Novel PET/MR Imaging Approach for Persistent Postsurgical Pain Following Joint Replacement

项目摘要 概述：该项目旨在开发一种可靠的18F-氟代脱氧葡萄糖(18F-FDG)PET/MRI方法 新的金属伪影矫正技术可提供假体并发症的早期识别 全髋关节置换术后持续性疼痛(PPSP)。 相关性：全髋关节置换术是治疗终末期髋关节疼痛和 据估计，到2030年，每年的病例将达到572,000例。不幸的是，有相当多的人 的患者在手术后出现PPSP，如果没有适当的治疗，可能会严重损害 生活质量。然而，早期识别这些患者的疼痛诱因是非常困难的，因为 目前的诊断方法包括X射线、CT和MRI，对疼痛的敏感性有限，并遭受严重的 假体中由金属引起的伪影。因此，迫切需要一种新的诊断方法来 准确识别引起持续性疼痛的异常炎性改变，适当引导 治疗与疼痛的确切来源相匹配。 方法：我们建议使用18F-FDGPET/MRI来早期识别全髋关节置换术后PPSP的来源。 我们先前对慢性疼痛综合征的18F-FDG PET/MRI研究显示，在 检测疼痛的炎症部位。然而，金属假体附近严重的金属伪影限制了 18F-FDGPET/MRI在全髋关节置换中的应用因此，我们在这个项目中的第一个目标是开发 PET的金属感知衰减校正，使金属假体附近的18F-FDG PET可靠。我们的 第二个目标是开发具有金属伪影校正的高分辨率3T髋关节磁共振成像，以改善我们的 识别PPSP症状的结构性原因的能力。我们的第三个目标是在18F之前验证改进- FDG PET/MRI在检测疼痛产生方面与PET/CT和常规MRI的比较。这将是 通过在6个月时将疼痛评分测量与18F-FDG PET/MRI异常相关联来完成， 术后12个月和18个月。 摘要：我们建议开发一种新的具有金属伪影校正方法的18F-FDG PET/MRI方法 以早期发现全髋关节置换术后引起PPSP的假体周围并发症。成功实施 我们的方法将使PPSP患者的个体化、有效治疗的早期指征成为可能。

Project Abstract Overview: This project aims to develop a reliable 18F-fluorodeoxyglucose (18F-FDG) PET/MRI method with novel metal artifact correction techniques to provide early identification of prosthetic complications causing persistent postsurgical pain (PPSP) following total hip arthroplasty (THA). Relevance: THA is one of the most rapidly growing procedures to treat the end-stage hip joint pain and dysfunction, and its annual cases are estimated to reach 572,000 by 2030. Unfortunately, a substantial number of patients experience PPSP after the procedure, which, without proper treatment, can significantly impair the quality of life. However, the early identification of pain generators for these patients is very difficult because the current diagnostic methods including X-ray, CT, and MRI, have limited sensitivity to pain and suffer from severe artifacts induced by metal in prostheses. Therefore, there is a pressing need for a novel diagnostic approach to accurately identify the abnormal inflammatory changes causing persistent pain to guide the appropriate treatment matched to the exact sources of pain. Approach: We propose the use of 18F-FDG PET/MRI for early identification of sources of PPSP following THA. Our previous 18F-FDG PET/MRI study of chronic pain syndromes demonstrated promising improvements in detecting sites of painful inflammation. However, the severe metal artifacts near metallic prostheses limit the application of 18F-FDG PET/MRI to THA patients. Therefore, our first aim in this project is the development of metal-aware attenuation correction for PET to enable reliable 18F-FDG PET near the metallic prosthesis. Our second aim is the development of high-resolution hip MRI at 3T with metal artifact correction to improve our ability for identifying structural causes of PPSP symptoms. Our third aim is to validate the improvements by 18F- FDG PET/MRI in detection of the pain generators compared to PET/CT and conventional MRI. This will be accomplished by correlating the pain score measurements with 18F-FDG PET/MRI abnormalities at 6 months, 12 months, and 18 months following the unilateral THA procedure. Summary: We propose to develop a novel 18F-FDG PET/MRI approach with metal artifact correction methods for early detection of periprosthetic complications causing PPSP following THA. Successful implementation of our method will enable early indication of individualized, effective treatments for THA patients with PPSP.