Advanced neuroimaging in pediatric spinal cord injury

小儿脊髓损伤的高级神经影像学

• 批准号: 9002079
• 负责人: Nadia Barakat
• 金额: $ 13.17万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-01 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9002079
• 关键词: Activities of Daily Living; Acute; Acute Transverse Myelitis; Address; Adult; Affect; Anisotropy; Cervical; Cervical spinal cord injury; Child; Childhood; Childhood Injury; Classification; Clinical; Clinical Protocols; Clinical Trials; Data; Demyelinations; Detection; Diagnosis; Diffusion; Diffusion Magnetic Resonance Imaging; Disease; Dorsal; Evaluation; Fiber; Future; Goals; Health; Human; Image; Impairment; Injury; Instruction; International; Laboratories; Learning; Lesion; Location; Magnetic Resonance Imaging; Measures; Mental disorders; Methods; Modality; Modeling; Motor; Myelitis; Nature; Neurobiology; Neurologic; Outcome; Outcome Study; Pain; Patients; Pediatric Research; Pediatrics; Population; Prevalence; Recovery; Reporting; Research; Research Personnel; Research Training; Sensory; Severities; Spinal Cord; Spinal cord damage; Spinal cord injury; Staging; Symptoms; T2 weighted imaging; Techniques; Testing; Time; Tissues; Training; Transverse Myelitis; Validation; Weight; Work; base; career development; chronic pain; clinical care; density; design; disability; experience; imaging biomarker; imaging modality; improved; mortality; neuroimaging; neuroinflammation; novel; outcome forecast; painful neuropathy; pediatric patients; programs; protocol development; spinal cord compression; spinal cord imaging; spinal cord injury pain; spinal cord regeneration; spinal cord white matter; white matter

DESCRIPTION (provided by applicant): The proposed work is designed to prepare the applicant with the training necessary to establish an independent research program on advanced neuroimaging techniques in children with non-traumatic spinal cord injury and associated pain. The goal of this project is to examine more advanced imaging biomarkers and pain involvement in non-traumatic spinal cord injuries, specifically transverse myelitis. Although MRI is the modality of choice in the detection of neuroinflammation, studies have shown it to have poor correlation with clinical status of patients with myelitis (1-4). Because Diffusion Tensor Imaging (DTI) offers an understanding on structural anisotropy of axonal white matter, it is believed to be a sensitive measure in assessing damage to the spinal cord. Magnetization Transfer is thought to be more sensitive is detecting different levels of demyelination. Diffusion Tensor Tractography can be used to identify viable spinal cord fibers. Used in combination, these advanced imaging markers have the potential to provide a more sensitive approach to existing methods used to diagnose and classify non-traumatic spinal cord injury. The candidate will also examine the clinical correlations between these imaging biomarkers, pain and severity of spinal cord injury (complete vs. incomplete) as assessed by the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). The hypothesis of this project is that children with transverse myelitis will show different DTI, Magnetization Transfer and Tractography parameter values compared to controls and that children with transverse myelitis will show strong correlation between imaging biomarkers and clinical exams (MRI, ISNCSCI, pain). The specific aims are: (1) To determine alterations in spinal cord white matter tracts in patients with acute (<1month), persistent (>6months) and resolved transverse myelitis. In this study, we will measure alterations in white matter tracts at early and later stages of the onset of transverse myelitis patients (n=30). We will determine the dynamic nature of lesions that regress vs. those that persist and how specific imaging measures of changes in white matter tract can provide a metric of white matter alterations that may predict outcome. (2) To define the relationship between the location of the white matter alteration and the severity of pain in pediatric patients with transverse myelitis (n=30) compared with healthy controls (n=20). We will identify the location (e.g., dorsal, dorsolateral, or central spinal cord) of changes and correlate with clinical severity of pain (results from Quantitative Sensory Testing), motor (ventral spinal cord) and sensory (dorsal spinal cord) symptoms. In both aims we will use MRI, an approach that we have shown to work in children with traumatic cervical injury in children. Specifically, th approach will include magnetization transfer to detect demyelination, DTI metrics to measure structural changes, and tractography to examine spinal cord fiber density. We expect children with transverse myelitis to show different DTI, magnetization transfer and tractography values compared to controls.

描述（由申请人提供）：拟议的工作旨在为申请人做好准备的培训，以建立针对非创伤性脊髓损伤和相关疼痛的儿童的高级神经影像学技术的独立研究计划。该项目的目的是检查非创伤性脊髓损伤，特别是横向骨髓炎的更先进的成像生物标志物和疼痛受累。尽管MRI是检测神经炎症的选择方法，但研究表明它与骨髓炎患者的临床状况的相关性差（1-4）。由于扩散张量成像（DTI）对轴突白质的结构各向异性提供了一种理解，因此据信它是评估脊髓损伤的敏感度量。磁化转移被认为更敏感正在检测不同水平的脱髓鞘。扩散张量拖拉机可用于识别可行的脊髓纤维。这些先进的成像标记有可能为诊断和对非创伤性脊髓损伤进行分类的现有方法提供更敏感的方法。候选人还将检查这些成像生物标志物，脊髓损伤的疼痛和严重程度（完全与不完整）之间的临床相关性，如脊髓损伤的国际神经系统标准（ISNCSCI）所评估。该项目的假设是，与对照组相比，患有横向脊髓炎的儿童将显示出不同的DTI，磁化转移和拖拉学参数值，并且横向脊髓炎的儿童将在成像生物标志物与临床检查之间显示强相关性（MRI，ISNCSCI，PAIN）。具体目的是：（1）确定急性（<1个月），持久性（> 6个月）和分辨出横向脊髓炎的患者的脊髓白质区的改变。在这项研究中，我们将测量在早期和后期开始的白质区的变化 横向骨髓炎患者（n = 30）。我们将确定病变的动态性质，这些病变与持续存在的病变，以及白质区域变化的特定成像度量如何提供可能预测结果的白质变化度量。 （2）与健康对照组相比（n = 20）相比，儿科患者（n = 30）的儿科患者（n = 30）的疼痛严重程度之间的关系（n = 20）之间的关系。我们将确定变化的位置（例如背侧，背外侧或中央脊髓）并相关 疼痛的临床严重程度（来自定量感觉测试的结果），运动（腹侧脊髓）和感觉（背脊髓）症状。在这两个目标中，我们都将使用MRI，这是我们证明在儿童创伤性宫颈损伤儿童中起作用的一种方法。具体而言，方法将包括磁化转移以检测脱髓鞘，DTI指标以测量结构变化和拖拉术以检查脊髓纤维密度。我们预计与对照组相比，患有横向脊髓炎的儿童会显示出不同的DTI，磁化转移和拖拉术值。