# Evaluation of digital ischemia in scleroderma with multiparametric MRI

> **NIH NIH K23** · YALE UNIVERSITY · 2024 · $173,216

## Abstract

PROJECT SUMMARY/ABSTRACT
 Systemic sclerosis (SSc) or scleroderma is a chronic multisystem autoimmune disorder. The underlying
pathophysiology includes innate/adaptive immune system abnormalities, endothelial injury with small vessel
vasculopathy, and fibroblast activation with subsequent fibrosis. Digital ischemia/digital loss is a feared
complication of SSc. Prospective studies report that an estimated 50% of patients with SSc experience digital
ulcerations over 5 years of follow-up, and 20% experience finger amputation secondary to ischemia. The
currently available clinical tools for the assessment and monitoring of the underlying pathophysiology
(vasculopathy, tissue ischemia and fibrosis) are only semi-quantitative. The dearth of quantitative tools to
evaluate potential treatments has resulted in patients with SSc enduring significant morbidity.
 Here we propose to use multiparametric magnetic resonance imaging (MRI) in patients with SSc for a
comprehensive quantitative assessment of vasculopathy, tissue hypoxia, and fibrosis in the hands, which
contributes the most to patient disability in SSc. In Aim 1, we will test quantitative MRI biomarkers to complement
established clinical assessments of vasculopathy, ischemia, and fibrosis. In SubAim1a, we will test whether
quantitative MRI physiologic biomarkers correlate with clinical assessment of vasculopathy, ischemia, and
fibrosis. In SubAim1b, we will determine the association between MRI physiological biomarkers and vascular
symptoms and complications (digital ulcers and digital loss). In Aim 2, we will test whether short-term changes
in quantitative MRI biomarkers can predict long-term changes (12 and 24 months) in symptoms and vascular
complications. Collectively, this work will provide new noninvasive imaging biomarkers to inform prevention and
treatment interventions and to monitor effectiveness of therapy for digital ischemia.
 Cardiovascular disease is the leading cause of death in patients with rheumatoid arthritis and systemic lupus
erythematosus. Peripheral vascular disease is the leading cause of disability in SSc. The applicant’s long-term
goal is to become a leader in cardiovascular imaging in patients with autoimmune rheumatic diseases. The
applicant is already an expert in cardiac imaging. Now, formal training in peripheral vascular imaging is
necessary. We propose a focused, intense career development training plan which will include 1) mentorship
from a team of experts led by the primary mentor, an expert in peripheral vascular imaging, 2) advanced didactic
coursework on peripheral vascular imaging, quantitative image analysis and machine learning, and 3) hands-on
experience with peripheral MRI techniques (guided by an expert MRI physicist, co-mentor) and quantitative
image analysis with integration of machine learning (guided by expert image analysis/machine learning advisor).
The proposed work will center on an established cohort of clinically well characterized SSc patients...

## Key facts

- **NIH application ID:** 10984568
- **Project number:** 1K23HL168223-01A1
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Attila Feher
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $173,216
- **Award type:** 1
- **Project period:** 2024-09-01 → 2029-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10984568

## Citation

> US National Institutes of Health, RePORTER application 10984568, Evaluation of digital ischemia in scleroderma with multiparametric MRI (1K23HL168223-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10984568. Licensed CC0.

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