Structural and functional imaging markers in Degenerative Cervical Myelopathy

退行性脊髓型颈椎病的结构和功能成像标志物

• 批准号: 10736303
• 负责人: Zachary A Smith
• 金额: $ 62.11万
• 依托单位: UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10736303
• 关键词: Age Years; Anterior; Cervical; Cervical spine; Characteristics; Chronic; Clinical; Consensus; Decision Making; Development; Diagnosis; Disease; Dorsal; Fiber; Functional Imaging; Functional Magnetic Resonance Imaging; Goals; Hand Strength; Health; Health Care Costs; Health Expenditures; Healthcare; Horns; Human; Image; Imaging technology; Impairment; Injury; Intervention; Lead; Magnetic Resonance Imaging; Measures; Medial; Methodology; Mission; Modeling; Modernization; Monitor; Motor; Motor Activity; Operative Surgical Procedures; Pathogenesis; Pathway interactions; Patient-Focused Outcomes; Patients; Pattern; Play; Prognosis; Protocols documentation; Public Health; Publications; Recovery; Research; Role; Sensory; Severities; Severity of illness; Spinal; Spinal Cord; Spinal Cord Diseases; Spinal Cord Tract; Spinal Injuries; Spinal cord grey matter structure; Standardization; Stimulus; Symptoms; Techniques; Testing; Translating; Translations; United States National Institutes of Health; Vertebral column; Work; clinical care; dexterity; experience; gray matter; imaging biomarker; imaging modality; improved; injured; innovation; median nerve; nerve injury; novel; novel marker; operation; postoperative recovery; prognostication; radiological imaging; response; reticulospinal tract; spinal cord compression; spinal cord imaging; spinal cord white matter; structural imaging; surgery outcome; white matter; white matter injury

PROJECT SUMMARY/ABSTRACT Degenerative cervical myelopathy (DCM) is the most common cause of spinal injury in patients over 55 years of age. It has a profound health care impact, leading to more than 100,000 operations a year and upwards of $2 billion in health care expenditure. Unfortunately, traditional cervical spine MRI techniques are imperfect predictors of ongoing spinal injury and cannot predict which patients will respond well to intervention. Further, there is a critical gap in our understanding of how the spinal cord is injured during ongoing degenerative compression. The application of new imaging technologies may help close this gap. Our previous work, during K23 studies, has shown the utility of both white matter (WM) imaging markers and spinal cord morphometrics for monitoring ongoing injury as well as predicting recovery. The development of tract-specific WM imaging methods, as proposed in this work, may aid in translating these findings to clinical care. Further, our work shows the volume of the cervical cord gray matter (GM) is decreased in DCM. Utilizing a novel spinal cord fMRI methodology, we have additionally seen decreased GM activation in DCM patients, a change that associates with patient symptoms. These findings challenge the traditional view that DCM is a disease primarily of the WM. An objective of our proposed studies is to utilize a newly developed Consensus spine imaging protocol to substantiate the role of WM markers in tracking spinal injury, a critical next step in the translation of these imaging results. Further, we develop a new fMRI methodology that is used to show that GM activity is decreased in the injured cord. Our central hypothesis is that while markers of WM injury are the leading predictor of symptoms of neural injury in DCM patients, GM injury also plays a key role in each patient’s clinical symptoms. We will test this hypothesis by developing new tract specific markers and novel spinal fMRI methodology. Building upon our previous experience, we will compare the alterations of both WM and GM markers in these patients, with the goal of enhancing our ability to accurately predict both ongoing injury and early recovery after surgery. These findings will have a significant positive impact on human health by providing new understanding of the drivers of spinal injury in degenerative cervical compressive disease and developing new markers of injury that may enhance our ability to monitor and treat injury as well as prognosticate recovery.

项目摘要/摘要 退化性宫颈骨髓病（DCM）是患者脊柱损伤的最常见原因 超过55岁。它具有深远的医疗保健影响，导致了100,000多个操作 年份和超过20亿美元的医疗保健支出。不幸的是，传统的颈椎MRI 技术是持续脊柱损伤的不完善的预测因素，无法预测哪些患者将 对干预的反应很好。此外，我们对脊髓的理解存在一个危险的差距 在持续的退行性压缩过程中受伤。新成像技术的应用可能 帮助缩小此差距。在K23研究期间，我们以前的工作表明了两种白质的实用性 （WM）成像标记和脊髓形态计量学用于监测正在进行的损伤以及 预测恢复。正如这项工作中提出的那样，区域特异性WM成像方法的发展， 可能有助于将这些发现转化为临床护理。此外，我们的工作显示了宫颈的体积 DCM中的脐带灰质（GM）减少。利用新型脊髓fMRI方法论，我们有 此外，DCM患者的GM激活有所改善，这一变化与患者相关联 症状。这些发现挑战了传统观点，即DCM是WM的主要疾病。一个 我们提出的研究的目的是利用新开发的共识脊柱成像协议来 证实WM标记在跟踪脊柱损伤中的作用，这是翻译的关键下一步 这些成像结果。此外，我们开发了一种新的fMRI方法，该方法用于表明GM 受伤的绳索的活动减少。我们的中心假设是，尽管WM损伤的标记是 DCM患者神经损伤症状的主要预测指标，GM损伤在 每个患者的临床符号。我们将通过开发新的特定标记来检验这一假设 和新型的脊柱fMRI方法论。在我们以前的经验的基础上，我们将比较 这些患者中WM和GM标记的改变，目的是增强我们的能力 准确地预测手术后持续的损伤和早期康复。这些发现将有一个 通过提供对脊柱驱动因素的新理解，对人类健康的重大积极影响 退化性宫颈压缩疾病的损伤，并产生新的损伤标记 增强我们监测和治疗伤害的能力，并探测恢复。