SmartHeart: Next-generation cardiovascular healthcare via integrated image acquisition, reconstruction, analysis and learning

The vision for our research programme is to pave the way for a fundamentally different approach in which cardiovascular diseases (CVD) are diagnosed, monitored and treated: We propose to develop a diagnosis-driven "smart Magnetic Resonance (MR) scanner" that it is no longer a mere imaging device but instead becomes a highly sophisticated diagnostic tool. The output of a patient scan with the proposed smart MR scanner will not be just an image, but instead a comprehensive diagnostic assessment and interpretation of the patient's cardiovascular health/disease, enabling optimal treatment decisions for best patient outcome.

The current approach to cardiovascular MR imaging (cMRI) is essentially serial: image acquisition is followed by image analysis and clinical interpretation. In addition, cardiac/respiratory motion is currently resulting in long scanning times for cMRI, with only a small fraction of the data (10-20%) being used for image reconstruction. This leads to breath-holds that are difficult to tolerate by sick patients. Furthermore, the characterization of clinically relevant tissue parameters requires the acquisition of multiple images which is inefficient. The absolute quantification of tissue parameters also remains a major technical challenge, leading to difficulties in interpreting tissue contrast parameters across scanners, clinical centres and patient populations. Finally, the objective interpretation of comprehensive, multi-parametric cMRI in the context of other complex non-imaging data is highly challenging for clinicians.

We propose a transformative approach in which acquisition, analysis and interpretation are tightly coupled, with feedback between the different stages in order to optimize the overall objective: Extracting clinically useful information. Developing such an integrated approach to cardiac imaging will enable rapid, continuous and comprehensive imaging that is both simpler and more efficient than current practice, eliminating "dead time" between separate specialized acquisitions and allowing extraction of multiple dynamic as well as tissue contrast parameters simultaneously.

Cardiovascular diseases (CVD) cause more than a quarter of all deaths in the UK (155,000 deaths pa). The cost to the UK of premature death, lost productivity, hospital treatment and prescriptions relating to CVD is estimated at £19B each year, with healthcare costs alone totalling an estimated £8B (source: BHF). The current gold standard for diagnosis is based on cardiac catheterisation to obtain coronary angiograms in order to measure parameters such as coronary stenosis and fractional flow reserve (FFR). This highly invasive and costly procedure is increasingly being replaced by imaging modalities such as cardiac Magnetic Resonance Imaging (cMRI). This programme grant will develop smart and integrated image acquisition, analysis and interpretation approaches for cMRI that enable far more accurate, reproducible and objective quantification of CVD. This has the potential to boost clinical decision making in terms of diagnostic and prognostic accuracy. The main beneficiaries are listed below:

The primary beneficiaries of the proposed research are patients with CVD as well as their families. They will benefit from improved diagnosis and prognosis of CVD which is crucial deciding on treatment strategies and preventative strategies for reducing further damage to the heart. This not only has the potential to improve the rehabilitation of patients with CVD but also can improve their quality of life following CVD. Another group of beneficiaries are clinicians (especially cardiologists and radiologists) involved in the care of patients with CVD as well as charities promoting cardiovascular health. They will benefit from better quantitative and objective information for making clinical decisions regarding patient management and as well as from increase confidence via the decision support tools developed in this project. Furthermore, the stratification tools developed here are a prerequisite for developing and evaluating novel therapeutic treatments and are thus of high interest for the pharma and medical device industry.

The healthcare industry also benefits from the research in this project. The medical imaging sector is the biggest component of this industry and will significantly benefit from further developments in medical imaging technologies. This is also illustrated by the fact that two of the world's largest medical imaging companies (Siemens and Philips) are partners in this project. The UK industry is playing a leading role in medical imaging and has a number of rapidly growing SMEs in this area, including Perspectum Diagnostics (project partner), IXICO (co-founded by Rueckert) and Intelligent Ultrasound (co-founded by Noble). In addition to the exploitation of technology and intellectual property, industry will also benefit from a pool of highly-skilled and trained researchers in this area.

Finally, society as a whole will benefit via improved diagnosis of patients as well as better prognosis of outcome and recovery, leading to improved healthcare economics. This will also benefit healthcare providers such as the NHS and policy makers.