Virtual Functional Anatomy

Clinical Center

Investigators

Linked publications, trials & patents

Abstract

Although the primary aim of diagnosing and treating musculoskeletal impairments is to restore functional three-dimensional (3D) movements, the majority of quantitative diagnostic and evaluation tools available clinically have remained static and two dimensional. Thus, the current focus is to develop and validate a combined set of tools that will enable the accurate and precise measurement, analysis and visualization of 3D static and dynamic musculoskeletal anatomy (i.e., bone shape, skeletal kinematics, tendon and ligament strain, muscle force, and joint space). To accomplish this, the MR imaging and analysis capabilities already developed will be combined with highly accurate, imaging-based measurement and registration methodologies to non-invasively quantify complete joint anatomy and tissue dynamics during functional movements. Additionally, these tools will enable the quantification of 3D bone shape so that the effect that alterations joint and tissue dynamics have on bone shape can be quantified. We have recently expanded this research with a strong focus on evaluating the viability of using ultrasound as a clinical diagnostic tool. Accomplishing the aims of the VFA initiative will fill an important knowledge gap that exists between the relationship of normal or impaired joint structure/function and the functional movement limitations associated with performing activities of daily living. In doing so, it will position the NIH as an international leader in diagnostic evaluation of musculoskeletal impairments by advancing musculoskeletal diagnostic and evaluation tools from primarily static 2D tools to dynamic tools that can quantify 3D musculoskeletal function during dynamic tasks. Due to the natural tiered structure of this research, two primary paths are currently being pursued, one based using the VFA project in its current state to evaluate both normative and impaired joint kinematics and the other is the continued development of the VFA tools so that full musculoskeletal kinetics can be evaluated. The latter requires the development of methodologies for creating 3D digital images of loaded and moving joint tissues (bone, cartilage, and connective tissues) to reveal joint contact patterns and tissue loads. We can then use these capabilities to document and evaluate the function of normal and impaired joint structures (e.g., Cerebral Palsy, Ehlers Danlos syndrome, and patellar tracking syndrome) functional movements. This past year focused on continuing work in three primary areas; bone shape/muscle volume analysis, automatic segmentation methodological development, and dynamic cartilage contact. In addition, we greatly expanded our efforts in studying the clinical viability of specific ultrasound measures. We have been able to leverage data collected (under protocols from NHGRI and NINDS) on patients with various neurodegenerative diseases. We are currently investigating if ultrasound is a precise biomarker in identifying the presence of these pathologies. This current protocol comes into play in two major ways. First, we are collected normative data as a comparator to these patient data and we are using the tools we have and are developing under this protocol to analyze the data. We are also evaluating the use in ultrasound to diagnosed hamstring strains and to categorize muscle involvement in runner’s dystonia. Musculoskeletal Architecture in children with OBPP This study provided a more complete understanding of shoulder musculoskeletal architecture changes in children/adolescents with OBPP, enhancing our understanding of the natural history of OBPP. This work has been completed. Based on a data-sharing agreement with Pierre-Henri Conze of Brest France, these data have been successfully used to develop automated segmentation methods for delineating shoulder muscles from MR images and another paper has been published in this area. These data are now being shared with our CIT collaborators and new segmentation algorithms are being developed. Lastly work is underway with an outside collaborator, Dr. Michael Pearl to add clinical data to our existing database. One paper has been submitted for review and one is in preparation. PF Dynamic Joint Contact The objective of this study is the continued improvement dynamic joint contact tools within the VFA toolbox. This project established the first validated database defining dynamic, in vivo PF cartilage contact kinematic parameters, acquired during volitional activity in healthy subjects. This provides crucial data for future studies of PF pain and OA. In addition, these data can be used for validation of, or as input to, future computational models. It is a clear advancement over previous studies that have little to no validation and have typically been limited to static analyses, cadaver studies, animal-based methodologies, or generic computational models. Work is continuing in the evaluation of PF contact during various activities and within various populations. These tools are the basis of data analysis for two other protocols. Using MRI and US to Diagnose Hamstring Tears. We are collaborating with Diagnostic Radiology to determine the optimal imaging sequences that will allow for a coordinated evaluation of hamstring tears. We aim to build a combined set of MR-US imaging and analysis tools for the quantification of musculoskeletal injury. Two abstracts have been accepted and presented. Using MRI as a biomarker in neurodegenerative disease We are working in collaboration with NHGRI to explore the ability of ultrasound measures to discern muscle degeneration patterns in individuals with neurodegenerative diseases. Mechanisms of ACL injury & Sports Injury The VFA toolbox was used to support an outside collaboration quantifying the mechanisms of ACL injury and sports injury. A manuscript was awarded the “top-cited” award from the Journal of Orthopeadic Research.