PET/MRI Imaging of Neuraxial Inflammation in Sciatica Patients

坐骨神经痛患者椎管内炎症的 PET/MRI 成像

• 批准号: 8729625
• 负责人: Jacob M. Hooker
• 金额: $ 25.84万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-15 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8729625
• 关键词: Accounting; Achievement; Age; American; Area; Back; Back Pain; Belief; Binding; Cells; Chronic; Clinical; Clinical Data; Clinical Treatment; Development; Diagnosis; Diagnostic; Disease; Effectiveness; Epidural Injections; Exhibits; Health; Human; Image; Imaging Techniques; Inflammation; Inflammatory; Injection of therapeutic agent; Intervertebral Disk Displacement; Laboratories; Lead; Location; Low Back Pain; Lower Extremity; Magnetic Resonance; Magnetic Resonance Imaging; Maintenance; Mediating; Medical; Methodology; Microglia; Motor; Nerve; Outcome; Pain; Pathway interactions; Patients; Pilot Projects; Plant Roots; Positron-Emission Tomography; Prevalence; Radiculitis; Radiology Specialty; Recording of previous events; Resolution; Role; Sciatica; Sensory; Spinal; Spinal Stenosis; Spinal nerve root structure; Stenosis; Steroids; Stratification; Structure; Symptoms; Technology; Testing; Tracer; Treatment outcome; Uncertainty; Vertebral column; Woman; Work; base; bioimaging; cost; design; disability; epidural space; imaging modality; improved; in vivo; innovation; macrophage; men; nerve supply; neuroinflammation; novel; relating to nervous system; response; socioeconomics; success; systematic review; tool; treatment response

DESCRIPTION (provided by applicant): A fundamental question in managing sciatica pain remains unanswered: Is chronic sciatica pain mediated by persistent inflammation? Sciatica refers to back pain with a radicular component. Sciatica pain accounts for up to 40% of all back pain, which is a leading cause of lost workdays in the US, costs employers an estimated $7.4 billion/year, and is the main reason for disability in Americans under 45 years old. Among the main causes of sciatica pain are intervertebral disk displacement and stenosis of the intervertebral foramen producing inflammation of neural structures and severe pain. Interlaminar and transforaminal injection of epidural steroids are extensively used to treat sciatica. The rationale is that reduction in regional inflammation promoted by steroids will lead to improvement of symptoms. However, there is very limited evidence on the association between structural abnormalities in the vertebral column, corresponding inflammatory changes around nerve roots, and sensory or motor symptoms associated with back and sciatica pain. There is also significant doubt on the effectiveness of steroid injections for treatment. Magnetic resonance imaging (MRI) is the main imaging technique to assess structural changes associated with pain of spinal origin. Recently, advances in Positron Emission Tomography (PET) introduced the tracer [11C]PBR28 to specifically investigate neuroinflammation. Availability of PET/MRI cameras offers a unique opportunity to study the association between neuroinflammation and structural changes in this major medical problem. We propose to use PET/MRI with [11C]PBR28 to study the association between inflammation, structural changes, symptoms and treatment outcome in patients with sciatica. The ability to image neuraxial inflammation developed in this study has the potential to revolutionize the diagnosis and treatment of low back pain. We plan to perform a pilot study of [11C]PBR28 PET/MRI of the lumbosacral spine in patients with sciatica pain to establish this methodology and explore the role of this technology in guiding clinical treatment of sciatica pain.

描述（由申请人提供）：管理坐骨神经痛疼痛的一个基本问题仍未得到解答：慢性坐骨神经痛是否是通过持续性炎症介导的？坐骨神经痛是指带有根部成分的背痛。坐骨神经痛占所有背痛的40％，这是美国工作日失业的主要原因，雇主估计为74亿美元，这是45岁以下美国人残疾的主要原因。坐骨神经痛的主要原因包括椎间盘位移和椎骨孔的狭窄，产生神经结构的炎症和剧烈疼痛。硬膜外类固醇的层间和透射膜注射被广泛用于治疗坐骨神经痛。理由是，类固醇促进的区域炎症减少将导致症状改善。但是，关于椎骨柱中结构异常，神经根周围的炎症变化以及与背部和坐骨神经痛相关的感觉或运动症状之间的相应炎症变化的证据非常有限。对于类固醇注射治疗的有效性也有很大的怀疑。磁共振成像（MRI）是评估与脊柱疼痛相关的结构变化的主要成像技术。最近，正电子发射断层扫描（PET）的进展引入了示踪剂[11C] PBR28，以特别研究神经炎症。 PET/MRI摄像机的可用性提供了一个独特的机会，可以研究这个主要医学问题的神经炎症与结构变化之间的关联。我们建议将PET/MRI与[11C] PBR28一起研究坐骨神经痛患者的炎症，结构变化，症状和治疗结果之间的关联。在这项研究中产生的神经炎症的能力有可能彻底改变腰痛的诊断和治疗。我们计划对坐骨疼痛患者的腰椎脊柱的[11C] PBR28 PET/MRI进行试验研究，以建立这种方法，并探讨该技术在指导坐骨神经痛临床治疗方面的作用。