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.

项目概要/摘要 退行性脊髓型颈椎病（DCM）是患者脊柱损伤的最常见原因 55 岁以上的人对医疗保健产生了深远的影响，每年导致超过 100,000 例手术。 不幸的是，传统的颈椎 MRI 每年需要花费 20 亿美元以上的医疗保健支出。 技术对于持续性脊柱损伤的预测并不完美，并且无法预测哪些患者会发生 此外，我们对脊髓如何运作的理解存在着重大差距。 在持续的退行性压缩过程中受伤。新成像技术的应用可能会导致受伤。 我们之前在 K23 研究中的工作已经证明了这两种白质的效用。 (WM) 成像标记和脊髓形态测量用于监测持续损伤以及 正如本工作中提出的，预测恢复情况。 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。 利用一种新的脊髓功能磁共振成像方法，我们发现扩张型心肌病 (DCM) 中脊髓灰质 (GM) 减少。 另外还发现 DCM 患者的 GM 激活减少，这一变化与患者相关 这些发现挑战了 DCM 是一种主要是 WM 疾病的传统观点。 我们提出的研究的目标是利用新开发的共识脊柱成像协议 证实 WM 标记物在跟踪脊髓损伤中的作用，这是转化的关键的下一步 此外，我们开发了一种新的功能磁共振成像方法，用于显示 GM。 我们的中心假设是，虽然 WM 损伤的标志物是减少的。 GM 损伤是 DCM 患者神经损伤症状的主要预测因素，在 我们将通过开发新的肠道特异性标记物来检验每个患者的临床症状。 根据我们之前的经验，我们将比较新的脊柱功能磁共振成像方法。 这些患者中 WM 和 GM 标记物的改变，目的是增强我们的能力 这些发现将有助于准确预测持续的损伤和手术后的早期恢复。 通过提供对脊柱驱动因素的新认识，对人类健康产生重大积极影响 退行性颈椎压缩性疾病中的损伤并开发新的损伤标志物 增强我们监测和治疗伤害以及预测康复的能力。