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Développements en IRM quantitative de perfusion pour le diagnostic de fibrose myocardique

Abstract : Heart failure represents a major public health issue in western world. It is a complex syndrome that could be the cause and/or the consequence of underlying pathologies such interstitial diffuse fibrosis. Magnetic Resonance Imaging (MRI) is the reference imaging modality for soft tissue assessment and especially the myocardium. Several imaging biomarkers such relaxation time T1 or extracellular volume fraction (ECV) have proven their diagnostic power in term of sensitivity and specificity. MRI with contrast agent injection has also demonstrated its usefulness in diagnostic of post-infarct local fibrosis for instance. Dynamic contrast enhancement (DCE) is widely investigated for its supposed ability to discriminate areas from which perfusion/permeability properties have been altered by the presence of fibrosis deposition. We hypothesized that the quantification of myocardial permeability and the estimation of the extracellular extravascular volume fraction Ve could led to a better detection of diffuse fibrosis. Consequently, we investigated the possibility of a shorter protocol for the evaluation of ECV. In this manuscript, we first present the methodological developments that allow the quantitative analysis of DCE cardiac MRI. This implied the development of a post-processing method for Arterial Input Function reconstruction, allowing DCE quantification without the need of specific sequences or protocols. A post-processing algorithm for perfusion images registration have been developed for pixel-wise parametric maps reconstruction. Data acquisition have been simulated in a Monte-Carlo fashion in order to assess the impact of acquisition strategies on parameters accuracy. This eventually led to the design of the shortest possible imaging strategy for Ve quantification. Secondly, clinical results obtained with our quantitative DCE analysis framework have been confronted to those obtained with classical ECV method for diffuse fibrosis detection. Correlation between those two parameters have been found a group of 12 patients presenting mitral valve prolapses. Permutation test on Ve distribution allowed us to show a significant difference between two groups the same way the ECV values did. The presented work describes a full quantitative DCE analysis framework that could allow to a shorter imaging protocol for extracellular extravascular estimation for diffuse myocardial fibrosis diagnosis.
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Submitted on : Friday, October 2, 2020 - 3:14:00 PM
Last modification on : Wednesday, October 14, 2020 - 3:50:44 AM


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Jean-Sébastien Louis. Développements en IRM quantitative de perfusion pour le diagnostic de fibrose myocardique. Sciences du Vivant [q-bio]. Université de Lorraine, 2020. Français. ⟨NNT : 2020LORR0061⟩. ⟨tel-02956237⟩



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