Imaging Strategies To Improve Diagnosis and Treatment of Entrapment Neuropathy

改善卡压神经病诊断和治疗的影像策略

• 批准号: 9350565
• 负责人: Sameer B. Shah
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-10-01 至 2019-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9350565
• 关键词: Address; Algorithms; Axon; Beds; Biomechanics; Blood Vessels; Cadaver; Carpal Tunnel Syndrome; Clinical; Complement; Contrast Sensitivity; Diabetic Neuropathies; Diagnosis; Diffusion; Diffusion Magnetic Resonance Imaging; Discrimination; Disease; Electrodiagnosis; Elements; Environment; Etiology; Extracellular Matrix; Geometry; Gold; Health; Healthcare Systems; Human; Image; Imagery; Imaging Techniques; Impairment; In Situ; Individual; Joints; Magnetic Resonance Imaging; Measurement; Measures; Mechanics; Methodology; Methods; Monitor; Morphologic artifacts; Morphology; Motor; Movement; Nerve; Nerve Entrapment; Nerve Fibers; Nerve compression syndrome; Neurologic; Neurons; Neuropathy; Numbness; Operative Surgical Procedures; Outcome; Patients; Peripheral Nerves; Predisposition; Prevalence; Protocols documentation; Radial; Rehabilitation therapy; Reporting; Research; Resolution; Scanning; Sensory; Stretching; Structure; Surgical Management; Techniques; Testing; Time; Tissues; Translating; Translations; Traumatic Nerve Injury; Treatment Efficacy; Ultrasonography; Veterans; Wrist; accurate diagnosis; associated symptom; base; design; elastography; ex vivo imaging; image processing; imaging modality; improved; in vivo; in vivo Model; injured; interdisciplinary approach; kinematics; mechanical load; mechanical properties; median nerve; neglect; non-invasive imaging; rehabilitation engineering; targeted imaging

Peripheral nerves are well-organized composite tissues that exist in a dynamic biomechanical environment created by the movement of articulating joints. To accommodate mechanical loads, nerves glide and stretch within their beds. Nerve entrapment alters the structure of nerves, restricts their ability to glide, and excessively increases regional deformation, ultimately impairing sensory and motor function. The most common entrapment neuropathy among Veterans is carpal tunnel syndrome (CTS), a disease in which the median nerve is impinged at the wrist, within the carpal tunnel. Surgical treatment of carpal tunnel syndrome is generally effective, but revision may be required for 3-20% of surgeries. Given the prevalence of CTS, this corresponds to a substantial number of patients. Electrodiagnostics are considered to be the gold standard for CTS diagnosis, inconclusive outcomes are not uncommon, especially in the presence of other overlying neuropathies, such as diabetic neuropathy. Despite their likely influence on neuropathic progression, nerve structural and biomechanical changes have been used only minimally to diagnose or track neuropathy, or to assess the efficacy of surgical management. This is in large part due to the challenges associated with imaging nerves using current techniques. Our research team has developed new magnetic resonance imaging (MRI) and ultrasound-based imaging methods that allow the visualization of nerves at high spatial resolution on contrast. These capabilities allow accurate measurement of nerve biomechanics (deformation and stiffness), and also identification and quantitative characterization of structural elements within nerves. These methods are expected to provide a powerful and sensitive approach to non-invasively assess neuropathy and surgical efficacy. Given its prevalence, CTS provides an ideal test-bed for translating our nerve imaging and image processing techniques to a clinical setting. In particular, we propose to use ultrasound and MRI techniques to evaluate structure and biomechanics of median nerves in patients requiring surgery for CTS. Our proposal uses a multi-disciplinary approach to address two specific aims. Our first aim is to optimize MRI-based and ultrasound imaging methodology in median nerves. We will use human cadaveric and in vivo models to validate and optimize imaging protocols that will be used clinically. We expect that MRI-based strategies will provide high resolution and high contrast structural images of nerves, while ultrasound will provide rapid assessment of nerve kinematics and stiffness. Our second aim is to examine structural and kinematic changes of median nerves in patients with CTS, before and after carpal tunnel release, using MRI and ultrasound. We hypothesize that MRI-based imaging will detect structural differences in epineurial, perineurial, and nerve fiber compartments between control and entrapped nerves, and ultrasound will detect differences in nerve deformation and stiffness among control nerves and entrapped nerves before and after surgery. More broadly, we anticipate applying our approach to other neurological conditions that impact the Veteran healthcare system, in which nerve structure and biomechanics may be altered. These include other entrapment neuropathies, diabetic neuropathy, and traumatic nerve injury. Ultimately, successful execution of our proposed study will enable earlier recognition of neuropathy, provide noninvasive monitoring of neuropathic progression, and facilitate more accurate assessment of rehabilitative and therapeutic efficacy. 1

周围神经是在动态生物力学环境中存在的组织良好的复合组织 由铰接关节的运动创建。为了适应机械载荷，神经滑行并拉伸 在他们的床内。神经夹带改变神经的结构，限制其滑行能力，并过度 增加区域变形，最终损害感觉和运动功能。最常见的 退伍军人中的夹杂神经病是腕管综合征（CTS），一种中位数的疾病 神经在腕管内的手腕撞击。腕管综合征的手术治疗是 通常有效，但是3-20％的手术可能需要修订。考虑到CTS的流行率 对应大量患者。电诊断被认为是金标准 CTS诊断，不确定的结果并不少见，尤其是在其他上覆的情况下 神经病，例如糖尿病神经病。 尽管它们可能影响神经性进展，但神经结构和生物力学变化还是 仅用于诊断或跟踪神经病或评估手术管理的功效。 这在很大程度上是由于使用当前技术与成像神经相关的挑战。我们的 研究团队开发了新的磁共振成像（MRI）和基于超声的成像方法 这允许在对比度高空间分辨率下可视化神经。这些功能允许准确 神经生物力学的测量（变形和刚度），以及识别和定量 神经内结构元素的表征。这些方法有望提供强大的和 对非侵入性评估神经病和手术功效的敏感方法。 鉴于其患病率，CTS提供了一个理想的测试床，用于翻译我们的神经成像和图像 处理技术到临床环境。特别是，我们建议使用超声和MRI技术来 评估需要进行CT手术的患者中位神经的结构和生物力学。我们的建议 使用多学科方法来解决两个具体目标。我们的第一个目的是优化基于MRI的和 中值神经中的超声成像方法。我们将使用人类尸体和体内模型来 验证和优化将在临床上使用的成像协议。我们希望基于MRI的策略将 提供高分辨率和高对比度结构图像，而超声将提供快速 评估神经运动学和僵硬。我们的第二个目的是检查结构和运动学变化 CTS患者的中位神经，使用MRI和超声检查腕管释放前后。我们 假设基于MRI的成像将检测到肾上腺激素，周围和神经纤维的结构差异 控制神经和被夹住的神经之间的隔室，超声将检测神经的差异 手术前后，对照神经和夹住神经之间的变形和僵硬。 更广泛地，我们预计将我们的方法应用于影响老兵的其他神经系统状况 医疗保健系统，其中神经结构和生物力学可能会改变。这些包括其他 诱捕神经病，糖尿病神经病和创伤性神经损伤。最终，成功执行 我们提出的研究将使对神经病的早期识别，提供神经性侵入性监测 进展，并促进对康复和治疗功效的更准确评估。 1