care teams. We know that patients want to receive the best possible care close to where they live and work. In parallel, they also want to retain the ability to move across our system when needed and experience a consistent standard of excellence at each NM site. To promote organizational alignment, improve access for our patients, and deliver highly coordinated care with system experts, this workgroup began to analyze the current state of NM protocols. Smaller groups were formed specifically to focus on Neuro, Body, Muskuloskeletal, and Chest/Cardio protocols. Each group, over the course of several months, collaborated with radiologists and technical leads from across the system to understand the essential sequences of a foundational set of imaging studies. They gathered feedback about what each site’s scanners are capable of and worked to address concerns.
Next, the team will work to implement the changes that each group has recommended. Moving forward, we will need to iterate upon this approach multiple times to address a substantial number of imaging orders. In addition to those efforts, the workgroup will evaluate the options that exist for a central repository to house these protocols and begin to consider what a committee might look like in the future for approval of changes to protocols. None of this challenging work could be accomplished without the time and help of so many of our radiologists, technical leads, and administrative team members. Thank you to all involved!
The Read | Volume 6 | Page 4
Department of Radiology
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