MRI Bone Texture: A Novel Biomarker for Assessment of Bone Quality and Prediction of Complications in Patients Having Spine Fusion Surgery

MRI 骨纹理：一种用于评估脊柱融合手术患者骨质量和预测并发症的新型生物标志物

• 批准号: 10669274
• 负责人: Emily Margaret Stein
• 金额: $ 18.03万
• 依托单位: HOSPITAL FOR SPECIAL SURGERY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10669274
• 关键词: Age; Anabolic Agents; Biopsy; Characteristics; Clinical; Clinical Treatment; Clinical Trials; Complex; Data; Detection; Diagnosis; Dual-Energy X-Ray Absorptiometry; Early Diagnosis; Elderly; Enrollment; Entropy; Evaluation; Failure; Fracture; Future; Goals; Health; Health Care Costs; Heterogeneity; Hip region structure; Incidence; Intervention; Intervention Trial; Knowledge; MRI Scans; Magnetic Resonance Imaging; Measurement; Measures; Methods; Monitor; Morbidity - disease rate; Morphologic artifacts; Operative Surgical Procedures; Orthopedic Procedures; Orthopedic Surgery; Orthopedics; Osteogenesis; Osteoporosis; Outcome; Patient-Focused Outcomes; Patients; Perioperative; Peripheral; Pharmaceutical Preparations; Population; Postmenopause; Postoperative Complications; Postoperative Period; Prevalence; Prospective Studies; Research; Resolution; Risk; Screening procedure; Spinal; Spinal Diseases; Spinal Fusion; Spine surgery; Techniques; Testing; Texture; Treatment Protocols; United States; Vertebral column; Woman; Work; X-Ray Computed Tomography; bone; bone quality; clinical care; clinical practice; cost; follow-up; high risk; improved; improved outcome; instrument; novel; novel marker; osteoporosis with pathological fracture; prospective; screening; skeletal; skeletal abnormality; spine bone structure; substantia spongiosa; success; tool

Project Summary Spine fusion surgery is one of the most common, and complex, orthopedic procedures. Complications occur in over 30% of cases, highlighting the need to identify modifiable factors associated with these negative sequelae. Bone quality is a critical determinant of post-operative outcomes, as stability of hardware in bone and de novo bone formation are required for successful fusion. Despite the importance of bone quality to post-operative outcomes, there are limited tools for pre-operative detection of abnormal bone in candidates for fusion. The most common clinical tool for skeletal assessment, dual energy x-ray absorptiometry (DXA), is subject to artifact from spinal abnormalities and infrequently performed for pre-operative evaluation. High resolution peripheral QCT (HRpQCT) can detect pre-operative skeletal abnormalities and predict complications after fusion but is a research tool not available in clinical practice. In contrast, MRI is routinely performed prior to fusion, for diagnosis of spinal disease and surgical planning, making an MRI-based technique ideal to screen for pre-operative skeletal deficits. Our group has recently developed a novel method to evaluate bone quality using standard, clinically acquired MRIs which analyzes the irregularity, or heterogeneity, of trabecular bone texture. In prior work, we found that postmenopausal women with fractures had greater heterogeneity of bone texture than age- matched controls. The proposed study will assess MRI trabecular bone texture as a new technique to detect poor bone quality, predict complications, and track post-operative skeletal changes in patients undergoing spinal fusion. We hypothesize that pre-operative MRI bone texture will relate to volumetric BMD (vBMD) and microarchitecture by HRpQCT and will predict skeletal complications after surgery. Post-operative changes in MRI bone texture will relate to baseline patient characteristics and clinical post-operative treatment regimen, including use of anabolic agents. We will prospectively enroll 100 patients having lumbar spine fusion and follow them for one year. Baseline DXA, HRpQCT, and our MRI-based method will be performed. MRIs will be repeated at 6 months post-operatively to determine whether early changes in MRI bone texture relate to patient characteristics, medication use, and predict complications. CT scans will be performed at one year to assess skeletal complications and completeness of fusion. This proposal aims to: 1) Investigate the relationship between pre-operative MRI bone texture and HRpQCT measurements of vBMD and microarchitecture; 2) Investigate whether MRI bone texture predicts skeletal complications after fusion; 3) Assess longitudinal changes in bone texture and the clinical factors that influence these changes in patients after spine fusion. The long-term goals of our research are to improve identification of patients at high risk for post-operative complications and provide knowledge that will advance future interventional trials. In subsequent work, we plan to extend this technique to other orthopedic populations. Ultimately, we hope to improve the outcomes of patients undergoing fusion and other high-risk orthopedic surgeries by facilitating the creation of new peri-operative treatment paradigms.

项目概要 脊柱融合手术是最常见、最复杂的骨科手术之一。并发症发生在 超过 30% 的病例，强调需要确定与这些负面后遗症相关的可改变因素。 骨质量是术后结果的关键决定因素，因为骨内硬件的稳定性和从头 成功融合需要骨形成。尽管骨质量对于术后很重要 结果，用于术前检测融合候选者异常骨的工具有限。最 用于骨骼评估的常用临床工具双能 X 射线吸收测定法 (DXA) 受到以下因素的影响： 脊柱异常且很少进行术前评估。高分辨率外围QCT (HRpQCT) 可以检测术前骨骼异常并预测融合后的并发症，但它是一种 研究工具在临床实践中不可用。相比之下，MRI 通常在融合前进行，用于诊断 脊柱疾病和手术计划，使得基于 MRI 的技术成为术前筛查的理想选择 骨骼缺陷。我们的小组最近开发了一种使用标准评估骨骼质量的新方法， 临床采集的 MRI 可以分析骨小梁纹理的不规则性或异质性。在之前的 工作中，我们发现患有骨折的绝经后女性的骨质地异质性比同龄女性更大。 匹配的控件。拟议的研究将评估 MRI 小梁骨纹理作为检测骨小梁的新技术 骨质量差、预测并发症并跟踪接受脊柱手术的患者术后骨骼变化 融合。我们假设术前 MRI 骨纹理与体积骨密度 (vBMD) 和 通过 HRpQCT 进行微结构分析，并预测手术后的骨骼并发症。术后变化 MRI 骨纹理将与基线患者特征和临床术后治疗方案相关， 包括使用合成代谢药物。我们将前瞻性招募 100 名腰椎融合患者并进行随访 他们为期一年。将执行基线 DXA、HRpQCT 和我们基于 MRI 的方法。 MRI 将重复进行 术后 6 个月确定 MRI 骨质地的早期变化是否与患者有关 特征、药物使用和预测并发症。 CT 扫描将在一年后进行评估 骨骼并发症和融合的完整性。该提案的目的是：1）调查之间的关系 术前 MRI 骨纹理以及 vBMD 和微结构的 HRpQCT 测量； 2）调查 MRI骨纹理是否可以预测融合后的骨骼并发症； 3）评估骨骼的纵向变化 脊柱融合后患者的质地和影响这些变化的临床因素。长期目标 我们的研究的目的是提高对术后并发症高风险患者的识别，并提供 将推进未来介入试验的知识。在后续工作中，我们计划将该技术扩展到 其他骨科人群。最终，我们希望改善接受融合和融合的患者的结果 通过促进创建新的围手术期治疗范例来开展其他高风险骨科手术。