Novel MR Image Processing as an Objective Diagnostic Test for Chiari Malformation

新型 MR 图像处理作为 Chiari 畸形的客观诊断测试

基本信息

批准号：
9813099
负责人：
PHILIP A. ALLEN
金额：
$ 46.88万
依托单位：
UNIVERSITY OF AKRON
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-30 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9813099
关键词：
Adult Alzheimer&apos s Disease Anatomy Area Attention Biomechanics Biomedical Research Birth Brain Brain Injuries Brain Stem Cardiac Cerebellar tonsil Cerebellum Cerebrospinal Fluid Chiari Malformation Type 1 Child Clinical Congresses Crowding Dementia Diagnosis Diagnostic Diagnostic radiologic examination Diagnostic tests Diffusion Magnetic Resonance Imaging Disease Early Diagnosis Engineering Financial cost Functional disorder Goals High School Student Human Image Analysis Individual Lead Liquid substance Magnetic Resonance Magnetic Resonance Imaging Measurement Measures Methods Morphology Motion Multiple Sclerosis National Institute of Neurological Disorders and Stroke Nerve Operative Surgical Procedures Outcome Patients Positioning Attribute Posterior Fossa Prevalence Prognostic Marker Quality of life Radiology Specialty Reporting Research Resistance Schedule Severities Severity of illness Statistical Data Interpretation Surgeon Surgical Decompression Symptoms Techniques Time Tonsil Translating Traumatic Brain Injury United States National Institutes of Health Work base brain morphology brain tissue cerebrospinal fluid flow chronic traumatic encephalopathy clinical diagnostics cognitive function experience foramen magnum graduate student healthy volunteer image processing improved in vivo malformation natural flow nervous system disorder novel outcome forecast patient population pressure societal costs symposium symptomatology undergraduate student

项目摘要

Summary: Chiari malformation Type I (CM) is a serious neurological disorder characterized by the cerebellar tonsillar position located below the foramen magnum (tonsillar ectopia). The “crowding” that occurs near the foramen magnum causes compression on the cerebellum and brainstem and disrupts the natural flow of cerebrospinal fluid. To further complicate matters, 3% of children and 1% of adults are shown to have tonsillar ectopia on a radiology report, but just 300,000 individuals (0.08%) are diagnosed with CM in the US. Thus, there are greater than 10 times more individuals with radiographic evidence of tonsillar ectopia than individuals that actually have a diagnosis of CM. As such, surgeons and patients are dissatisfied with the current radiological measurement as a diagnostic criterion. Approximately 20,000 CM patients are evaluated each year for surgery in the US from which half receive surgical decompression of the posterior fossa with the goal of creating more space around the cerebellar tonsils. While the majority of CM patients have reported improvement in quality of life after surgery, this improvement is not consistent across different symptoms. The significance of the situation even got the attention of Congress, which in 2009 directed NINDS to, “encourage aggressive measures toward advanced engineering and imaging analysis to an objective diagnostic test for CM.” Static anatomical measurements alone are NOT adequate to diagnose CM. The combination of altered brain anatomy with altered CSF motion and dynamic brain tissue strain during the cardiac cycle likely work together to cause CM symptoms. Thus, understanding the relationship between biomechanical and disease severity measures would lead to an objective diagnostic test for CM. The goal of the proposed study is to obtain novel MR-based dynamic biomechanical measures before decompression surgery and determine their relationship with disease severity measures. We hypothesize that these biomechanical measures are correlated with disease severity measures. Furthermore, these biomechanical measures may reflect the underlying pathophysiology associated with CM, and serve as a better prognostic indicator than the standard methods that are currently being used clinically. Our group has developed several novel MR image-processing techniques that provide in-vivo subject-specific biomechanical measures of 1) resistance to CSF motion, 2) brain tissue strain, and 3) brain morphometrics. In a different group of CM patients, we have examined disease severity measures including DTI, cognitive function, and symptomology. Preliminary results have demonstrated these biomechanical and disease severity measures to be significantly different in CM subjects compared to healthy controls. However, these measures need to be acquired on the same patient population in order to determine their precise relationship. We will obtain biomechanical and disease severity measures in 50 adult CM patients before surgery. This study will provide an understanding of the importance of biomechanical measures in the pathophysiology of CM that may lead to better clinical diagnostic testing for CM.

摘要：Chiari畸形I型（CM）是一种严重的神经系统疾病，其特征是小脑扁桃体位置位于大孔（Tonsillar Ectopia）下方。在附近发生的“拥挤” 大孔大酒瓶会在小脑和脑干上引起压缩，并破坏脑脊液。为了进一步复杂化，有3％的儿童和1％的成年人有扁桃体在放射学报告中的单位，但在美国只有30万个人（0.08％）被诊断出患有CM。那，具有扁桃体外生的射线照相证据的人数比个体多10倍以上实际上，它具有CM的诊断。因此，外科医生和患者对电流不满意放射学测量作为诊断标准。每年评估大约20,000厘米患者在美国的手术中，一半从一半接受了后窝的手术减压，目的是在小脑扁桃体周围创建更多空间。大多数CM患者报告手术后生活质量的改善，这种改善在不同症状之间不一致。这局势的重要性甚至引起了国会的注意，国会在2009年指示尼德斯“鼓励对高级工程和成像分析的积极措施进行客观的诊断测试 CM。“仅静态解剖测量不足以诊断CM。心脏周期期间CSF运动和动态脑组织应变改变的大脑解剖结构可能有效一起引起CM症状。这是了解生物力学与疾病之间的关系严重性度量将导致CM的客观诊断测试。拟议的研究的目的是减压手术前获得基于MR的新型动态生物力学测量并确定其与疾病严重程度测量的关系。我们假设这些生物力学测量是与疾病的严重程度测量相关。此外，这些生物力学测量可能反映与商业相关的基本病理生理学，并作为比标准更好的预后指标目前正在临床使用的方法。我们的小组开发了几种小说MR图像处理提供了体内主体特异性生物力学测量的技术1）对CSF运动的抗性，2）脑组织菌株和3）脑形态计量学。在不同的CM患者中，我们检查了疾病严重程度的措施，包括DTI，认知功能和症状。初步结果已证明与CM受试者相比健康控制。但是，这些措施需要在同一患者群体上获得确定他们的精确关系。我们将在50个成年人中获得生物力学和疾病严重程度手术前CM患者。这项研究将对生物力学的重要性有所了解 CM的病理生理学的措施可能会导致CM更好的临床诊断测试。