Pre-Operative QCT Planning Protocol for Treating the Structural Deficiency of Spi

治疗 SPI 结构缺陷的术前 QCT 规划方案

基本信息

批准号：
7475488
负责人：
RON N ALKALAY
金额：
$ 35.86万
依托单位：
BETH ISRAEL DEACONESS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-07-03 至 2012-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7475488
关键词：
Accounting Adult Affect Algorithms Behavior Biocompatible Materials Biopolymers Cadaver Cancer Patient Caring Carrying Capacities Categories Chest Classification Clinical Compatible Complex Computer Simulation Condition Containment Cytotoxic agent Daily Data Decompression Sickness Defect Dependency Development Elderly Engineering Exhibits Failure Finite Element Analysis Fracture Goals Grant Guidelines High Chair Homeostasis Hormones Human Image In Vitro Incidence Injectable Intractable Pain Invasive Laboratories Life Life Expectancy Ligaments Linear Regressions Location Lytic Lytic Metastatic Lesion Malignant Neoplasms Materials Testing Measures Mechanics Metastatic Neoplasm to the Bone Methods Modeling Monitor Morbidity - disease rate Muscle Rigidity Nature Neoplasm Metastasis Neurologic Operative Surgical Procedures Osteolysis Osteolytic Outcome Pathologic Pathological fracture Pathology Patient Monitoring Patients Pattern Performance Physiological Polymers Polymethyl Methacrylate Polyurethanes Predisposition Prevention Probability Procedures Process Property Prophylactic treatment Protocols documentation Radiation Radiation therapy Range Research Resources Risk Role Sensitivity and Specificity Series Simulate Site Skeletal system Slice Spinal Spinal Fractures Staging Standards of Weights and Measures Structure System Techniques Testing Time Torsion Tumor Pathology Vertebral Bone Vertebral column Weight-Bearing state Work X-Ray Computed Tomography base bisphosphonate bone caN protocol clinically relevant cone-beam computed tomography design improved in vivo indexing instrument kinematics loss of function malignant breast neoplasm novel prevent prophylactic reconstitution reconstruction response restoration soft tissue spine bone structure tool tumor

项目摘要

DESCRIPTION (provided by applicant): The spine is the skeletal site most often affected by metastatic breast cancer, and 17-50% of patients with spinal metastasis sustain a vertebral fracture. Systemic treatments with cytotoxic agents, hormone manipulation, bisphosphonates and/or local treatment with radiation and/or surgical stabilization, constitute the range of therapies available to breast cancer patients with skeletal metastasis. However, there are no objective methods for selecting which treatment will best reduce the patient's risk for sustaining a pathologic fracture and for monitoring the patient's response to therapy. Therefore, establishing objective criteria to evaluate the load carrying capacity of the involved vertebrae can be used both to monitor changes in bone structure that reflect the interaction of the tumor with the host bone, and to guide treatment for fracture prevention. Objective measures of fracture risk will both enhance patient management and resource utilization. Our overall hypothesis is that the loss of structural integrity of the spine due to tumor induced osteolysis, assessed using CT based structural analysis protocol, can be restored using structural polymers deployed in a minimally invasive manner. In Aim 1, in a series of in vitro tests, the ability of a QCT based structural analysis protocol to classify the fracture risk of thoracolumbar human spines with simulated critical osteolytic defects will be quantified under physiological loading conditions. Predicated fracture load, computed for the vertebrae, will be compared to the failure load measured by mechanical testing. The role of spinal ligaments in effecting the predicted failure load will be investigated. In Aim 2, a novel image-based algorithm will be developed and integrated within the CT structural analysis protocol, to provide pre-operative planning for prophylactic augmentation of the affected vertebra. Specific anatomically and materially detailed computational models will be used to optimize the design rules incorporated within the image based module to achieve restoration of the structural integrity of the affected vertebra. Using a series of in vitro studies, we will characterize the dependencies of the mechanical properties of treated vertebrae on the material properties of the injectable biopolymer and the geometrical properties of the lytic defect. We will compare this performance to the use of Polymethylmetacrylate cement. In Aim 3, the efficacy of the developed CT based pre-operative analysis, prediction and augmentation system, in restoring the structural integrity of thoracolumbar spines with simulated lytic defects, will be quantified. In summary, Drawing on principles of structural engineering, a novel CT based pre-operative analysis, prediction and augmentation system, will be developed to allow pre-operative planning for prophylactic augmentation of the human thoracolumbar spines with critical lytic defects.

描述（由申请人提供）：脊柱是最常受转移性乳腺癌影响的骨骼部位，脊柱转移患者中有17-50％维持椎骨骨折。用细胞毒性剂，激素操纵，双膦酸盐和/或局部治疗进行辐射和/或手术稳定的局部治疗的全身治疗构成了可用于骨骼转移的乳腺癌患者可用的疗法。但是，没有客观的方法可以选择哪种治疗方法可以最好地降低患者患病理性骨折的风险和监测患者对治疗的反应。因此，建立客观标准以评估相关椎骨的承载能力，既可以用来监测反映肿瘤与宿主骨骼相互作用的骨结构的变化，又可以指导预防断裂的治疗方法。骨折风险的客观度量既可以增强患者管理和资源利用率。我们的总体假设是，使用基于CT的结构分析方案评估，由于肿瘤诱导的溶溶引起的脊柱结构完整性丧失，可以使用以微创方式部署的结构聚合物来恢复。在AIM 1中，在一系列体外测试中，将在生理负荷条件下量化基于QCT的结构分析方案的能力，该方案将具有模拟的临界骨化缺陷对胸木骨棘突的断裂风险进行分类。针对椎骨计算的预测断裂负荷将与通过机械测试测量的破坏负荷进行比较。脊柱韧带在影响预测的衰竭载荷中的作用将得到研究。在AIM 2中，将开发基于图像的新型算法并将其集成到CT结构分析方案中，以提供术前计划，以预防受影响的椎骨。特定的解剖学和物质详细的计算模型将用于优化基于图像的模块中包含的设计规则，以实现受影响的椎骨的结构完整性的恢复。使用一系列体外研究，我们将表征处理过的椎骨对注射生物聚合物的材料特性和裂解缺陷的几何特性的依赖性。我们将将这种性能与使用聚甲基丙烯酸酯水泥进行比较。在AIM 3中，将量化基于开发的CT的术前分析，预测和增强系统的疗效，在恢复具有模拟裂解缺陷的Thoracolumbar棘的结构完整性方面。总而言之，将制定基于结构工程的原理，这是一种基于CT的新型术前分析，预测和增强系统，以允许术前计划，以预防具有严重裂解缺陷的人胸骨刺。