MRI Bone Texture: A Novel Biomarker for Assessment of Bone Quality and Prediction of Complications in Patients Having Spine Fusion Surgery

MRI 骨纹理：一种用于评估脊柱融合手术患者骨质量和预测并发症的新型生物标志物

• 批准号: 10518526
• 负责人: Emily Margaret Stein
• 金额: $ 17.64万
• 依托单位: HOSPITAL FOR SPECIAL SURGERY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10518526
• 关键词: Age; Anabolic Agents; Biopsy; Characteristics; Clinical; Clinical Treatment; Clinical Trials; Complex; Data; Detection; Diagnosis; Dual-Energy X-Ray Absorptiometry; Early Diagnosis; Elderly; Enrollment; Entropy; Evaluation; Failure; Fracture; Future; Goals; Health; Healthcare; Heterogeneity; Hip region structure; Incidence; Intervention; Intervention Trial; Knowledge; Lead; MRI Scans; Magnetic Resonance Imaging; Masks; Measurement; Measures; Methods; Monitor; Morbidity - disease rate; Morphologic artifacts; Operative Surgical Procedures; Orthopedic Procedures; Orthopedic Surgery; Orthopedics; Osteogenesis; Outcome; Patient-Focused Outcomes; Patients; Perioperative; Peripheral; Pharmaceutical Preparations; Population; Postmenopause; Postoperative Complications; Postoperative Period; Prevalence; Prospective Studies; Reading; Research; Resolution; Risk; Screening procedure; Spinal; Spinal Diseases; Spinal Fusion; Spine surgery; Techniques; Testing; Texture; Treatment Protocols; Vertebral column; Woman; Work; X-Ray Computed Tomography; base; bone; bone quality; clinical care; clinical practice; cost; follow-up; high risk; improved; improved outcome; instrument; novel; novel marker; osteoporosis with pathological fracture; prospective; screening; skeletal; skeletal abnormality; spine bone structure; substantia spongiosa; success; tool

Project Summary Spine fusion surgery is one of the most common, and complex, orthopedic procedures. Complications occur in over 30% of cases, highlighting the need to identify modifiable factors associated with these negative sequelae. Bone quality is a critical determinant of post-operative outcomes, as stability of hardware in bone and de novo bone formation are required for successful fusion. Despite the importance of bone quality to post-operative outcomes, there are limited tools for pre-operative detection of abnormal bone in candidates for fusion. The most common clinical tool for skeletal assessment, dual energy x-ray absorptiometry (DXA), is subject to artifact from spinal abnormalities and infrequently performed for pre-operative evaluation. High resolution peripheral QCT (HRpQCT) can detect pre-operative skeletal abnormalities and predict complications after fusion but is a research tool not available in clinical practice. In contrast, MRI is routinely performed prior to fusion, for diagnosis of spinal disease and surgical planning, making an MRI-based technique ideal to screen for pre-operative skeletal deficits. Our group has recently developed a novel method to evaluate bone quality using standard, clinically acquired MRIs which analyzes the irregularity, or heterogeneity, of trabecular bone texture. In prior work, we found that postmenopausal women with fractures had greater heterogeneity of bone texture than age- matched controls. The proposed study will assess MRI trabecular bone texture as a new technique to detect poor bone quality, predict complications, and track post-operative skeletal changes in patients undergoing spinal fusion. We hypothesize that pre-operative MRI bone texture will relate to volumetric BMD (vBMD) and microarchitecture by HRpQCT and will predict skeletal complications after surgery. Post-operative changes in MRI bone texture will relate to baseline patient characteristics and clinical post-operative treatment regimen, including use of anabolic agents. We will prospectively enroll 100 patients having lumbar spine fusion and follow them for one year. Baseline DXA, HRpQCT, and our MRI-based method will be performed. MRIs will be repeated at 6 months post-operatively to determine whether early changes in MRI bone texture relate to patient characteristics, medication use, and predict complications. CT scans will be performed at one year to assess skeletal complications and completeness of fusion. This proposal aims to: 1) Investigate the relationship between pre-operative MRI bone texture and HRpQCT measurements of vBMD and microarchitecture; 2) Investigate whether MRI bone texture predicts skeletal complications after fusion; 3) Assess longitudinal changes in bone texture and the clinical factors that influence these changes in patients after spine fusion. The long-term goals of our research are to improve identification of patients at high risk for post-operative complications and provide knowledge that will advance future interventional trials. In subsequent work, we plan to extend this technique to other orthopedic populations. Ultimately, we hope to improve the outcomes of patients undergoing fusion and other high-risk orthopedic surgeries by facilitating the creation of new peri-operative treatment paradigms.

项目摘要 脊柱融合手术是最常见、最复杂的骨科手术之一。并发症发生在 超过30%的病例，突出了确定与这些负面后遗症相关的可修改因素的必要性。 骨质量是决定手术后结果的关键因素，就像骨内硬件和新生血管的稳定性一样。 骨形成是成功融合所必需的。尽管骨骼质量对术后的重要性 结果，在进行融合的候选患者中，术前检测异常骨的工具有限。最多的 临床上常用的骨骼评估工具，双能x射线骨密度仪(DXA)，容易受到 脊柱异常且不常用于术前评估。高分辨率外周QCT (HRpQCT)可以发现术前骨骼异常并预测融合后的并发症，但 临床实践中没有可用的研究工具。相反，为了诊断，在融合前常规进行核磁共振检查。 脊柱疾病和手术计划，使基于MRI的技术成为术前筛查的理想方法 骨骼缺陷。我们团队最近开发了一种新的方法来评估骨质量，使用标准， 临床获得的核磁共振成像，分析骨小梁纹理的不规则性或异质性。在之前 工作中，我们发现，绝经后骨折女性的骨骼质地异质性比年龄更大。 配对的对照组。这项拟议的研究将评估mri松质骨纹理作为一种新的检测技术。 脊柱手术患者的骨质量差、预测并发症和追踪术后骨骼变化 核聚变。我们假设术前MRI骨质地将与体积骨密度(VBMD)和 HRpQCT的微结构，并将预测术后骨骼并发症。手术后的变化 核磁共振骨质地将与基线患者的特征和临床术后治疗方案有关， 包括使用合成代谢剂。我们将前瞻性地招募100名接受腰椎融合术的患者并进行随访。 一年的时间。将进行基线DXA、HRpQCT和我们基于MRI的方法。将重复进行核磁共振检查 以确定术后6个月核磁共振骨质地的早期变化是否与患者有关 特征、用药和预测并发症。CT扫描将在一年内进行，以评估 骨骼并发症和融合的完整性。这项建议旨在：1)调查两者之间的关系 术前MRI骨质地和HRpQCT测量vBMD和微结构；2)调查 核磁共振骨质地是否能预测融合后的骨骼并发症；3)评估骨的纵向变化 脊柱融合术后患者的质地和影响这些变化的临床因素。长期目标 我们的研究的目的是提高对术后并发症高危患者的识别，并提供 这些知识将推动未来的介入试验。在后续工作中，我们计划将此技术扩展到 其他骨科人群。最终，我们希望改善接受融合和治疗的患者的结果。 通过促进创建新的围手术期治疗范例，促进其他高风险整形外科手术。