MRI Bone Texture: A Novel Biomarker for Assessment of Bone Quality and Prediction of Complications in Patients Having Spine Fusion Surgery

MRI 骨纹理：一种用于评估脊柱融合手术患者骨质量和预测并发症的新型生物标志物

• 批准号: 10669274
• 负责人: Emily Margaret Stein
• 金额: $ 18.03万
• 依托单位: HOSPITAL FOR SPECIAL SURGERY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10669274
• 关键词: Age; Anabolic Agents; Biopsy; Characteristics; Clinical; Clinical Treatment; Clinical Trials; Complex; Data; Detection; Diagnosis; Dual-Energy X-Ray Absorptiometry; Early Diagnosis; Elderly; Enrollment; Entropy; Evaluation; Failure; Fracture; Future; Goals; Health; Health Care Costs; Heterogeneity; Hip region structure; Incidence; Intervention; Intervention Trial; Knowledge; MRI Scans; Magnetic Resonance Imaging; Measurement; Measures; Methods; Monitor; Morbidity - disease rate; Morphologic artifacts; Operative Surgical Procedures; Orthopedic Procedures; Orthopedic Surgery; Orthopedics; Osteogenesis; Osteoporosis; Outcome; Patient-Focused Outcomes; Patients; Perioperative; Peripheral; Pharmaceutical Preparations; Population; Postmenopause; Postoperative Complications; Postoperative Period; Prevalence; Prospective Studies; Research; Resolution; Risk; Screening procedure; Spinal; Spinal Diseases; Spinal Fusion; Spine surgery; Techniques; Testing; Texture; Treatment Protocols; United States; Vertebral column; Woman; Work; X-Ray Computed Tomography; bone; bone quality; clinical care; clinical practice; cost; follow-up; high risk; improved; improved outcome; instrument; novel; novel marker; osteoporosis with pathological fracture; prospective; screening; skeletal; skeletal abnormality; spine bone structure; substantia spongiosa; success; tool

Project Summary Spine fusion surgery is one of the most common, and complex, orthopedic procedures. Complications occur in over 30% of cases, highlighting the need to identify modifiable factors associated with these negative sequelae. Bone quality is a critical determinant of post-operative outcomes, as stability of hardware in bone and de novo bone formation are required for successful fusion. Despite the importance of bone quality to post-operative outcomes, there are limited tools for pre-operative detection of abnormal bone in candidates for fusion. The most common clinical tool for skeletal assessment, dual energy x-ray absorptiometry (DXA), is subject to artifact from spinal abnormalities and infrequently performed for pre-operative evaluation. High resolution peripheral QCT (HRpQCT) can detect pre-operative skeletal abnormalities and predict complications after fusion but is a research tool not available in clinical practice. In contrast, MRI is routinely performed prior to fusion, for diagnosis of spinal disease and surgical planning, making an MRI-based technique ideal to screen for pre-operative skeletal deficits. Our group has recently developed a novel method to evaluate bone quality using standard, clinically acquired MRIs which analyzes the irregularity, or heterogeneity, of trabecular bone texture. In prior work, we found that postmenopausal women with fractures had greater heterogeneity of bone texture than age- matched controls. The proposed study will assess MRI trabecular bone texture as a new technique to detect poor bone quality, predict complications, and track post-operative skeletal changes in patients undergoing spinal fusion. We hypothesize that pre-operative MRI bone texture will relate to volumetric BMD (vBMD) and microarchitecture by HRpQCT and will predict skeletal complications after surgery. Post-operative changes in MRI bone texture will relate to baseline patient characteristics and clinical post-operative treatment regimen, including use of anabolic agents. We will prospectively enroll 100 patients having lumbar spine fusion and follow them for one year. Baseline DXA, HRpQCT, and our MRI-based method will be performed. MRIs will be repeated at 6 months post-operatively to determine whether early changes in MRI bone texture relate to patient characteristics, medication use, and predict complications. CT scans will be performed at one year to assess skeletal complications and completeness of fusion. This proposal aims to: 1) Investigate the relationship between pre-operative MRI bone texture and HRpQCT measurements of vBMD and microarchitecture; 2) Investigate whether MRI bone texture predicts skeletal complications after fusion; 3) Assess longitudinal changes in bone texture and the clinical factors that influence these changes in patients after spine fusion. The long-term goals of our research are to improve identification of patients at high risk for post-operative complications and provide knowledge that will advance future interventional trials. In subsequent work, we plan to extend this technique to other orthopedic populations. Ultimately, we hope to improve the outcomes of patients undergoing fusion and other high-risk orthopedic surgeries by facilitating the creation of new peri-operative treatment paradigms.

项目摘要 脊柱融合手术是最常见，最复杂的骨科手术之一。并发症发生 超过30％的病例强调了确定与这些负后遗症相关的可修改因素的需求。 骨质质量是术后结果的关键决定因素，因为硬件在骨骼和从头上的稳定性 成功融合需要骨形成。尽管骨骼质量对术后的重要性很重要 结果，有限的工具有限用于术前检测候选物中骨骼异常的融合。最多 骨骼评估的常见临床工具，双能X射线吸收法（DXA）受到伪影 脊柱异常和很少进行术前评估。高分辨率外周QCT （HRPQCT）可以检测术前骨骼异常并预测融合后的并发症，但是一个 研究工具在临床实践中没有。相比之下，MRI在融合之前定期进行，以进行诊断 脊柱疾病和外科手术计划，使基于MRI的技术非常适合筛选术前的术 骨骼缺陷。我们的小组最近开发了一种新颖的方法来使用标准评估骨质质量， 临床上获得的MRI分析小梁骨质地的不规则或异质性。在先验 工作，我们发现，骨折的绝经后妇女的骨质地异质性比年龄更大 - 匹配的控件。拟议的研究将评估MRI小梁骨纹理作为一种新技术来检测 骨质质量差，预测并发症并跟踪脊柱患者的术后骨骼变化 融合。我们假设术前MRI骨纹理将与体积BMD（VBMD）有关 HRPQCT的微体系结构，并将预测手术后的骨骼并发症。术后变化 MRI骨纹理将与基线患者特征和临床术后治疗方案有关， 包括使用合成代谢剂。我们将前瞻性地招募100名患有腰椎融合的患者，然后跟随 他们一年。将执行基线DXA，HRPQCT和我们的基于MRI的方法。 MRI将重复 术后6个月以确定MRI骨纹理的早期变化是否与患者有关 特征，药物使用和预测并发症。 CT扫描将在一年后进行评估 骨骼并发症和融合的完整性。该建议的目的是：1）调查 术前MRI骨纹理和VBMD和微体系结构的HRPQCT测量； 2）调查 MRI骨纹理是否预测融合后的骨骼并发症； 3）评估骨骼的纵向变化 脊柱融合后影响患者的这些变化的质地和临床因素。长期目标 我们的研究是提高对术后并发症风险高风险的患者的识别，并提供 可以推进未来介入试验的知识。在随后的工作中，我们计划将此技术扩展到 其他骨科人群。最终，我们希望改善接受融合的患者的结果 通过促进新的围手术治疗范例的创建，其他高风险骨科手术。