Imaging Strategies To Improve Diagnosis and Treatment of Entrapment Neuropathy

改善卡压神经病诊断和治疗的影像策略

• 批准号: 9525148
• 负责人: Sameer B. Shah
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-10-01 至 2019-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9525148
• 关键词: Address; Algorithms; Axon; Beds; Biomechanics; Blood Vessels; Cadaver; Carpal Tunnel Syndrome; Clinical; Complement; Contrast Sensitivity; Diabetic Neuropathies; Diagnosis; Diffusion; Diffusion Magnetic Resonance Imaging; Discrimination; Disease; Electrodiagnosis; Elements; Environment; Etiology; Extracellular Matrix; Geometry; Gold; Health; Healthcare Systems; Human; Image; Imagery; Imaging Techniques; Impairment; In Situ; Individual; Joints; Magnetic Resonance Imaging; Measurement; Measures; Mechanics; Methodology; Methods; Morphologic artifacts; Morphology; Motor; Movement; Nerve; Nerve Entrapment; Nerve Fibers; Nerve compression syndrome; Neurologic; Neurons; Neuropathy; Numbness; Operative Surgical Procedures; Outcome; Patients; Peripheral Nerves; Predisposition; Prevalence; Protocols documentation; Radial; Rehabilitation therapy; Reporting; Research; Resolution; Scanning; Sensory; Stretching; Structure; Surgical Management; Techniques; Testing; Time; Tissues; Translating; Translations; Traumatic Nerve Injury; Treatment Efficacy; Ultrasonography; Veterans; Wrist; accurate diagnosis; associated symptom; base; design; elastography; ex vivo imaging; experimental group; image processing; imaging modality; improved; in vivo Model; in vivo imaging; injured; interdisciplinary approach; kinematics; mechanical load; mechanical properties; median nerve; neglect; non-invasive imaging; non-invasive monitor; rehabilitation engineering; targeted imaging

Peripheral nerves are well-organized composite tissues that exist in a dynamic biomechanical environment created by the movement of articulating joints. To accommodate mechanical loads, nerves glide and stretch within their beds. Nerve entrapment alters the structure of nerves, restricts their ability to glide, and excessively increases regional deformation, ultimately impairing sensory and motor function. The most common entrapment neuropathy among Veterans is carpal tunnel syndrome (CTS), a disease in which the median nerve is impinged at the wrist, within the carpal tunnel. Surgical treatment of carpal tunnel syndrome is generally effective, but revision may be required for 3-20% of surgeries. Given the prevalence of CTS, this corresponds to a substantial number of patients. Electrodiagnostics are considered to be the gold standard for CTS diagnosis, inconclusive outcomes are not uncommon, especially in the presence of other overlying neuropathies, such as diabetic neuropathy. Despite their likely influence on neuropathic progression, nerve structural and biomechanical changes have been used only minimally to diagnose or track neuropathy, or to assess the efficacy of surgical management. This is in large part due to the challenges associated with imaging nerves using current techniques. Our research team has developed new magnetic resonance imaging (MRI) and ultrasound-based imaging methods that allow the visualization of nerves at high spatial resolution on contrast. These capabilities allow accurate measurement of nerve biomechanics (deformation and stiffness), and also identification and quantitative characterization of structural elements within nerves. These methods are expected to provide a powerful and sensitive approach to non-invasively assess neuropathy and surgical efficacy. Given its prevalence, CTS provides an ideal test-bed for translating our nerve imaging and image processing techniques to a clinical setting. In particular, we propose to use ultrasound and MRI techniques to evaluate structure and biomechanics of median nerves in patients requiring surgery for CTS. Our proposal uses a multi-disciplinary approach to address two specific aims. Our first aim is to optimize MRI-based and ultrasound imaging methodology in median nerves. We will use human cadaveric and in vivo models to validate and optimize imaging protocols that will be used clinically. We expect that MRI-based strategies will provide high resolution and high contrast structural images of nerves, while ultrasound will provide rapid assessment of nerve kinematics and stiffness. Our second aim is to examine structural and kinematic changes of median nerves in patients with CTS, before and after carpal tunnel release, using MRI and ultrasound. We hypothesize that MRI-based imaging will detect structural differences in epineurial, perineurial, and nerve fiber compartments between control and entrapped nerves, and ultrasound will detect differences in nerve deformation and stiffness among control nerves and entrapped nerves before and after surgery. More broadly, we anticipate applying our approach to other neurological conditions that impact the Veteran healthcare system, in which nerve structure and biomechanics may be altered. These include other entrapment neuropathies, diabetic neuropathy, and traumatic nerve injury. Ultimately, successful execution of our proposed study will enable earlier recognition of neuropathy, provide noninvasive monitoring of neuropathic progression, and facilitate more accurate assessment of rehabilitative and therapeutic efficacy. 1

周围神经是存在于动态生物力学环境中的组织良好的复合组织 由关节的运动产生。为了适应机械负荷，神经会滑动和伸展 在他们的床上。神经卡压会改变神经的结构，限制其滑动能力，并过度 增加区域变形，最终损害感觉和运动功能。最常见的 退伍军人中的卡压性神经病是腕管综合症（CTS），这种疾病的中位神经 神经在手腕的腕管内受到撞击。腕管综合症的手术治疗方法是 一般有效，但 3-20% 的手术可能需要翻修。鉴于 CTS 的流行， 对应相当数量的患者。电诊断被认为是金标准 CTS 诊断、不确定的结果并不少见，特别是在存在其他重叠的情况下 神经病，例如糖尿病性神经病。 尽管它们可能对神经病变进展产生影响，但神经结构和生物力学的变化已经 仅很少用于诊断或追踪神经病变，或评估手术治疗的效果。 这在很大程度上是由于使用当前技术对神经进行成像所面临的挑战。我们的 研究小组开发了新的磁共振成像（MRI）和超声成像方法 允许在对比度上以高空间分辨率可视化神经。这些功能允许准确 神经生物力学（变形和刚度）的测量，以及识别和定量 神经内结构元素的表征。这些方法有望提供强大且 非侵入性评估神经病变和手术疗效的敏感方法。 鉴于其普遍性，CTS 为翻译我们的神经成像和图像提供了理想的测试平台 临床环境的处理技术。特别是，我们建议使用超声波和 MRI 技术 评估需要 CTS 手术的患者的正中神经的结构和生物力学。我们的建议 使用多学科方法来解决两个具体目标。我们的首要目标是优化基于 MRI 的 正中神经超声成像方法。我们将使用人类尸体和体内模型来 验证和优化将在临床上使用的成像协议。我们预计基于 MRI 的策略将 提供高分辨率和高对比度的神经结构图像，而超声波将提供快速 神经运动学和刚度的评估。我们的第二个目标是检查结构和运动学的变化 使用 MRI 和超声检查 CTS 患者的正中神经在腕管松解前后的变化。我们 假设基于 MRI 的成像将检测神经外膜、神经周围和神经纤维的结构差异 控制神经和被困神经之间的隔室，超声波将检测神经的差异 手术前后控制神经和卡压神经之间的变形和僵硬。 更广泛地说，我们预计将我们的方法应用于影响退伍军人的其他神经系统疾病 医疗保健系统，其中神经结构和生物力学可能会改变。这些包括其他 卡压性神经病、糖尿病性神经病和创伤性神经损伤。最终成功执行 我们提出的研究将能够更早地识别神经病变，提供神经病变的无创监测 进展，并有助于更准确地评估康复和治疗效果。 1