Enhanced Clinical Diagnosis of Early Osteoarthritis

描述（由申请人提供）：骨关节炎预计将在全球范围内达到流行比例。预防的关键之一是足够早地诊断软骨退行性过程以进行疾病修饰治疗。光学相干断层扫描（OCT）是一种新型的成像技术，可以在不损伤或去除组织的情况下以微观分辨率对人体关节软骨进行成像。初步数据显示，OCT可检测的软骨形式双折射的损失预测了潜在可逆的早期代谢变化，这些变化与骨关节炎的发病机制有关。PI还成功地使用了临床光纤OCT系统来评估体内人关节软骨的微结构和形状双折射。该建议的中心假设是，OCT可以在临床上用于改善关节镜下诊断早期关节软骨退变。提出了三个相关的具体目标：（1）检验OCT增强传统关节镜诊断人类早期软骨退变的敏感性和特异性的假设。(2)旨在检验OCT可检测的微结构损伤在接受关节镜检查治疗退行性膝关节撕裂的人类受试者的大体正常承重软骨中普遍存在的假设。(3)旨在检验OCT可用于临床预测急性前交叉韧带（ACL）损伤后通过系列MRI确定的进行性软骨退变发展的假设。实现提出的目标将引入关于人类骨关节炎早期变化的有价值的新数据，这些数据可通过新型成像技术（OCT）、3.0 T MRI和传统关节镜检查辨别。初步数据显示，OCT可以在不可逆变化发展之前识别人类软骨退变。因此，该提案具有高度创新性和重要性，因为实现目标可以提供诊断能力，以潜在地支持在目前可能的情况之前数年向软骨退行性过程治疗的临床范式转变。早期治疗的潜在优势包括延迟甚至预防致残性骨关节炎发作的可能性。

DESCRIPTION (provided by applicant): Osteoarthritis is expected to reach epidemic proportions worldwide. One of the keys to prevention is to diagnose cartliage degenerative processes early enough for disease modifying treatment. Optical coherence tomography (OCT) is a novel imaging technology that can image human articular cartilage at microscopic resolutions without damaging or removing the tissue. Preliminary data shows that loss of OCT detectable cartilage form birefringence was predictive of potentially reversible early metabolic changes that have been implicated in the pathogenesis of osteoarthritis. The PI has also successfully used a clinical fiberoptic OCT system to assess the microstructure and form birefringence of human articular cartilage in vivo. The central hypothesis of this proposal is that OCT can be used clinically to improve arthroscopic diagnosis of early articular cartilage degeneration. Three related specific aims are proposed: (1) To test the hypothesis that OCT enhances the sensitivity and specificity of conventional arthroscopic diagnosis of early cartilage degeneration in humans. (2) To test the hypothesis that OCT detectable microstructural damage is prevalent in grossly normal appearing weight bearing cartilage of human subjects undergoing arthroscopy to treat degenerative meniscal tears. (3) To test the hypothesis that OCT can be used clinically to predict the development of progressive cartilage degeneration as determined by serial MRI after acute anterior cruciate ligament (ACL) injury. Accomplishing the proposed aims will introduce valuable new data on the early changes in human osteoarthritis as discernible by novel imaging technology (OCT), 3.0 T MRI, and conventional arthroscopy. Preliminary data shows that OCT can identify human cartilage degeneration prior to the development of irreversible changes. As such, the proposal is highly innovative and significant in that achieving the aims can provide the diagnostic capability to potentially support a clinical paradigm shift towards treatment of cartilage degenerative processes years before what is currently possible. Potential advantages of earlier treatment include the possibility of delaying or even preventing the onset of disabling osteoarthritis.