Spinal cord structure-function relationships in degenerative cervical myelopathy

退行性脊髓型颈椎病的脊髓结构与功能关系

• 批准号: 10734685
• 负责人: Aditya Vedantam
• 金额: $ 52.3万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10734685
• 关键词: Acute; Cervical; Clinical; Clinical assessments; Clinical/Radiologic; Data; Decision Making; Demyelinations; Detection; Deterioration; Diagnosis; Diffusion Magnetic Resonance Imaging; Dissociation; Elderly; Equilibrium; Evaluation; Exhibits; Functional disorder; Future; Goals; Hand Strength; Histologic; Image; Imaging Techniques; Impairment; Injury; Knowledge; Link; Magnetic Resonance Imaging; Measurement; Measures; Metals; Methods; Monitor; Morphologic artifacts; Morphology; Motor; Nervous System Physiology; Neurologic; Operative Surgical Procedures; Outcome; Pathologic; Patients; Persons; Prognosis; Quality of life; Radiology Specialty; Recommendation; Recovery; Recovery of Function; Research; Residual state; Resolution; Sensorimotor functions; Sensory; Signal Transduction; Specificity; Spinal; Spinal Cord; Spinal Cord Diseases; Spinal cord damage; Spinal cord injury; Stenosis; Structure; Structure-Activity Relationship; Surgical Decompression; Symptoms; Techniques; Testing; Upper Extremity; Vertebral column; Walking; axon injury; biomechanical test; clinical diagnosis; clinical examination; clinical phenotype; clinical translation; cohort; disability; experience; functional gain; imaging approach; imaging biomarker; imaging modality; improved; individualized medicine; insight; instrumentation; metallicity; motor impairment; novel; outcome prediction; postoperative recovery; prognostic; prognostication; public health relevance; quantitative imaging; spinal cord compression; spinal cord imaging; structural imaging; surgery outcome; tool

ABSTRACT: Degenerative cervical myelopathy (DCM) is the commonest cause of spinal cord dysfunction in older adults and an important cause of disability and impaired quality of life. Conventional MRI, which is used for surgical planning, does not distinguish irreversible spinal cord damage and is frequently inconsistent with clinical examination. Routine clinical assessment for DCM relies on subjective symptom scores, and lacks objective quantifiable measures of function. Neither of these current standards of practice overcome the disassociation between radiology and clinical function in DCM, and neither are strong predictors of surgical outcome. To overcome the lack of pathological specificity of diffusion tensor imaging (DTI), we developed filtered diffusion weighted imaging (fDWI), which enhances detection of axonal injury. We developed metal-suppression multi- spectral diffusion weighted imaging (MSI-DWI) to assess post-surgical spinal cord microstructure in the presence of spinal instrumentation. To better identify the functional correlates of these novel imaging approaches, we demonstrate techniques to assess subtle sensorimotor dysfunction in DCM. The long term goal of this project is to incorporate advanced multi-parametric spinal cord MRI in the routine clinical assessment of DCM to improve diagnosis and prognostication of surgical outcome. The overall objective of this project is to determine if quantification of spinal cord microstructure and function can disambiguate clinico-radiologic data in DCM and improve prognostication of outcome after surgery for DCM. The first aim will determine if multi-parametric MRI measures of axonal injury (fDWI) and demyelination (magnetization transfer [MT] imaging) can outperform conventional MRI for structure-function correlations. To achieve the second aim, we will use quantitative tests of motor, sensory and balance function to objectively track functional recovery after surgery and determine if these measures are superior to standard symptom scores. The third aim will use post-surgical MSI-DWI to detect microstructural changes in the decompressed spinal cord that are associated with quantitative function after surgery. Together, the successful completion of these aims will advance the clinical translational of multiparametric spinal cord MRI for diagnosis, prognostication and monitoring of spinal cord integrity in DCM.

摘要：退行性脊髓型颈椎病（DCM）是导致脊髓功能障碍的最常见原因。 老年人是残疾和生活质量受损的重要原因。传统 MRI，用于 手术计划不能区分不可逆的脊髓损伤，并且经常与临床不一致 考试。 DCM的常规临床评估依赖于主观症状评分，缺乏客观 可量化的功能测量。这些现行的实践标准都没有克服分离的问题 DCM 的放射学和临床功能之间存在差异，两者都不是手术结果的强有力预测因素。到 克服扩散张量成像（DTI）缺乏病理特异性，我们开发了过滤扩散 加权成像（fDWI），增强轴突损伤的检测。我们开发了金属抑制多 光谱扩散加权成像 (MSI-DWI) 用于评估术后脊髓微观结构 的脊柱器械。为了更好地识别这些新颖成像方法的功能相关性，我们 展示评估 DCM 中细微感觉运动功能障碍的技术。该项目的长期目标是 将先进的多参数脊髓 MRI 纳入 DCM 的常规临床评估中，以改善 手术结果的诊断和预测。该项目的总体目标是确定是否 脊髓微观结构和功能的量化可以消除 DCM 和 改善 DCM 手术后的预后。第一个目标将确定多参数 MRI 是否 轴突损伤 (fDWI) 和脱髓鞘（磁化转移 [MT] 成像）的测量效果优于 用于结构功能相关性的常规 MRI。为了实现第二个目标，我们将使用定量测试 运动、感觉和平衡功能，客观跟踪手术后的功能恢复情况，并确定这些功能是否恢复 测量优于标准症状评分。第三个目标将使用术后 MSI-DWI 来检测 减压后脊髓的微观结构变化与定量功能相关 外科手术。这些目标的成功完成将共同推进临床转化 多参数脊髓 MRI 用于 DCM 脊髓完整性的诊断、预测和监测。