Quantitative Assessment of Dynamic Joint Instabilities Using 4D CT Imaging

描述(申请人提供)：诊断腕关节异常运动的临床技术主观性很强，假阳性率很高。此外，常规的放射学检查不能显示腕关节的动态不稳定。这是一个重大的临床问题，因为患有腕关节不稳定的人会经历进行性退行性疾病，导致功能障碍和骨关节炎(OA)。伴随而来的疼痛不仅使他们无法从事重要的职业任务，而且往往使他们无法进行日常生活中的简单活动。然而，如果医生能够在早期阶段诊断出动态关节不稳定，手术干预可以在关节炎或静态畸形发作之前恢复正常功能。因此，为了对临床结果产生关键影响，迫切需要一种能够及早发现功能性腕关节异常的方法。为了解决这一重大的公共卫生问题，我们团队的长期目标是非侵入性地诊断和量化只有在关节运动过程中才能观察到的腕部微妙的动态关节不稳定性。我们已经证明，我们可以使用四维(4D；3D+时间)CT成像技术来满足这一关键需求。基于我们成功的前期工作，我们的中心假设是，我们可以使用4D CT成像技术非侵入性地确定腕骨的复杂运动路径。我们在这项应用中的目标是开发一种实用的四维CT检查，以检测由于舟月骨不稳而发生的腕关节异常运动。具体地说，在目标1中，我们将开发一种健壮的低剂量4D CT成像技术来成像腕关节运动。我们的工作假设是，低剂量双源CT可以提供运动手腕的无伪影图像，其速度类似于日常生活活动的速度。我们将开发生物力学运动设备，在身体标本中测试这一假说，并确定最低辐射剂量水平。在目标2中，我们将使用身体标本、基于光学的运动分析系统、图像配准技术和定制的运动模拟器来测量所开发技术的准确性和精确度。最后，在目标3中，我们将确定4D CT腕关节成像在无症状受试者和关节不稳定受试者中的临床可行性。这一方案的创新之处在于使用最先进的CT技术来提供一种健壮的、低剂量的成像技术，能够检测动态腕关节的不稳定性。我们期待着三个重要的结果：1)用于量化腕关节的优化的低剂量临床CT技术，2)所开发技术的准确性和精确度数据，以及3)首次对有症状和无症状的人类受试者的腕关节进行在体4D评估。这些数据将为量化正常和病理性腕关节运动的临床试验提供基础。这一建议的意义在于，通过在早期阶段诊断动态腕关节不稳定，恢复正常运动的干预可以显著减少与腕关节骨关节炎相关的人类痛苦、生产力损失以及个人和社会成本。 与公共健康相关：这项提议的目标是设计一种计算机断层扫描检查(CT，或CAT扫描)，可以在患者移动关节时拍摄非常详细的腕关节照片。这些病人骨骼的三维电影可以回放，从任何角度观察关节，让医生看到并准确测量骨骼表面是如何移动的。这一点非常重要，因为关节运动异常，目前很难准确诊断，如果不治疗，可能会导致疼痛、关节炎或严重畸形。

DESCRIPTION (provided by applicant): Clinical techniques to diagnose abnormal wrist joint motion are highly subjective and have a high false positive rate. Additionally, routine radiographic examinations cannot demonstrate dynamic wrist instabilities. This is a significant clinical problem, since individuals suffering from wrist joint instabilities experience progressive degenerative disease that leads to functional disabilities and osteoarthritis (OA). The associated pain prevents them not only from conducting important occupational tasks, but often simple activities of daily living. However, if physicians are able to diagnose dynamic joint instabilities at an early stage, surgical intervention can restore normal function before the onset of arthritis or static deformities. Thus, to have a critical impact on clinical outcomes, a method that allows early detection of functional wrist joint abnormalities is desperately needed. To address this significant public health problem, the long-term goal of our team is to non-invasively diagnose and quantify subtle dynamic joint instabilities of the wrist that can only be observed during joint motion. We have shown that we can meet this critical need using four-dimensional (4D; 3D + time) CT imaging techniques. Based on our successful preliminary work, our central hypothesis is that we can non-invasively determine the complex motion paths of the carpal bones using 4D CT imaging techniques. Our objective in this application is to develop a practical 4D CT examination to detect abnormal wrist joint motion occurring as a result of scapholunate instability. Specifically, in Aim 1, we will develop a robust low dose 4D CT imaging technique to image joint motion in the wrist. Our working hypothesis is that low dose dual-source CT can provide artifact-free images of the moving wrist, at velocities similar to those of activities of daily living. We will develop biomechanical motion devices to test this hypothesis in cadaveric specimens, and determine the minimum radiation dose levels. In Aim 2, we will measure the accuracy and precision of the developed techniques using cadaveric specimens, an optical-based motion analysis system, image registration techniques, and a custom motion simulator. Finally, in Aim 3, we will determine the clinical feasibility of 4D CT wrist joint imaging in asymptomatic subjects and subjects with joint instability. The innovation of this proposal is the use of state-of-the-art CT technology to provide a robust, low dose imaging technique capable of detecting dynamic wrist joint instabilities. We expect three important outcomes: 1) an optimized low dose clinical CT technique for the quantification of wrist articulation, 2) accuracy and precision data for the developed technique, and 3) the first in vivo 4D assessments of wrist joint articulation in both symptomatic and asymptomatic human subjects. These data will provide the foundation for clinical trials to quantify normative and pathologic wrist joint motion. The significance of this proposal is that by diagnosing dynamic wrist joint instabilities at an early stage, intervention to restore normal motion can markedly reduce the human suffering, loss of productivity, and personal and societal costs associated with OA of the wrist. PUBLIC HEALTH RELEVANCE: The goal of this proposal is to design a computed tomography exam (CT, or CAT scan) that can take highly-detailed pictures of the wrist joint while the patient is moving the joint. These three-dimensional movies of the patient's bones can be played back, looking at the joint from any angle, to let the physician see and measure exactly how the surfaces of the bones move. This is very important because abnormal joint motion, which is currently very hard to accurately diagnose, can lead to pain, arthritis or crippling deformities when left untreated.