R01HL164717

Classification and Prognostication in Pulmonary Thromboembolism Using Computed Tomography Image Analytics - Project Summary.

Pulmonary thromboembolism remains a significant cause of morbidity and mortality in the Western world. While many of the initial symptoms in acute pulmonary embolism (PE) resolves with appropriate treatment, there is increasing awareness of chronic impact of the disease ranging from development of chronic thromboembolic pulmonary hypertension (CTEPH) to persisting dyspnea and exercise impairment.

Many patients initially diagnosed with PE may already have chronic disease and inappropriate treatment for acute disease in these cases may be harmful and delay referral to specialized centers with experience in treating chronic disease. On the other hand, many patients with acute PE go on to develop chronic disease despite current treatment options and follow-up to ensure resolution remains a challenge, particularly without the ability to predict who will develop chronic disease.

Furthermore, prognostication and selection of treatments can be difficult, particularly in submassive acute PE and CTEPH, particularly with newly emerging treatment choices. Quantitative methods are needed to help define disease trajectories early in presentation, help guide prognostication and treatment, and improve our understanding of the pathophysiology of this condition.

Computed tomography (CT) imaging is the cornerstone of evaluation of pulmonary thromboembolism. In acute PE, it is often the first imaging modality available for assessing treatment options. As the patient recovers, it is used to detect chronic or recurring clot and guide interventions in chronic disease.

Advances in CT imaging quality, image processing (including application of deep learning), coupled with increasing computation power make possible the extraction of a large number of novel features from CT imaging. In this proposal, we seek to combine our team's experience in CT image quantification with multi-center longitudinal data to develop CT imaging features that can identify and predict disease chronicity, its impact on the pulmonary circulation, and its response to treatment.

In Aim 1, we utilize longitudinal data from three academic hospitals (Brigham and Women's Hospital, Massachusetts General Hospital, Northwestern University) to assess CT features at presentation that predict the presence or development of chronic disease.

In Aim 2, we study both the presentation and follow-up image to build quantitative models of the impact of acute and chronic disease on the pulmonary circulation in order to help with prognostication and improve non-invasive methods of predicting the relevance of persistent disease to the clinical state of patients.

In Aim 3, we use a combination of longitudinal imaging in CTEPH patients having undergone surgery and patients with pulmonary arterial hypertension to identify patients that would have the most optimal surgical outcomes.

We believe that the combination of the features and models developed in these complementary aims will advance our ability to use clinically available CT imaging to improve phenotyping, prognostication, and treatment decisions, and improve our understanding of the longitudinal progression of pulmonary thromboembolic disease.

Brigham & Womens Hospital

THE DIVISION OF LUNG DISEASES SUPPORTS RESEARCH AND RESEARCH TRAINING ON THE CAUSES, DIAGNOSIS, PREVENTION, AND TREATMENT OF LUNG DISEASES AND SLEEP DISORDERS. RESEARCH IS FUNDED THROUGH INVESTIGATOR-INITIATED AND INSTITUTE-INITIATED GRANT PROGRAMS AND THROUGH CONTRACT PROGRAMS IN AREAS INCLUDING ASTHMA, BRONCHOPULMONARY DYSPLASIA, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, CYSTIC FIBROSIS, RESPIRATORY NEUROBIOLOGY, SLEEP AND CIRCADIAN BIOLOGY, SLEEP-DISORDERED BREATHING, CRITICAL CARE AND ACUTE LUNG INJURY, DEVELOPMENTAL BIOLOGY AND PEDIATRIC PULMONARY DISEASES, IMMUNOLOGIC AND FIBROTIC PULMONARY DISEASE, RARE LUNG DISORDERS, PULMONARY VASCULAR DISEASE, AND PULMONARY COMPLICATIONS OF AIDS AND TUBERCULOSIS. THE DIVISION IS RESPONSIBLE FOR MONITORING THE LATEST RESEARCH DEVELOPMENTS IN THE EXTRAMURAL SCIENTIFIC COMMUNITY AS WELL AS IDENTIFYING RESEARCH GAPS AND NEEDS, OBTAINING ADVICE FROM EXPERTS IN THE FIELD, AND IMPLEMENTING PROGRAMS TO ADDRESS NEW OPPORTUNITIES. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO STIMULATE TECHNOLOGICAL INNOVATION, USE SMALL BUSINESS TO MEET FEDERAL RESEARCH AND DEVELOPMENT NEEDS, FOSTER AND ENCOURAGE PARTICIPATION IN INNOVATION AND ENTREPRENEURSHIP BY SOCIALLY AND ECONOMICALLY DISADVANTAGED PERSONS, AND INCREASE PRIVATE-SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT FUNDING. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE TECHNOLOGICAL INNOVATION, FOSTER TECHNOLOGY TRANSFER THROUGH COOPERATIVE R&D BETWEEN SMALL BUSINESSES AND RESEARCH INSTITUTIONS, AND INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL R&D.

93.837 - Cardiovascular Diseases Research

National Heart Lung and Blood Institute (NHLBI) [HHS - NIH]

Boston, Massachusetts 021156110 United States

Single Zip Code

NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed) (PA-20-185)

Amendment Since initial award the total obligations have increased 294% from $768,679 to $3,024,998.