Non-Invasive Imaging to Quantify Peripheral Nerve Injury and Repair in Clinic

无创成像在临床上量化周围神经损伤和修复

• 批准号: 8245788
• 负责人: KAZIM A SHEIKH
• 金额: $ 52.09万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-01 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8245788
• 关键词: Acute; Affect; Animals; Area; Clinic; Clinical; Clinical Research; Data; Data Set; Denervation; Development; Diffusion Magnetic Resonance Imaging; Disease; Distal; Forearm; Goals; Healed; Histology; Human; Image; Imaging Techniques; Imaging technology; Individual; Injury; Institution; Investigative Techniques; Knowledge; Left; Lesion; Limb structure; Magnetic Resonance; Magnetic Resonance Imaging; Measurement; Measures; Medical; Modality; Modeling; Monitor; Morbidity - disease rate; Muscle; Natural regeneration; Nature; Nerve; Nerve Degeneration; Nerve Fibers; Nerve Regeneration; Neuropathy; Normal Range; Outcome; Pathway interactions; Patient Recruitments; Patients; Peripheral Nerves; Peripheral nerve injury; Rodent Model; Site; Skin; Structure of radial nerve; Structure of ulnar nerve; Subgroup; Techniques; Technology; Testing; Time; Tissues; Trauma; Traumatic Nerve Injury; Upper Extremity; Validation; Work; base; clinical practice; combat; comparative; disability; healing; in vivo; injured; injury and repair; male; median nerve; morphometry; mortality; nerve injury; preclinical study; public health relevance; regenerative; reinnervation; repaired; response; trauma centers

DESCRIPTION (provided by applicant): Civilian and combat trauma to limbs often results in serious injuries to the peripheral nerves that cause significant morbidity. Advances in trauma management have significantly reduced overall mortality; however, patients are left with significant disability and morbidity due to peripheral nerve injuries. There is an acute need for reliable measures to monitor nerve injury and repair to make informed management decisions in clinic. Currently, noninvasive techniques that allow early assessment of regeneration in traumatic nerve injuries are not available in clinical practice. We propose to develop and validate non-invasive magnetic resonance (MR) based diffusion tensor imaging (DTI) technology, to monitor the degenerative and regenerative response in the nerves after traumatic injuries. We hypothesize that alterations in DTI parameters can detect nerve fiber degeneration and regeneration. Our preliminary studies in animals support our hypothesis that this technique can measure Wallerian-like degeneration and regeneration in the injured nerves. We show that normal human nerves can be imaged with this technology supporting the feasibility of this project. The gaps in knowledge in this area include lack of: a) normative DTI parameters for different peripheral nerves; and b) studies demonstrating utility of DTI technology to detect peripheral nerve degeneration and regeneration in humans. Our specific Aims are: 1) To establish in vivo DTI-based techniques of imaging intact peripheral nerves in humans; and 2) To establish in vivo DTI-based techniques of imaging peripheral nerve degeneration and regeneration in traumatic peripheral nerve disorders in humans. The goals of the proposed studies are to collect normative data in controls and apply it to patients with complete nerve injuries (Sunderland grade V) undergoing nerve repairs. The principle reason to focus on patients with complete nerve injury and nerve repair in this initial project evaluating DTI technology is that in this clinical situation maximal change in DTI parameters is expected because of complete denervation and subsequent reinnervation of the distal nerve stumps, which will allow setting up thresholds of DTI parameters in individual nerves. DTI parameters will be correlated with currently used clinical, electrodiagnostic, and histological (when available) measures to assess nerve regeneration. Validation of DTI technology in patients with complete nerve injuries will allow broader application of this modality in patients with different grades of traumatic nerve injuries in clinic. We anticipate that this technology will facilitate medical management decisions in these patients. These studies are likely to establish thresholds for different DTI parameters in controls and completely denervated nerve segments, which will provide important range of comparative data with potential applicability to non-traumatic neuropathic conditions to monitor nerve degeneration and regeneration. PUBLIC HEALTH RELEVANCE: Civilian and combat trauma to limbs often results in serious injuries to the peripheral nerves that cause significant morbidity. Presently non-invasive clinical investigative techniques do not exist that allow accurate measurement of extent of nerve injury and natural responses of repair/healing. This project proposes to develop magnetic resonance imaging (MRI) technology to assess the extent of nerve injury and repair in patients with traumatic nerve injuries.

描述（由申请人提供）：肢体的平民和战斗创伤通常会导致周围神经严重伤害引起明显的发病率。创伤管理的进步大大降低了总体死亡率。然而，由于周围神经损伤，患者持有严重的残疾和发病率。迫切需要采取可靠的措施来监测神经损伤和维修以在诊所做出明智的管理决策。当前，临床实践中没有允许早期评估创伤性神经损伤再生的非侵入性技术。我们建议开发和验证基于非侵入性磁共振（MR）扩散张量成像（DTI）技术，以监测创伤性损伤后神经中神经中的退化和再生反应。我们假设DTI参数的改变可以检测神经纤维的变性和再生。我们在动物中的初步研究支持我们的假设，即该技术可以测量受伤神经中的沃勒式样变性和再生。我们表明，可以通过这项技术支持该项目的可行性来成像正常的人类神经。该领域的知识差距包括：a）不同外周神经的规范性DTI参数； b）研究表明DTI技术可以检测人类周围神经变性和再生的研究。我们的具体目的是：1）建立人类成像完整神经的基于体内DTI的技术； 2）建立人类创伤性周围神经疾病的外周神经变性和再生的基于体内DTI的技术。拟议的研究的目标是在对照中收集规范性数据，并将其应用于接受神经维修的完全神经损伤（Sunderland V）的患者。在此初始项目中，专注于完全神经损伤和神经修复患者的主要原因是，在这种临床情况下，由于完全的神经性和随后的远端神经性能的重新连接，预计DTI参数的最大变化将允许设置单个神经中DTI参数的阈值。 DTI参数将与当前使用的临床，电诊断和组织学（如果有）进行评估神经再生的措施相关。对完全神经损伤的患者进行DTI技术的验证将使这种方式在诊所中具有不同成绩创伤性神经损伤的患者中更广泛地应用。我们预计这项技术将有助于这些患者的医疗管理决策。这些研究可能会在对照组中建立不同DTI参数的阈值，并完全取消神经段，这将提供重要的比较数据范围，并可能适用于非创伤性​​神经性疾病，以监测神经变性和再生。 公共卫生的相关性：平民和四肢的创伤通常会导致周围神经严重受伤，从而导致明显的发病率。目前不存在无创临床研究技术，可以准确地测量神经损伤程度和修复/愈合的自然反应。该项目建议开发磁共振成像（MRI）技术，以评估创伤性神经损伤患者的神经损伤和修复程度。