Michael D. Hope, MD, is a Professor in Residence and Vice-Chair in the Department of Radiology and Biomedical Imaging at UCSF. He is Chief of Radiology at the San Francisco VA Health Care System (SFVAHCS). Dr. Hope obtained his medical degree from Stanford. He did a Medicine internship at California Pacific Medical Center, and then completed both his Diagnostic Radiology residency and fellowship in Cardiopulmonary Imaging at UCSF.
My principal research interest is studying the drivers of cardiovascular disease. My focus has been the application of advanced imaging techniques to better understand progressive aortic disease. These techniques include hemodynamic imaging with 4D Flow MRI, imaging of inflammation with a hybrid PET/MRI approach, and vessel lumen and wall imaging with novel MRI contrast agents. The overall goal is to target challenging and incompletely understood cardiovascular issues as detailed below, and use innovative imaging-derived analyses to better inform their clinical management.
Since assuming the role of Chief of Radiology at SFVAHCS in 2018, I have worked to organize, diversify and reinvigorate imaging research at the VA. We have established a new research leadership group called the VA Advanced Imaging Research Center (VAARC), which is intended to mirror the research structure of the UCSF Radiology Department and to clearly define responsibilities in a democratic leadership framework. The overarching goal is to promote teamwork as we strengthen and broaden our unique VA research program. We established a Steering Committee for VAARC that meets monthly and is composed of Directors for the 5 research domains (i.e., Neuro, CV, Body, AI and Informatics, Advanced Imaging), Key Investigators (M. Weiner) and the Chief of Radiology, who chairs the committee and facilitates discussion.
With our colleagues in Orthopedic Surgery at SFVAHCS, we established a VISN 21 Anatomic 3D Visualization/Printing Service in 2020 called Translational Radiology and Surgical Technologies, or TRST, that will provide 3D advanced visualization and printed to models of radiology exams to improve surgical planning for Veterans and concurrently improve resource utilization of VHA OR suites. This center will be based out of San Francisco. To develop this program, we have been granted FTE for two 3D technologists and a Biomedical Engineer, in addition to generous start up funds for hardware and software resources to enable routine 3D printing and/or visualization of cross-sectional studies, including capabilities for virtual and augmented reality.
Along with my colleague Travis Henry, I have taken on the issue of the judicious use of imaging during the COVID-19 pandemic. We have published in leading journals (Lancet, Annals of Internal Medicine) about the importance of careful and critical review of literature as we collectively better understand the role that CT may play in the management of COVID-19.
*Abnormal systolic blood flow with valve-related aortic disease.* My early cardiovascular research investigated hemodynamic alterations seen with aortic valve disease, a common clinical issue with relevance for up to 4% of people. Using 4D Flow MR imaging, I was the first to describe the helical systolic blood flow in the ascending thoracic aorta of patients with bicuspid aortic valves (BAV), and relate it to different aortic valve leaflet fusion patterns and the valve-related aortic disease seen in this population.
*Quantifying eccentric blood flow.* I hypothesized that the abnormal valve-related aortic flow we observed with BAV was directly related to asymmetrically elevated aortic wall shear stress, and as a consequence, that eccentric flow is associated with increased aortic growth rates. To better evaluate this, we explored a range of quantitative approaches to describe eccentric systolic blood flow and correlated them with growth.
*Advanced cardiovascular imaging with 4D Flow.* Our group at UCSF has pioneered the use of 4D Flow imaging for neurovascular and aortic evaluation. We have focused on practical, noninvasive clinical applications for challenging cardiovascular issues that may otherwise need invasive tests. We have expanded our investigation of hemodynamics with sequences that allow quantification of flow turbulence.
*Advanced aortic imaging.* I believe that a combined hemodynamic and inflammatory assessment using functional aortic imaging techniques will have the greatest impact in the evaluation of abdominal aortic aneurysms (AAA). We have explored new functional techniques including vessel wall strain analysis, inflammatory imaging, and combined PET/MRI. We seek to meaningfully advance the assessment of risk in patients who do not meet current intervention thresholds and improve outcomes by refining surveillance imaging regimens and decisions regarding early intervention for AAAs.
*Improved risk stratification of abdominal aortic aneurysm (AAA) disease.* Currently maximum aortic diameter is the principal metric used to manage AAA disease clinically, but this approach misses much of the complexity of the disease process, including intraluminal thrombus (ILT) and wall stress. We have focused on better defining the relationship between a range of anatomic and hemodynamic parameters and disease progression.