Quantiative MRI and Myelin-PET for the Assessment of Degenerative Cervical Myelopathy

Study Overview
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Brief Summary
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To use advanced imaging techniques, including MRI Brain and Spinal Cord, and MRI/PET Spinal Cord to provide an assessment of Degenerative Cervical Myelopathy to improve understanding of the pathophysiology and natural history of DCM.

Detailed Description
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Degenerative Cervical Myelopathy (DCM) is a disabling condition affecting up to 2% of adults. It arises when arthritic changes in the cervical spine compress and injure the spinal cord, causing progressive loss of bodily function. Surgery will remove compression and stop injury. However, for a full recovery, it must occur before irreversible spinal cord damage. Current assessments cannot provide this information and today, 95% of patients are left disabled: an assessment that measures spinal cord damage would change this tomorrow. Imaging advances, well established for measuring disease of the brain, have the potential to provide this in DCM, but requires further investigation. This is the subject of this proposed application: specifically, to investigate 3 different but promising imaging approaches for the assessment of DCM: Advanced magnetic resonance imaging (MRI) to image within the spinal cord Advanced MRI to measure the changes that occur within the brain following DCM Positron Emission Tomography (PET) to measure the active disease biology within the spinal cord. Individuals with a diagnosis of DCM, will be invited to undergo one of these options, before and after their surgical treatment. Clinical measures used in routine practice will be noted, in order to draw comparisons with imaging. A healthy control group will also be used for MRI imaging, in order to identify changes specific to DCM. Aside from the additional imaging, there will be no changes in routine care.

Official Title
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Evaluating Advanced Imaging Techniques for Use in the Assessment of Degenerative Cervical Myelopathy

Conditions
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Cervical Spondylosis With Myelopathy, Degenerative Cervical Myelopathy

Intervention / Treatment
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* Diagnostic Test: 3T MR Imaging of the cervical spinal cord
* Other: Positron Emission Tomography using [11C]PIB
* Other: 3T MR Imaging of the Brain
* Other: 7T MR Imaging of the Spinal Cord


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria Participant has a diagnosis of DCM, based on a combination of symptoms, signs and conventional MRI findings (Table 2) Participant is scheduled for surgical treatment for DCM Participant is willing and able to give informed consent for participation in the study; Male or Female, aged 18 - 85 years (inclusive); Exclusion Criteria The participant may not enter the study if ANY of the following apply: Participant unable to give informed consent; Participant unable to undergo, or intolerant of MR or PET/MR imaging Participant has co-existing or prior neurological disease of the brain, spinal cord, or peripheral nervous system, including but not limited to, Lumbar Canal Stenosis, Multiple Sclerosis, Dementia and Parkinson's Disease. Contraindications to MRI: These are chiefly the presence of metallic implants that are not known to be MR safe, particularly in terms of movement or substantial heating. Devices that may need to be considered in this context include (this is not an exhaustive list, and this issue will be considered on a case-by-case basis for any implant or external fixation device): Cerebral aneurysm clips not known to be MR safe Intra-ocular metallic shards Cochlear implants Automatic cardioverter defibrillators Nerve stimulation units Other electronic implants, such as cardiac pacemakers Orthopedic external fixations Exclusion Criteria Specific for PET/MR Imaging Stream In addition, the following exclusion criteria will apply for PET imaging, to reduce implications of exposure to ionising radiation, or interpretation of findings. Female patients who are pregnant or breast-feeding Participants whose DCM surgery will include the insertion of metallic implants to secure multiple levels of the spine (technically termed 'instrumentation') Age <40 4.3.2 Volunteers Inclusion Criteria Participant is willing and able to give informed consent for participation in the study; Male or Female, aged 18 - 85 years (inclusive); Exclusion Criteria The participant may not enter the study if ANY of the following apply: Participant unable to give informed consent; Participant unable to undergo, or intolerant of MR imaging Participant has co-existing or prior neurological disease of the brain, spinal cord, or peripheral nervous system, including but not limited to, Lumbar Canal Stenosis, Multiple Sclerosis, Dementia and Parkinson's Disease.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Observational study of patients undergoing surgery for degenerative cervical myelopathy, allocated to receive an additional form of imaging assessment before and after surgery.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: DCM1: MRI Spinal Cord<br>3T MR Imaging of the cervical spinal cord, before and at 3-6 months after surgery. | Diagnostic Test: 3T MR Imaging of the cervical spinal cord<br>* Patients will undergo either Magnetic Resonance Imaging of the Spinal Cord<br>|
| Other: DCM2: MRI Brain and Spinal Cord<br>3T MR Imaging of the brain and cervical spinal cord, before and at 3-6 months after surgery. A subset will also be invited to undergo 7T MRI Brain and Spinal Cord Imaging. | Diagnostic Test: 3T MR Imaging of the cervical spinal cord<br>* Patients will undergo either Magnetic Resonance Imaging of the Spinal Cord<br>Other: 3T MR Imaging of the Brain<br>* 3T MR Imaging of the Brain<br>Other: 7T MR Imaging of the Spinal Cord<br>* 7T MR Imaging of the Spinal Cord<br>|
| Other: DCM3: [11C]-PIB MR/PET Cervical Spinal Cord<br>[11C]PIB PET/MR Imaging of the cervical spinal cord, before and at 3-6 months after surgery. | Other: Positron Emission Tomography using [11C]PIB<br>* Patients will undergo combination MRI/PET using a [11C]PIB radiotracer<br>|
| Other: Healthy Volunteer: MRI Brain and Spinal Cord<br>Age-Matched Healthy Controls will undergo MRI Brain and Spinal Cord. A subset will also be invited to undergo interval imaging at 3-6 months. | Diagnostic Test: 3T MR Imaging of the cervical spinal cord<br>* Patients will undergo either Magnetic Resonance Imaging of the Spinal Cord<br>Other: 3T MR Imaging of the Brain<br>* 3T MR Imaging of the Brain<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modified Japanese Orthopaedics Association (mJOA) |  | 6 Months Post Surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Short-Form 36 (SF-36) | Quality of Life (0-100, where 50 is normal for geographical population. Higher score is better) | Routine Clinical Care: Baseline and 3-6 Months Post-Operatively | 
| Numeric Rating Scale (NRS) Pain | Pain Score (0-10, where 10 is maximum pain, and 0 is no pain. Lower score is better) | Routine Clinical Care: Baseline and 3-6 Months Post-Operatively | 
| Myelopathy.org Symptom Inventory [MOSI] | Quality of Life and Disease Specific Measure (Range of Myelopathy symptoms are scored as Not present, on an intensity scale of 0 to 10, where 10 is worse). | Routine Clinical Care: Baseline and 3-6 Months Post-Operatively | 
| Neurological Exam | Routine Neurological Exam (Motor and Sensory changes to hands, arms and legs, long-tract signs in cluded reflexes, Hoffman's and Babbinski's reflexes) | Routine Clinical Care: Baseline and 3-6 Months Post-Operatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Positron Emission Tomography, Magnetic Resonance Imaging