4D CT Imaging for Improved Diagnosis and Treatment of Wrist Ligament Injuries

项目摘要/摘要 手腕关节允许上肢的复杂运动，这对精确度和力量都是至关重要的。 日常活动中的运动；因此，导致骨关节炎(OA)的手腕损伤发生在 由于休假、手术费用和相关发病率造成的重大社会经济成本。伤势严重。 舟月骨间韧带(SLIL)，在近端连接舟骨和月骨 腕关节损伤是上肢最重要、最常见的损伤之一。精准的诊断 SLIL损伤的位置对于提供最有效的治疗至关重要，这样撕裂的位置可以 在量身定做的治疗计划中予以考虑。此外，手术重建不成功的比例高达20%- 30%的时间，患者经常发生骨性关节炎。目前SLIL损伤的诊断方法包括 磁共振成像缺乏评估损伤位置的特异性，腕关节镜检查 是侵入性的，导致损伤等级是主观的，容易发生观察者之间的变异性。因此，有 迫切需要一种准确的、非侵入性的定量方法来评估SLIL损伤的位置和 治疗结果：我们的新型动态计算机断层扫描(CT)成像技术将填补这一空白。我们的 高空间和时间分辨率4D(3D+时间)CT技术(4DCT)能够准确地量化 系统性红斑狼疮损伤患者腕关节运动的关键指标。这种成像方法，已经被严格地 经过验证并基于强大的科学前提，将通过取代侵入性和 不准确的诊断测试，并提供了一种量化手术修复结果的手段。在这个项目中， 我们建议：建立SLIL损伤与体外4DCT指标的关系(目标1)；评估 是否可以使用4DCT指标预测患者SLIL损伤的位置(目标2)；以及确定 韧带损伤的靶向治疗是否改善了手术后的结果(目标3)。它的创新之处在于 项目使用经过严格验证的、动态的、非侵入性的4DCT指标来满足以下关键需求 为SLIL损伤的诊断和治疗提供循证信息。其意义在于 对SLIL损伤的准确诊断将导致最佳治疗方法，从而预防OA 由于受伤或维修不当。

PROJECT SUMMARY/ABSTRACT The wrist joint permits complex motion of the upper extremity that is crucial for both precision and power movements during daily activities; therefore, wrist injuries which result in osteoarthritis (OA) come at a significant socioeconomic cost due to time off work, surgical fees and associated morbidity. Injury to the scapholunate interosseus ligament (SLIL), which connects the scaphoid and lunate bones in the proximal carpal row, is one of the most important and common upper extremity injuries. Accurate diagnosis of the location of SLIL injuries is crucial for providing the most effective treatments so that the location of the tear can be considered in a tailored treatment plan. Further, unsuccessful surgical reconstructions occur up to 20%- 30% of the time, with patients often developing OA. Current diagnostic approaches for SLIL injury include magnetic resonance imaging, which lacks the specificity to assess injury location, and wrist arthroscopy, which is invasive and results in an injury grade that is subjective and prone to interobserver variability. Thus, there is a critical need for an accurate, noninvasive, quantitative method for assessing SLIL injury location and treatment outcomes; our novel, dynamic computed tomography (CT) imaging technique will fill this gap. Our high spatial and temporal resolution 4D (3D + time) CT technique (4DCT) enables accurate quantification of key metrics during wrist motion in patients with SLIL injury. This imaging approach, which has been rigorously validated and is based on strong scientific premise, will improve clinical practice by replacing invasive and inaccurate diagnostic tests and providing a means of quantifying outcomes of surgical repairs. In this project, we propose to: establish the relationship between SLIL injury and 4DCT metrics in vitro (Aim 1); assess whether the location of SLIL injury in patients can be predicted using 4DCT metrics (Aim 2); and determine whether targeted treatment of ligament injury improves post-surgical outcomes (Aim 3). The innovation of this project is the use of rigorously validated, dynamic, noninvasive 4DCT metrics to meet the critical need to provide evidence-based information for the diagnosis and treatment of SLIL injury. The significance lies in the accurate diagnosis of SLIL injuries that will lead to optimal treatment approaches, resulting in prevention of OA due to injury or incorrect repair.