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Novel MR Image Processing as an Objective Diagnostic Test for Chiari Malformation

新型 MR 图像处理作为 Chiari 畸形的客观诊断测试

基本信息

批准号：
9813099
负责人：
PHILIP A. ALLEN
金额：
$ 46.88万
依托单位：
UNIVERSITY OF AKRON
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-30 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9813099
关键词：
Adult Alzheimer&apos s Disease Anatomy Area Attention Biomechanics Biomedical Research Birth Brain Brain Injuries Brain Stem Cardiac Cerebellar tonsil Cerebellum Cerebrospinal Fluid Chiari Malformation Type 1 Child Clinical Congresses Crowding Dementia Diagnosis Diagnostic Diagnostic radiologic examination Diagnostic tests Diffusion Magnetic Resonance Imaging Disease Early Diagnosis Engineering Financial cost Functional disorder Goals High School Student Human Image Analysis Individual Lead Liquid substance Magnetic Resonance Magnetic Resonance Imaging Measurement Measures Methods Morphology Motion Multiple Sclerosis National Institute of Neurological Disorders and Stroke Nerve Operative Surgical Procedures Outcome Patients Positioning Attribute Posterior Fossa Prevalence Prognostic Marker Quality of life Radiology Specialty Reporting Research Resistance Schedule Severities Severity of illness Statistical Data Interpretation Surgeon Surgical Decompression Symptoms Techniques Time Tonsil Translating Traumatic Brain Injury United States National Institutes of Health Work base brain morphology brain tissue cerebrospinal fluid flow chronic traumatic encephalopathy clinical diagnostics cognitive function experience foramen magnum graduate student healthy volunteer image processing improved in vivo malformation natural flow nervous system disorder novel outcome forecast patient population pressure societal costs symposium symptomatology undergraduate student

项目摘要

Summary: Chiari malformation Type I (CM) is a serious neurological disorder characterized by the cerebellar tonsillar position located below the foramen magnum (tonsillar ectopia). The “crowding” that occurs near the foramen magnum causes compression on the cerebellum and brainstem and disrupts the natural flow of cerebrospinal fluid. To further complicate matters, 3% of children and 1% of adults are shown to have tonsillar ectopia on a radiology report, but just 300,000 individuals (0.08%) are diagnosed with CM in the US. Thus, there are greater than 10 times more individuals with radiographic evidence of tonsillar ectopia than individuals that actually have a diagnosis of CM. As such, surgeons and patients are dissatisfied with the current radiological measurement as a diagnostic criterion. Approximately 20,000 CM patients are evaluated each year for surgery in the US from which half receive surgical decompression of the posterior fossa with the goal of creating more space around the cerebellar tonsils. While the majority of CM patients have reported improvement in quality of life after surgery, this improvement is not consistent across different symptoms. The significance of the situation even got the attention of Congress, which in 2009 directed NINDS to, “encourage aggressive measures toward advanced engineering and imaging analysis to an objective diagnostic test for CM.” Static anatomical measurements alone are NOT adequate to diagnose CM. The combination of altered brain anatomy with altered CSF motion and dynamic brain tissue strain during the cardiac cycle likely work together to cause CM symptoms. Thus, understanding the relationship between biomechanical and disease severity measures would lead to an objective diagnostic test for CM. The goal of the proposed study is to obtain novel MR-based dynamic biomechanical measures before decompression surgery and determine their relationship with disease severity measures. We hypothesize that these biomechanical measures are correlated with disease severity measures. Furthermore, these biomechanical measures may reflect the underlying pathophysiology associated with CM, and serve as a better prognostic indicator than the standard methods that are currently being used clinically. Our group has developed several novel MR image-processing techniques that provide in-vivo subject-specific biomechanical measures of 1) resistance to CSF motion, 2) brain tissue strain, and 3) brain morphometrics. In a different group of CM patients, we have examined disease severity measures including DTI, cognitive function, and symptomology. Preliminary results have demonstrated these biomechanical and disease severity measures to be significantly different in CM subjects compared to healthy controls. However, these measures need to be acquired on the same patient population in order to determine their precise relationship. We will obtain biomechanical and disease severity measures in 50 adult CM patients before surgery. This study will provide an understanding of the importance of biomechanical measures in the pathophysiology of CM that may lead to better clinical diagnostic testing for CM.

摘要：Chiari 畸形 I 型 (CM) 是一种严重的神经系统疾病，其特征是小脑扁桃体位置位于枕骨大孔下方（扁桃体异位）。发生在附近的“拥挤” 枕骨大孔会压迫小脑和脑干，并扰乱大脑的自然流动脑脊液。更复杂的是，3% 的儿童和 1% 的成人患有扁桃体放射学报告显示异位，但在美国只有 300,000 人 (0.08%) 被诊断出患有 CM。因此，有扁桃体异位放射影像证据的人数比实际人数多 10 倍以上实际上已诊断为 CM。因此，外科医生和患者对当前的情况不满意放射测量作为诊断标准。每年约有 20,000 名 CM 患者接受评估在美国进行手术，其中一半接受后颅窝减压手术，目的是在小脑扁桃体周围创造更多空间。虽然大多数 CM 患者报告手术后生活质量的改善，这种改善在不同症状之间并不一致。这这种情况的重要性甚至引起了国会的关注，国会于 2009 年指示 NINDS“鼓励采取积极的措施进行先进的工程和成像分析，以进行客观的诊断测试厘米。” 仅静态解剖测量不足以诊断 CM。改变的组合心动周期期间脑脊液运动和动态脑组织应变改变的大脑解剖结构可能起作用一起引起 CM 症状。因此，了解生物力学和疾病之间的关系严重程度测量将导致对 CM 进行客观的诊断测试。拟议研究的目标是在减压手术前获得基于 MR 的新颖动态生物力学测量并确定其与疾病严重程度测量的关系。我们假设这些生物力学措施是与疾病严重程度测量相关。此外，这些生物力学措施可能反映与 CM 相关的潜在病理生理学，并且作为比标准更好的预后指标目前临床上使用的方法。我们小组开发了几种新颖的 MR 图像处理提供体内特定受试者生物力学测量的技术：1) 对脑脊液运动的抵抗力，2) 脑组织应变，以及 3) 脑形态测量。在另一组 CM 患者中，我们检查了疾病严重程度测量，包括 DTI、认知功能和症状。初步结果已表明与 CM 受试者相比，这些生物力学和疾病严重程度测量值显着不同健康的控制。然而，这些措施需要在同一患者群体中获得，以便确定他们的精确关系。我们将获得 50 名成人的生物力学和疾病严重程度测量 CM 患者在手术前。这项研究将让人们了解生物力学的重要性 CM 病理生理学方面的措施可能会导致更好的 CM 临床诊断测试。