Weight-Bearing Imaging of the Knee Using C-Arm CT

 描述（由申请人提供）：最常与下肢骨关节炎（OA）相关的关节是膝关节，其主要症状包括疼痛和僵硬。骨骼组织受到其机械环境的调节，骨骼和软组织内对机械刺激做出反应的受体被认为在关节疼痛中发挥着重要作用。骨关节炎发生和进展的一种潜在途径是由于关节运动学异常，导致关节应力升高和软骨损伤。改变骨骼机械应力和代谢活动的治疗可能是减轻这些患者疼痛的有效策略。然而，临床医生无法诊断或治疗这些“病理力学”，因为他们缺乏评估膝关节负重功能和组织应力的工具。这项研究的总体目标是开发新型负重计算机断层扫描 (CT) 成像，以支持膝关节健康的定量测量，从而测量关节的形态和力学。作为实现这一目标的第一步，我们将研究和优化一种新的、非常高分辨率（210 µm 各向同性）、基于 C 形臂 CT 的成像测试，该测试将在受试者处于完全负重位置时测量软骨变形随时间的变化。我们假设，由于软骨材料特性及其对机械负载的响应的差异，变形负载曲线的机械模型将提供 OA 状态的敏感且早期成像生物标志物。我们将优化离体尸体膝盖变形-时间曲线的采集，并进行一项 40 名受试者的初步研究，以证明新的成像生物标记物区分非 OA 和 OA 进展不同阶段的潜在敏感性。我们相信，我们新的关节健康测试将能够测试患者特定的治疗策略，从而减缓或逆转膝关节骨关节炎的进展。

 DESCRIPTION (provided by applicant): The joint most often implicated in lower extremity osteoarthritis (OA) is the knee, where major symptoms include pain and stiffness. Skeletal tissues are regulated by their mechanical environment and receptors within bone and soft tissue that respond to mechanical stimulation are believed to play a major role in joint pain. One potential pathway for the onset and progression of OA is due to abnormal joint kinematics, resulting in elevated joint stress and cartilage damage. Treatments that alter mechanical stresses and metabolic activity in bone may be an effective strategy to alleviate pain in these patients. However, clinicians are unable to diagnose or treat these `pathomechanics' as they lack the tools to assess weight-bearing knee function and tissue stress. The overarching goal of this research is to develop novel weight-bearing computed tomography (CT) imaging to support a quantitative measure of knee joint health that measures both morphology and mechanics of the joint. As a first step towards this goal, we will research and optimize a new, very high resolution (210 µm isotropic), C-arm CT-based imaging test that will measure cartilage deformation as a function of time with the subject standing in a fully weight-bearing position. We hypothesize that a mechanical model of the deformation-load curve will provide a sensitive and early imaging biomarker of OA status due to differences in cartilage material properties and their response to mechanical loading. We will optimize the acquisition of the deformation-time curve in ex vivo cadaver knees, and conduct a 40-subject preliminary study to demonstrate the potential sensitivity of the new imaging biomarker to distinguish between non-OA and different stages of OA progression. We believe that our new joint health test will enable testing of patient-specific treatment strategies that may slow or reverse the progression of knee OA.