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

项目摘要 脊柱融合手术是最常见和最复杂的骨科手术之一。并发症发生在 超过30%的病例，突出表明需要确定与这些负面后遗症相关的可改变因素。 骨质量是术后结局的关键决定因素，因为内固定器械在骨中的稳定性和新发 骨形成是成功融合所必需的。尽管骨质量对术后的重要性 结果，在融合候选者中，术前检测异常骨的工具有限。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）受到来自 脊柱异常，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， 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，使基于MRI的技术成为术前筛查的理想选择。 骨骼缺陷我们小组最近开发了一种新的方法来评估骨质量， 临床获得的MRI，其分析骨小梁纹理的不规则性或异质性。于过往 我们发现，绝经后骨折妇女的骨质地比年龄更不均匀， 匹配的对照。拟议的研究将评估MRI骨小梁纹理作为一种新的技术，以检测 骨质量差，预测并发症，并跟踪脊柱手术患者的术后骨骼变化 核聚变我们假设术前MRI骨纹理与体积BMD（vBMD）相关， 通过HRpQCT的微结构，并将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， 包括使用合成代谢剂。我们将前瞻性入组100例腰椎融合患者，并随访 他们一年。将进行基线DXA、HRpQCT和基于MRI的方法。将重复进行MRI 以确定MRI骨纹理的早期变化是否与患者 特征、药物使用和预测并发症。将在1年时进行CT扫描，以评估 骨骼并发症和融合完整性。本建议旨在：（1）研究 术前MRI骨纹理和vBMD和微结构的HRpQCT测量; 2）研究 MRI骨纹理是否可预测融合后的骨骼并发症; 3）评估骨的纵向变化 纹理和影响脊柱融合术后患者这些变化的临床因素。远景目标 我们的研究的目的是提高对术后并发症高危患者的识别， 这些知识将推动未来的干预性试验。在随后的工作中，我们计划将这项技术扩展到 其他骨科人群。最终，我们希望改善接受融合术的患者的结局， 通过促进新的围手术期治疗模式的创建，

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.