Novel PET/MR Imaging Approach for Persistent Postsurgical Pain Following Joint Replacement

项目摘要 概述：本项目旨在开发一种新的18F-脱氧葡萄糖(18F-FDG)PET/MRI方法 金属伪影矫正技术可提供假体关节疼痛并发症的早期识别 全髋关节置换术后引起持续性疼痛(PPSP)的区域。 相关性：全髋关节置换术是治疗终末期髋关节疼痛和 功能障碍，估计到2030年每年将达到572,000例。不幸的是，相当数量的 患者在手术后出现PPSP，如果没有适当的治疗，可能会严重损害 生活质量。然而，早期识别这些患者的疼痛诱因是非常困难的，因为 目前的诊断方法包括X射线、CT和MRI，对疼痛的敏感性有限，并遭受严重的 假体中由金属引起的伪影。因此，迫切需要一种新的诊断方法来 准确识别引起疼痛的异常炎性改变，无需禁忌性金属伪影引导 适当的治疗与疼痛的确切原因相匹配。 方法：我们建议使用18F-FDGPET/MRI来早期识别全髋关节置换术后PPSP的来源。 我们先前对慢性疼痛综合征的18F-FDG PET/MRI研究显示，在 检测疼痛的炎症部位。然而，金属假体附近严重的金属伪影限制了 18F-FDGPET/MRI在全髋关节置换中的应用因此，我们在这个项目中的第一个目标是开发 PET的金属感知衰减校正，使金属假体附近的18F-FDG PET可靠。我们的 第二个目标是开发具有金属伪影校正功能的高分辨率3T髋关节磁共振成像，以最大限度地提高我们的 识别PPSP症状的形态原因的能力。我们的第三个目标是验证以下改进 使用18F-FDGPET/MRI序列检查疼痛的皮损。这将通过关联来实现 18F-FDGPET/MRI在6个月、12个月和18个月时的疼痛评分 在单侧全髋关节置换手术后。 摘要：我们建议开发一种新的具有金属伪影校正的18F-FDG PET/MRI方法 THA术后引起PPSP并发症的早期检测技术。成功实施我们的 该方法将使PPSP患者的个体化、有效治疗的早期指征成为可能。

Project Abstract Overview: This project aims to develop a novel 18F-fluorodeoxyglucose (18F-FDG) PET/MRI method with novel metal artifact correction techniques to provide early identification of painful complications in the prosthetic joint area causing persistent postsurgical pain (PPSP) following total hip arthroplasty (THA). Relevance: THA is one of the most rapidly growing procedures to treat the end-stage hip joint pain and dysfunction and is estimated to reach 572,000 annual cases by 2030. Unfortunately, a substantial number of patients experience PPSP after the procedure, which, without proper treatment, can significantly impair the quality of life. However, the early identification of pain generators for these patients is very difficult because the current diagnostic methods including X-ray, CT, and MRI, have limited sensitivity to pain and suffer from severe artifacts induced by metal in prostheses. Therefore, there is a pressing need for a novel diagnostic approach to accurately identify the abnormal inflammatory changes causing pain without prohibitive metal artifacts to guide the appropriate treatment matched to the exact cause of pain. Approach: We propose the use of 18F-FDG PET/MRI for early identification of sources of PPSP following THA. Our previous 18F-FDG PET/MRI study of chronic pain syndromes demonstrated promising improvements in detecting sites of painful inflammation. However, the severe metal artifacts near metallic prostheses limit the application of 18F-FDG PET/MRI to THA patients. Therefore, our first aim in this project is the development of metal-aware attenuation correction for PET to enable reliable 18F-FDG PET near the metallic prosthesis. Our second aim is the development of high-resolution hip MRI at 3T with metal artifact correction to maximize our ability to identify morphologic causes of PPSP symptoms. Our third aim is to validate the improvements in detection of the painful lesions using serial 18F-FDG PET/MRI sessions. This will be accomplished by correlating the pain score measurements with 18F-FDG PET/MRI abnormalities at 6 months, 12 months, and 18 months following the unilateral THA procedure. Summary: We propose to develop a novel 18F-FDG PET/MRI method with metal artifact correction techniques for early detection of complications causing PPSP following THA. Successful implementation of our method will enable early indication of individualized, effective treatments for THA patients with PPSP.