Structural and functional imaging markers in Degenerative Cervical Myelopathy

项目摘要/摘要 退行性脊髓型颈椎病(DCM)是导致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，每年导致超过10万例手术 每年的医疗保健支出超过20亿美元。不幸的是，传统的颈椎核磁共振 技术不能完美地预测持续的脊柱损伤，也不能预测哪些患者会 很好地应对干预。此外，在我们对脊髓是如何 在持续的退行性压迫中受伤。新成像技术的应用可以 帮助缩小这一差距。我们之前的工作，在K23研究期间，已经显示了这两种白质的效用 (WM)成像标记物和脊髓形态计量学用于监测持续损伤以及 预测经济复苏。本工作中提出的针对特定区域的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，我们的工作显示了颈部的体积 DCM时脊髓灰质(GM)减少。利用一种新的脊髓功能磁共振成像方法，我们已经 此外，DCM患者的GM活性降低，这一变化与患者有关 症状。这些发现挑战了传统观点，即扩张型心肌病主要是一种西医疾病。一个 我们建议的研究的目标是利用新开发的共识脊柱成像方案来 证实WM标记物在追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 损伤脊髓中的活动减少。我们的中心假设是，虽然WM损伤的标志是 作为DCM患者神经损伤症状的主要预测因子，GM损伤在 每名患者的临床症状。我们将通过开发新的区域特异性标记来检验这一假设 和新的脊柱功能磁共振成像方法学。根据我们以前的经验，我们将比较 这些患者的WM和GM标志物的变化，目的是提高我们的能力 准确预测持续损伤和术后早期恢复。这些发现将有一个 通过提供对脊柱疾病驱动因素的新理解，对人类健康产生重大积极影响 退行性颈椎压迫症的损伤和发展新的损伤标志物 增强我们监测和治疗损伤以及预测康复的能力。

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.