Structural and functional imaging markers in Degenerative Cervical Myelopathy

退行性脊髓型颈椎病的结构和功能成像标志物

• 批准号: 10736303
• 负责人: Zachary A Smith
• 金额: $ 62.11万
• 依托单位: UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10736303
• 关键词: Age Years; Anterior; Cervical; Cervical spine; Characteristics; Chronic; Clinical; Consensus; Decision Making; Development; Diagnosis; Disease; Dorsal; Fiber; Functional Imaging; Functional Magnetic Resonance Imaging; Goals; Hand Strength; Health; Health Care Costs; Health Expenditures; Healthcare; Horns; Human; Image; Imaging technology; Impairment; Injury; Intervention; Lead; Magnetic Resonance Imaging; Measures; Medial; Methodology; Mission; Modeling; Modernization; Monitor; Motor; Motor Activity; Operative Surgical Procedures; Pathogenesis; Pathway interactions; Patient-Focused Outcomes; Patients; Pattern; Play; Prognosis; Protocols documentation; Public Health; Publications; Recovery; Research; Role; Sensory; Severities; Severity of illness; Spinal; Spinal Cord; Spinal Cord Diseases; Spinal Cord Tract; Spinal Injuries; Spinal cord grey matter structure; Standardization; Stimulus; Symptoms; Techniques; Testing; Translating; Translations; United States National Institutes of Health; Vertebral column; Work; clinical care; dexterity; experience; gray matter; imaging biomarker; imaging modality; improved; injured; innovation; median nerve; nerve injury; novel; novel marker; operation; postoperative recovery; prognostication; radiological imaging; response; reticulospinal tract; spinal cord compression; spinal cord imaging; spinal cord white matter; structural imaging; surgery outcome; white matter; white matter injury

PROJECT SUMMARY/ABSTRACT Degenerative cervical myelopathy (DCM) is the most common cause of spinal injury in patients over 55 years of age. It has a profound health care impact, leading to more than 100,000 operations a year and upwards of $2 billion in health care expenditure. Unfortunately, traditional cervical spine MRI techniques are imperfect predictors of ongoing spinal injury and cannot predict which patients will respond well to intervention. Further, there is a critical gap in our understanding of how the spinal cord is injured during ongoing degenerative compression. The application of new imaging technologies may help close this gap. Our previous work, during K23 studies, has shown the utility of both white matter (WM) imaging markers and spinal cord morphometrics for monitoring ongoing injury as well as predicting recovery. The development of tract-specific WM imaging methods, as proposed in this work, may aid in translating these findings to clinical care. Further, our work shows the volume of the cervical cord gray matter (GM) is decreased in DCM. Utilizing a novel spinal cord fMRI methodology, we have additionally seen decreased GM activation in DCM patients, a change that associates with patient symptoms. These findings challenge the traditional view that DCM is a disease primarily of the WM. An objective of our proposed studies is to utilize a newly developed Consensus spine imaging protocol to substantiate the role of WM markers in tracking spinal injury, a critical next step in the translation of these imaging results. Further, we develop a new fMRI methodology that is used to show that GM activity is decreased in the injured cord. Our central hypothesis is that while markers of WM injury are the leading predictor of symptoms of neural injury in DCM patients, GM injury also plays a key role in each patient’s clinical symptoms. We will test this hypothesis by developing new tract specific markers and novel spinal fMRI methodology. Building upon our previous experience, we will compare the alterations of both WM and GM markers in these patients, with the goal of enhancing our ability to accurately predict both ongoing injury and early recovery after surgery. These findings will have a significant positive impact on human health by providing new understanding of the drivers of spinal injury in degenerative cervical compressive disease and developing new markers of injury that may enhance our ability to monitor and treat injury as well as prognosticate recovery.

项目总结/摘要 退行性颈脊髓病（DCM）是患者脊柱损伤的最常见原因 年龄超过55岁。它对医疗保健产生了深远的影响，导致10万多例手术， 每年，医疗保健支出超过20亿美元。不幸的是，传统的颈椎核磁共振 技术是不完善的预测正在进行的脊髓损伤，并不能预测哪些患者将 积极应对干预。此外，在我们对脊髓如何 在持续的退行性压迫中受伤新成像技术的应用可能 帮助缩小这一差距。我们之前的工作，在K23研究期间，已经表明了白色物质 (WM)用于监测持续性损伤的成像标记物和脊髓形态测量学，以及 预测复苏。本研究中提出的特定脑束WM成像方法的发展， 可能有助于将这些发现转化为临床护理。此外，我们的工作表明，颈部的体积 脊髓灰质（GM）在DCM中减少。利用一种新的脊髓功能磁共振成像方法，我们 此外，在DCM患者中还观察到GM激活减少，这一变化与患者的 症状这些发现挑战了DCM主要是WM疾病的传统观点。一个 我们提出的研究的目的是利用新开发的共识脊柱成像协议， 证实WM标记物在跟踪脊髓损伤中的作用，这是翻译 这些成像结果。此外，我们开发了一种新的功能磁共振成像方法，用于显示GM 受损脊髓的活动减少。我们的中心假设是，虽然WM损伤的标志物是 作为DCM患者神经损伤症状的主要预测因素，GM损伤也在 每个病人的临床症状。我们将通过开发新的道特异性标记来验证这一假设 和新的脊髓功能磁共振成像方法。根据我们以前的经验，我们将比较 这些患者的WM和GM标志物的改变，目的是提高我们的能力， 准确预测持续的损伤和手术后的早期恢复。这些发现将有一个 通过提供对脊柱疾病驱动因素的新认识， 退行性颈椎压迫性疾病的损伤，并开发新的损伤标记物， 提高我们监测和治疗受伤以及快速恢复的能力。