Medical Imaging of Peripheral Nerve Injury and Repair

周围神经损伤与修复的医学影像

• 批准号: 10117512
• 负责人: Sameer B. Shah
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10117512
• 关键词: Acute; Address; Anatomy; Architecture; Axon; Biological; Biomechanics; Cadaver; Carpal Tunnel Syndrome; Cervical spinal cord injury; Chronic; Clinic; Clinical; Complex; Data; Decision Making; Development; Diagnosis; Disease; Environment; Excision; Extracellular Matrix; Fascicle; Funding; General Population; Geometry; Growth; Human; Image; Imaging Techniques; Individual; Injury; Limb structure; Magnetic Resonance Imaging; Medical Imaging; Methods; Modality; Modeling; Monitor; Morphology; Muscle; Muscular Atrophy; Myelin; Natural regeneration; Nerve; Nerve Degeneration; Nerve Regeneration; Nerve Transfer; Neuromuscular Diseases; Neuropathy; Operative Surgical Procedures; Outcome; Pain; Patients; Peripheral Nerves; Peripheral nerve injury; Physical therapy; Prognosis; Prospective Studies; Protocols documentation; Rattus; Recovery; Recovery of Function; Rehabilitation therapy; Research; Resolution; Sensory; Soldier; Spinal cord injury; Structure; Structure of ulnar nerve; Surgeon; Testing; Time; Tissues; Traumatic injury; Ultrasonography; Veterans; Work; base; clinical efficacy; efficacy testing; experience; functional outcomes; human model; iatrogenic injury; imaging approach; improved; injury and repair; innovation; limb injury; median nerve; military veteran; motor impairment; muscular structure; nerve damage; nerve injury; nerve repair; neuromuscular; neuromuscular system; novel; patient population; peripheral nerve damage; pre-clinical; predictive tools; prognostic tool; prospective; quantitative ultrasound; regenerative; repaired; sciatic nerve injury; secondary outcome; success; tool

Peripheral nerve damage is a debilitating consequence of both traumatic injury to the extremities of soldiers, and a secondary outcome following spinal cord injury (SCI). Equally devastating, for both the Veteran and general population, is nerve damage during excision of surrounding tissue, disease, or iatrogenic injury. Functional recovery from nerve damage is often incomplete, resulting in impaired motor function, sensory loss, and pain. Recovery is especially poor for chronic nerve injuries, which can result from unrepaired nerves or from delayed or failed primary repair. A major challenge in treating nerve injury is the current lack of effective methods to medically image nerves. As a consequence, surgeons are unable to accurately assess the extent of nerve injury, plan surgical intervention in an informed and data-driven manner, or assess the success of nerve repair at early time points, to predict long-term recovery. We have developed innovative quantitative strategies for nerve imaging, which overcome challenges created by the complex structure and architecture of nerves. Our approach employs two widely deployed clinical modalities, ultrasound (US) and magnetic resonance imaging (MRI). Our imaging approach is motivated by strong preliminary data demonstrating that quantitative US (qUS) and MRI (qMRI) are powerful and clinically feasible strategies for monitoring nerve structure and composition at high-resolution and with high sensitivity. These approaches are also intended to provide non-invasive surrogates for biological changes that occur during nerve degeneration and regeneration, but which cannot be evaluated in patients. To establish the validity and utility of qUS and qMRI in evaluating nerve structure and composition in a clinical setting, we will address the following specific aims in rat (Aim 1) and human (Aim 2) models of acute and chronic nerve injury: 1) To test the efficacy of quantitative US and MR imaging strategies in assessing neuromuscular morphology and composition during peripheral nerve degeneration and following repair of acute and chronic models of rat sciatic nerve injury. 2) To test the clinical efficacy of quantitative US and MR imaging strategies in assessing neuromuscular morphology and composition in acute and chronic models of human median and ulnar nerve injury immediately prior to surgical repair. Our approach has the potential to transform the diagnosis and treatment of nerve injury. Immediate clinical impacts include: (i) objective guidance on deciding whether to perform nerve repair or nerve transfer surgery; (ii) predicting and monitoring the efficacy of nerve repair; (iii) guidance for post-op rehabilitation protocols. This work will also set the stage for a prospective study in which imaging strategies will be deployed as prognostic tools for predicting the efficacy of neuromuscular recovery following nerve repair, towards improved treatment of nerve injury in Veteran and general populations. More broadly, our nerve imaging strategy will aid in the diagnosis and prediction of nerve structure and damage for a wider array of neuropathies and nerve diseases.

周围神经损伤是肢体的创伤性伤害的令人衰弱的结果 士兵，以及脊髓损伤后的次要结果（SCI）。同样毁灭性的，对于老兵 和普通人群是在周围组织，疾病或医源性损伤切除过程中神经损伤。 从神经损伤中恢复功能通常是不完整的，导致运动功能受损，感觉丧失， 和痛苦。慢性神经损伤的恢复尤其较差，这可能是由未修复的神经或 由延迟或失败的初级维修。治疗神经损伤的主要挑战是目前缺乏有效 医学形象神经的方法。结果，外科医生无法准确评估 神经损伤，以知情和数据驱动的方式计划手术干预，或评估 在早期时间点神经修复，以预测长期恢复。 我们为神经成像开发了创新的定量策略，这克服了挑战 由神经的复杂结构和结构创建。我们的方法采用了两个广泛部署的 临床方式，超声（US）和磁共振成像（MRI）。我们的成像方法是 由强大的初步数据激励，表明US（QUS）和MRI（QMRI）具有强大 以及在高分辨率上监测神经结构和组成的临床可行策略，并且 灵敏度。这些方法还旨在为生物学变化提供非侵入性替代物， 发生在神经变性和再生期间，但不能在患者中评估。建立 QUS和QMRI在评估临床环境中的神经结构和组成方面的有效性和效用，我们将 解决急性和慢性神经损伤的大鼠（AIM 1）和人类（AIM 2）模型中的以下特定目标： 1）测试定量美国和MR成像策略评估神经肌肉形态的功效 和周围神经变性期间的组成以及大鼠急性和慢性模型的修复后 坐骨神经损伤。 2）测试定量US和MR成像策略的临床功效 人类和尺神经的急性和慢性模型中的神经肌肉形态和组成 手术修复前立即受伤。 我们的方法有可能改变神经损伤的诊断和治疗。立即进行临床 影响包括：（i）确定是进行神经修复还是神经转移手术的客观指导； （ii）预测和监测神经修复的功效； （iii）后康复方案指南。这 工作还将为前瞻性研究奠定基础，其中将成像策略作为预后部署 预测神经修复后神经肌肉恢复功效的工具，以改善治疗 老兵和一般人群中的神经损伤。更广泛地，我们的神经成像策略将有助于 神经结构和损害的诊断和预测，用于更广泛的神经病和神经疾病。