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病的程度。预防的关键之一是及早诊断软骨退行性过程，以便进行疾病修饰治疗。光学相干断层扫描（OCT）是一种新型成像技术，可以在不损伤或移除组织的情况下对人体关节软骨进行显微分辨率成像。初步数据显示，OCT可检测到的双折射软骨的缺失可以预测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系统来评估人体关节软骨的微观结构和形成双折射。本提案的中心假设是OCT可以在临床上用于改善早期关节软骨退变的关节镜诊断。提出了三个相关的具体目的：(1)验证OCT增强常规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)为了验证在接受关节镜治疗退行性半月板撕裂的人类受试者中，OCT可检测到的微结构损伤普遍存在于外观正常的负重软骨中。(3)验证临床应用OCT预测急性前交叉韧带（ACL）损伤后连续MRI进展性软骨退变的假设。完成提出的目标将通过新的成像技术（OCT）、3.0 T MRI和传统关节镜检查，为人类骨关节炎的早期变化提供有价值的新数据。初步数据显示，OCT可以在软骨退行性变发展之前识别出不可逆的变化。因此，该建议具有高度创新性和重要意义，因为实现目标可以提供诊断能力，潜在地支持软骨退行性过程治疗的临床范式转变，比目前可能的早几年。早期治疗的潜在优势包括延缓甚至预防致残性骨关节炎发病的可能性。

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.