1
|
Heerfordt J, Karlsson M, Kusama M, Ogata S, Mukasa R, Kiyosawa N, Sato N, Widholm P, Dahlqvist Leinhard O, Ahlgren A, Mori-Yoshimura M. Volumetric muscle composition analysis in sporadic inclusion body myositis using fat-referenced magnetic resonance imaging: Disease pattern, repeatability, and natural progression. Muscle Nerve 2024. [PMID: 39318110 DOI: 10.1002/mus.28252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/26/2024]
Abstract
INTRODUCTION/AIMS Fat-referenced magnetic resonance imaging (MRI) has emerged as a promising volumetric technique for measuring muscular volume and fat in neuromuscular disorders, but the experience in inflammatory myopathies remains limited. Therefore, this work aimed at describing how sporadic inclusion body myositis (sIBM) manifests on standardized volumetric fat-referenced MRI muscle measurements, including within-scanner repeatability, natural progression rate, and relationship to clinical parameters. METHODS Ten sIBM patients underwent whole-leg Dixon MRI at baseline (test-retest) and after 12 months. The lean muscle volume (LMV), muscle fat fraction (MFF), and muscle fat infiltration (MFI) of the quadriceps, hamstrings, adductors, medial gastrocnemius, and tibialis anterior were computed. Clinical assessments of IBM Functional Rating Scale (IBMFRS) and knee extension strength were also performed. The baseline test-retest MRI measurements were used to estimate the within-subject standard deviation (sw). 12-month changes were derived for all parameters. RESULTS The MRI measurements showed high repeatability in all muscles; sw ranged from 2.7 to 18.0 mL for LMV, 0.7-1.3 percentage points (pp) for MFF, and 0.2-0.7 pp for MFI. Over 12 months, average LMV decreased by 7.4% while MFF and MFI increased by 3.8 pp and 1.8 pp, respectively. Mean IBMFRS decreased by 2.4 and mean knee extension strength decreased by 32.8 N. DISCUSSION The MRI measurements showed high repeatability and 12-month changes consistent with muscle atrophy and fat replacement as well as a decrease in both muscle strength and IBMFRS. Our findings suggest that fat-referenced MRI measurements are suitable for assessing disease progression and treatment response in inflammatory myopathies.
Collapse
Affiliation(s)
| | | | - Midori Kusama
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Seiya Ogata
- Drug Metabolism & Pharmacokinetics Research Laboratories, Daiichi Sankyo, Co. Ltd., Tokyo, Japan
| | - Ryuta Mukasa
- Translational Science Department II, Daiichi Sankyo, Co. Ltd., Tokyo, Japan
| | - Naoki Kiyosawa
- Translational Science Department II, Daiichi Sankyo, Co. Ltd., Tokyo, Japan
| | - Noriko Sato
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Per Widholm
- AMRA Medical AB, Linköping, Sweden
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Olof Dahlqvist Leinhard
- AMRA Medical AB, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | | |
Collapse
|
2
|
Cabello-Murgui J, Jiménez-Jiménez J, Vílchez JJ, Azorín I, Martí-Martínez P, Millet E, Lupo V, Sevilla T, Sivera R. ITPR3-associated neuropathy: Report of a further family with adult onset intermediate Charcot-Marie-Tooth disease. Eur J Neurol 2024:e16485. [PMID: 39287469 DOI: 10.1111/ene.16485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/19/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND AND PURPOSE ITPR3 encodes type 3 inositol-tri-phosphate receptor (IP3R3), a protein expressed in Schwann cells, predominantly in the paranodal region, and involved in the regulation of Ca2+ release from the endoplasmic reticulum. Dominant variants in ITPR3 have recently been recognized as a rare cause of intermediate Charcot-Marie-Tooth disease (CMT). METHODS We collected the clinical data of a family with autosomal dominant neuropathy whose proband was diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) for many years. The genetic diagnosis was achieved by whole exome sequencing. RESULTS The proband developed symmetrical sensory-motor neuropathy with demyelinating features at 32 years old. He was diagnosed with CIDP and received numerous immunomodulatory treatments. However, his condition progressed, leading to severe proximal leg and hand atrophy that confined him to a wheelchair at 60 years. The patient's two sons began to exhibit symptoms suggestive of neuropathy shortly after age 30 years, and the condition was reoriented as inherited. Exome sequencing identified a heterozygous c.4271C > T variant in the ITPR3 gene segregating with the disease. Nerve conduction studies showed a combination of demyelinating and axonal features that vary by nerve, disease duration, and patient. A uniform thickening of the nerves was identified on nerve echography, as was distal symmetric fatty infiltration in lower limb muscle imaging. CONCLUSIONS The c.4271C > T ITPR3 variant causes a late onset CMT that can be considered an intermediate CMT. Considering the electrophysiological findings and the distribution of IP3R3, we hypothesize that this variant could start as nodal dysfunction that progresses to widespread nerve degeneration.
Collapse
Affiliation(s)
- Javier Cabello-Murgui
- Neuromuscular Diseases Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Jesús Jiménez-Jiménez
- Neuromuscular Diseases Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Juan J Vílchez
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III (U763), Madrid, Spain
| | - Inmaculada Azorín
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III (U763), Madrid, Spain
| | - Pilar Martí-Martínez
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III (U763), Madrid, Spain
| | - Elvira Millet
- Neuromuscular Diseases Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Vincenzo Lupo
- Rare Neurodegenerative Diseases Laboratory, Centro de Investigación Príncipe Felipe, Valencia, Spain
| | - Teresa Sevilla
- Neuromuscular Diseases Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III (U763), Madrid, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Rafael Sivera
- Neuromuscular Diseases Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III (U763), Madrid, Spain
| |
Collapse
|
3
|
Lee SA, Kim HS, Yang E, Yoon YC, Lee JH, Choi BO, Kim JH. Efficient data labeling strategies for automated muscle segmentation in lower leg MRIs of Charcot-Marie-Tooth disease patients. PLoS One 2024; 19:e0310203. [PMID: 39241036 PMCID: PMC11379393 DOI: 10.1371/journal.pone.0310203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 08/24/2024] [Indexed: 09/08/2024] Open
Abstract
We aimed to develop efficient data labeling strategies for ground truth segmentation in lower-leg magnetic resonance imaging (MRI) of patients with Charcot-Marie-Tooth disease (CMT) and to develop an automated muscle segmentation model using different labeling approaches. The impact of using unlabeled data on model performance was further examined. Using axial T1-weighted MRIs of 120 patients with CMT (60 each with mild and severe intramuscular fat infiltration), we compared the performance of segmentation models obtained using several different labeling strategies. The effect of leveraging unlabeled data on segmentation performance was evaluated by comparing the performances of few-supervised, semi-supervised (mean teacher model), and fully-supervised learning models. We employed a 2D U-Net architecture and assessed its performance by comparing the average Dice coefficients (ADC) using paired t-tests with Bonferroni correction. Among few-supervised models utilizing 10% labeled data, labeling three slices (the uppermost, central, and lowermost slices) per subject exhibited a significantly higher ADC (90.84±3.46%) compared with other strategies using a single image slice per subject (uppermost, 87.79±4.41%; central, 89.42±4.07%; lowermost, 89.29±4.71%, p < 0.0001) or all slices per subject (85.97±9.82%, p < 0.0001). Moreover, semi-supervised learning significantly enhanced the segmentation performance. The semi-supervised model using the three-slices strategy showed the highest segmentation performance (91.03±3.67%) among 10% labeled set models. Fully-supervised model showed an ADC of 91.39±3.76. A three-slice-based labeling strategy for ground truth segmentation is the most efficient method for developing automated muscle segmentation models of CMT lower leg MRI. Additionally, semi-supervised learning with unlabeled data significantly enhances segmentation performance.
Collapse
Affiliation(s)
- Seung-Ah Lee
- Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ehwa Yang
- Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung-Ok Choi
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae-Hun Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|
4
|
Huang Y, Chen T, Hu Y, Li Z. Muscular MRI and magnetic resonance neurography in spinal muscular atrophy. Clin Radiol 2024; 79:673-680. [PMID: 38945793 DOI: 10.1016/j.crad.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/08/2024] [Accepted: 06/03/2024] [Indexed: 07/02/2024]
Abstract
Spinal muscular atrophy (SMA) is an autosomal recessive genetic disease caused by the degeneration of the α-motor neurons in the anterior horn of the spinal cord. SMA is clinically characterized by progressive and symmetrical muscle weakness and muscle atrophy and ends up with systemic multisystem abnormalities. Quantitative MRI (qMRI) has the advantages of non-invasiveness, objective sensitivity, and high reproducibility, and has important clinical value in evaluating the severity of neuromuscular diseases and monitoring the efficacy of treatment. This article summarizes the clinical use of muscular MRI and magnetic resonance neurography in assessing the progress of SMA.
Collapse
Affiliation(s)
- Y Huang
- Department of Radiology, Shenzhen Childrens Hospital, Shantou University Medical College Affiliated Shenzhen Childrens Hospital, Shenzhen, China
| | - T Chen
- Department of Radiology, Shenzhen Childrens Hospital, Shantou University Medical College Affiliated Shenzhen Childrens Hospital, Shenzhen, China; Department of Radiology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Y Hu
- Department of Radiology, Shenzhen Childrens Hospital, Shantou University Medical College Affiliated Shenzhen Childrens Hospital, Shenzhen, China; Department of Radiology, Shenzhen Children's Hospital, China Medical University, Shenzhen, China
| | - Z Li
- Department of Radiology, Shenzhen Childrens Hospital, Shantou University Medical College Affiliated Shenzhen Childrens Hospital, Shenzhen, China.
| |
Collapse
|
5
|
Morrow JM, Shah S, Cristiano L, Evans MRB, Doherty CM, Alnaemi T, Saab A, Emira A, Klickovic U, Hammam A, Altuwaijri A, Wastling S, Reilly MM, Hanna MG, Yousry TA, Thornton JS. Development of an initial training and evaluation programme for manual lower limb muscle MRI segmentation. Eur Radiol Exp 2024; 8:85. [PMID: 39060637 PMCID: PMC11282017 DOI: 10.1186/s41747-024-00475-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/26/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) quantification of intramuscular fat accumulation is a responsive biomarker in neuromuscular diseases. Despite emergence of automated methods, manual muscle segmentation remains an essential foundation. We aimed to develop a training programme for new observers to demonstrate competence in lower limb muscle segmentation and establish reliability benchmarks for future human observers and machine learning segmentation packages. METHODS The learning phase of the training programme comprised a training manual, direct instruction, and eight lower limb MRI scans with reference standard large and small regions of interest (ROIs). The assessment phase used test-retest scans from two patients and two healthy controls. Interscan and interobserver reliability metrics were calculated to identify underperforming outliers and to determine competency benchmarks. RESULTS Three experienced observers undertook the assessment phase, whilst eight new observers completed the full training programme. Two of the new observers were identified as underperforming outliers, relating to variation in size or consistency of segmentations; six had interscan and interobserver reliability equivalent to those of experienced observers. The calculated benchmark for the Sørensen-Dice similarity coefficient between observers was greater than 0.87 and 0.92 for individual thigh and calf muscles, respectively. Interscan and interobserver reliability were significantly higher for large than small ROIs (all p < 0.001). CONCLUSIONS We developed, implemented, and analysed the first formal training programme for manual lower limb muscle segmentation. Large ROI showed superior reliability to small ROI for fat fraction assessment. RELEVANCE STATEMENT Observers competent in lower limb muscle segmentation are critical to application of quantitative muscle MRI biomarkers in neuromuscular diseases. This study has established competency benchmarks for future human observers or automated segmentation methods. KEY POINTS • Observers competent in muscle segmentation are critical for quantitative muscle MRI biomarkers. • A training programme for muscle segmentation was undertaken by eight new observers. • We established competency benchmarks for future human observers or automated segmentation methods.
Collapse
Affiliation(s)
- Jasper M Morrow
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UCLH, London, WC1N 3BG, UK
| | - Sachit Shah
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, UCLH, London, UK
| | - Lara Cristiano
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK
- Department of Radiology and Pediatric Neurology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matthew R B Evans
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology, London, UK
| | - Carolynne M Doherty
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology, London, UK
| | - Talal Alnaemi
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK
| | - Abeer Saab
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK
| | - Ahmed Emira
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK
| | - Uros Klickovic
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology, London, UK
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ahmed Hammam
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK
| | - Afnan Altuwaijri
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK
| | - Stephen Wastling
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, UCLH, London, UK
| | - Mary M Reilly
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UCLH, London, WC1N 3BG, UK
| | - Michael G Hanna
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UCLH, London, WC1N 3BG, UK
| | - Tarek A Yousry
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, UCLH, London, UK.
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK.
| | - John S Thornton
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, UCLH, London, UK
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK
| |
Collapse
|
6
|
Salam S, Symonds T, Doll H, Rousell S, Randall J, Lloyd-Price L, Hudgens S, Guldberg C, Herbelin L, Barohn RJ, Hanna MG, Dimachkie MM, Machado PM. Measurement properties of the Inclusion Body Myositis Functional Rating Scale. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333617. [PMID: 38960586 DOI: 10.1136/jnnp-2024-333617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES To evaluate the validity, reliability, responsiveness and meaningful change threshold of the Inclusion Body Myositis (IBM) Functional Rating Scale (FRS). METHODS Data from a large 20-month multicentre, randomised, double-blind, placebo-controlled trial in IBM were used. Convergent validity was tested using Spearman correlation with other health outcomes. Discriminant (known groups) validity was assessed using standardised effect sizes (SES). Internal consistency was tested using Cronbach's alpha. Intrarater reliability in stable patients and equivalence of face-to-face and telephone administration were tested using intraclass correlation coefficients (ICCs) and Bland-Altman plots. Responsiveness was assessed using standardised response mean (SRM). A receiver operator characteristic (ROC) curve anchor-based approach was used to determine clinically meaningful IBMFRS change. RESULTS Among the 150 patients, mean (SD) IBMFRS total score was 27.4 (4.6). Convergent validity was supported by medium to large correlations (rs modulus: 0.42-0.79) and discriminant validity by moderate to large group differences (SES=0.51-1.59). Internal consistency was adequate (overall Cronbach's alpha: 0.79). Test-retest reliability (ICCs=0.84-0.87) and reliability of telephone versus face-to-face administration (ICCs=0.93-0.95) were excellent, with Bland-Altman plots showing good agreement. Responsiveness in the worsened group defined by various external constructs was large at both 12 (SRM=-0.76 to -1.49) and 20 months (SRM=-1.12 to -1.57). In ROC curve analysis, a drop in at least two IBMFRS total score points was shown to represent a meaningful decline. CONCLUSIONS When administered by trained raters, the IBMFRS is a reliable, valid and responsive tool that can be used to evaluate the impact of IBM and its treatment on physical function, with a 2-point reduction representing meaningful decline. TRIAL REGISTRATION NUMBER NCT02753530.
Collapse
Affiliation(s)
- Sharfaraz Salam
- Department of Neuromuscular Diseases, University College London, London, UK
| | | | - Helen Doll
- Clinical Outcomes Solutions Ltd, Folkestone, UK
| | - Sam Rousell
- Clinical Outcomes Solutions Ltd, Folkestone, UK
| | | | | | | | | | - Laura Herbelin
- Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Richard J Barohn
- Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Michael G Hanna
- Department of Neuromuscular Diseases, University College London, London, UK
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas City Medical Center, Kansas City, Missouri, USA
| | - Pedro M Machado
- Department of Neuromuscular Diseases, University College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals National Health Service (NHS) Trust, London, UK
| |
Collapse
|
7
|
Doherty CM, Howard P, O'Donnell LF, Zuccarino R, Wastling S, Milev E, Banks T, Shah S, Zafeiropoulos N, Stephens KJ, Sarkozy A, Grider T, Feely SME, Manzur A, Shy RR, Skorupinska M, Pipis M, Nicolaisen E, McDowell A, Dilek N, Rossor AM, Laura M, Clark C, Muntoni F, Thedens D, Thornton J, Morrow JM, Shy ME, Reilly MM. Quantitative Foot Muscle Magnetic Resonance Imaging Reliably Measures Disease Progression in Children and Adolescents with Charcot-Marie-Tooth Disease Type 1A. Ann Neurol 2024; 96:170-174. [PMID: 38613459 DOI: 10.1002/ana.26934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/15/2024]
Abstract
Quantitative muscle fat fraction (FF) responsiveness is lower in younger Charcot-Marie-Tooth disease type 1A (CMT1A) patients with lower baseline calf-level FF. We investigated the practicality, validity, and responsiveness of foot-level FF in this cohort involving 22 CMT1A patients and 14 controls. The mean baseline foot-level FF was 25.9 ± 20.3% in CMT1A patients, and the 365-day FF (n = 15) increased by 2.0 ± 2.4% (p < 0.001 vs controls). Intrinsic foot-level FF demonstrated large responsiveness (12-month standardized response mean (SRM) of 0.86) and correlated with the CMT examination score (ρ = 0.58, P = 0.01). Intrinsic foot-level FF has the potential to be used as a biomarker in future clinical trials involving younger CMT1A patients. ANN NEUROL 2024;96:170-174.
Collapse
Affiliation(s)
- Carolynne M Doherty
- Center for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Paige Howard
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Luke F O'Donnell
- Center for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Riccardo Zuccarino
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Fondazione Serena Onlus, Centro Clinico NeMO Trento, Italy
| | - Stephen Wastling
- Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Evelin Milev
- Dubowitz Neuromuscular Center, Great Ormond Street Hospital, London, UK
| | - Tina Banks
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Sachit Shah
- Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Nick Zafeiropoulos
- Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Katherine J Stephens
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Anna Sarkozy
- Dubowitz Neuromuscular Center, Great Ormond Street Hospital, London, UK
| | - Tiffany Grider
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Shawna M E Feely
- Division of Pediatric Neurology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Adnan Manzur
- Dubowitz Neuromuscular Center, Great Ormond Street Hospital, London, UK
| | - Rosemary R Shy
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Mariola Skorupinska
- Center for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Menelaos Pipis
- Center for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Emma Nicolaisen
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Amy McDowell
- Center for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
- Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Nuran Dilek
- University of Rochester School of Medicine and Dentistry, New York, NY, USA
| | - Alexander M Rossor
- Center for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Matilde Laura
- Center for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | | | - Francesco Muntoni
- Dubowitz Neuromuscular Center, Great Ormond Street Hospital, London, UK
| | - Daniel Thedens
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - John Thornton
- Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jasper M Morrow
- Center for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Michael E Shy
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Mary M Reilly
- Center for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| |
Collapse
|
8
|
Mastropietro A, Casali N, Taccogna MG, D’Angelo MG, Rizzo G, Peruzzo D. Classification of Muscular Dystrophies from MR Images Improves Using the Swin Transformer Deep Learning Model. Bioengineering (Basel) 2024; 11:580. [PMID: 38927816 PMCID: PMC11200745 DOI: 10.3390/bioengineering11060580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Muscular dystrophies present diagnostic challenges, requiring accurate classification for effective diagnosis and treatment. This study investigates the efficacy of deep learning methodologies in classifying these disorders using skeletal muscle MRI scans. Specifically, we assess the performance of the Swin Transformer (SwinT) architecture against traditional convolutional neural networks (CNNs) in distinguishing between healthy individuals, Becker muscular dystrophy (BMD), and limb-girdle muscular Dystrophy type 2 (LGMD2) patients. Moreover, 3T MRI scans from a retrospective dataset of 75 scans (from 54 subjects) were utilized, with multiparametric protocols capturing various MRI contrasts, including T1-weighted and Dixon sequences. The dataset included 17 scans from healthy volunteers, 27 from BMD patients, and 31 from LGMD2 patients. SwinT and CNNs were trained and validated using a subset of the dataset, with the performance evaluated based on accuracy and F-score. Results indicate the superior accuracy of SwinT (0.96), particularly when employing fat fraction (FF) images as input; it served as a valuable parameter for enhancing classification accuracy. Despite limitations, including a modest cohort size, this study provides valuable insights into the application of AI-driven approaches for precise neuromuscular disorder classification, with potential implications for improving patient care.
Collapse
Affiliation(s)
- Alfonso Mastropietro
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato, Consiglio Nazionale delle Ricerche, 20133 Milan, Italy; (A.M.); (N.C.)
| | - Nicola Casali
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato, Consiglio Nazionale delle Ricerche, 20133 Milan, Italy; (A.M.); (N.C.)
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
| | - Maria Giovanna Taccogna
- Istituto di Tecnologie Biomediche, Consiglio Nazionale delle Ricerche, 20054 Segrate, Milan, Italy;
| | - Maria Grazia D’Angelo
- Unit of Rehabilitation of Rare Diseases of the Central and Peripheral Nervous System, Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy;
| | - Giovanna Rizzo
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato, Consiglio Nazionale delle Ricerche, 20133 Milan, Italy; (A.M.); (N.C.)
| | - Denis Peruzzo
- Neuroimaging Unit, Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| |
Collapse
|
9
|
Flores-Opazo M, Kopinke D, Helmbacher F, Fernández-Verdejo R, Tuñón-Suárez M, Lynch GS, Contreras O. Fibro-adipogenic progenitors in physiological adipogenesis and intermuscular adipose tissue remodeling. Mol Aspects Med 2024; 97:101277. [PMID: 38788527 DOI: 10.1016/j.mam.2024.101277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/27/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
Excessive accumulation of intermuscular adipose tissue (IMAT) is a common pathological feature in various metabolic and health conditions and can cause muscle atrophy, reduced function, inflammation, insulin resistance, cardiovascular issues, and unhealthy aging. Although IMAT results from fat accumulation in muscle, the mechanisms underlying its onset, development, cellular components, and functions remain unclear. IMAT levels are influenced by several factors, such as changes in the tissue environment, muscle type and origin, extent and duration of trauma, and persistent activation of fibro-adipogenic progenitors (FAPs). FAPs are a diverse and transcriptionally heterogeneous population of stromal cells essential for tissue maintenance, neuromuscular stability, and tissue regeneration. However, in cases of chronic inflammation and pathological conditions, FAPs expand and differentiate into adipocytes, resulting in the development of abnormal and ectopic IMAT. This review discusses the role of FAPs in adipogenesis and how they remodel IMAT. It highlights evidence supporting FAPs and FAP-derived adipocytes as constituents of IMAT, emphasizing their significance in adipose tissue maintenance and development, as well as their involvement in metabolic disorders, chronic pathologies and diseases. We also investigated the intricate molecular pathways and cell interactions governing FAP behavior, adipogenesis, and IMAT accumulation in chronic diseases and muscle deconditioning. Finally, we hypothesize that impaired cellular metabolic flexibility in dysfunctional muscles impacts FAPs, leading to IMAT. A deeper understanding of the biology of IMAT accumulation and the mechanisms regulating FAP behavior and fate are essential for the development of new therapeutic strategies for several debilitating conditions.
Collapse
Affiliation(s)
| | - Daniel Kopinke
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, 32610, FL, USA; Myology Institute, University of Florida College of Medicine, Gainesville, FL, USA.
| | | | - Rodrigo Fernández-Verdejo
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA; Laboratorio de Fisiología Del Ejercicio y Metabolismo (LABFEM), Escuela de Kinesiología, Facultad de Medicina, Universidad Finis Terrae, Chile.
| | - Mauro Tuñón-Suárez
- Laboratorio de Fisiología Del Ejercicio y Metabolismo (LABFEM), Escuela de Kinesiología, Facultad de Medicina, Universidad Finis Terrae, Chile.
| | - Gordon S Lynch
- Centre for Muscle Research, Department of Anatomy and Physiology, The University of Melbourne, Melbourne, Victoria, Parkville 3010, Australia.
| | - Osvaldo Contreras
- Developmental and Regenerative Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, NSW, 2010, Australia; School of Clinical Medicine, UNSW Sydney, Kensington, NSW 2052, Australia.
| |
Collapse
|
10
|
Reyngoudt H, Baudin P, Caldas de Almeida Araújo E, Bachasson D, Boisserie J, Mariampillai K, Annoussamy M, Allenbach Y, Hogrel J, Carlier PG, Marty B, Benveniste O. Effect of sirolimus on muscle in inclusion body myositis observed with magnetic resonance imaging and spectroscopy. J Cachexia Sarcopenia Muscle 2024; 15:1108-1120. [PMID: 38613252 PMCID: PMC11154752 DOI: 10.1002/jcsm.13451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Finding sensitive clinical outcome measures has become crucial in natural history studies and therapeutic trials of neuromuscular disorders. Here, we focus on 1-year longitudinal data from quantitative magnetic resonance imaging (MRI) and phosphorus magnetic resonance spectroscopy (31P MRS) in a placebo-controlled study of sirolimus for inclusion body myositis (IBM), also examining their links to functional, strength, and clinical parameters in lower limb muscles. METHODS Quantitative MRI and 31P MRS data were collected at 3 T from a single site, involving 44 patients (22 on placebo, 22 on sirolimus) at baseline and year-1, and 21 healthy controls. Assessments included fat fraction (FF), contractile cross-sectional area (cCSA), and water T2 in global leg and thigh segments, muscle groups, individual muscles, as well as 31P MRS indices in quadriceps or triceps surae. Analyses covered patient-control comparisons, annual change assessments via standard t-tests and linear mixed models, calculation of standardized response means (SRM), and exploration of correlations between MRI, 31P MRS, functional, strength, and clinical parameters. RESULTS The quadriceps and gastrocnemius medialis muscles had the highest FF values, displaying notable heterogeneity and asymmetry, particularly in the quadriceps. In the placebo group, the median 1-year FF increase in the quadriceps was 3.2% (P < 0.001), whereas in the sirolimus group, it was 0.7% (P = 0.033). Both groups experienced a significant decrease in cCSA in the quadriceps after 1 year (P < 0.001), with median changes of 12.6% for the placebo group and 5.5% for the sirolimus group. Differences in FF and cCSA changes between the two groups were significant (P < 0.001). SRM values for FF and cCSA were 1.3 and 1.4 in the placebo group and 0.5 and 0.8 in the sirolimus group, respectively. Water T2 values were highest in the quadriceps muscles of both groups, significantly exceeding control values in both groups (P < 0.001) and were higher in the placebo group than in the sirolimus group. After treatment, water T2 increased significantly only in the sirolimus group's quadriceps (P < 0.01). Multiple 31P MRS indices were abnormal in patients compared to controls and remained unchanged after treatment. Significant correlations were identified between baseline water T2 and FF at baseline and the change in FF (P < 0.001). Additionally, significant correlations were observed between FF, cCSA, water T2, and functional and strength outcome measures. CONCLUSIONS This study has demonstrated that quantitative MRI/31P MRS can discern measurable differences between placebo and sirolimus-treated IBM patients, offering promise for future therapeutic trials in idiopathic inflammatory myopathies such as IBM.
Collapse
Affiliation(s)
- Harmen Reyngoudt
- NMR Laboratory, Neuromuscular Investigation CenterInstitute of MyologyParisFrance
| | - Pierre‐Yves Baudin
- NMR Laboratory, Neuromuscular Investigation CenterInstitute of MyologyParisFrance
| | | | - Damien Bachasson
- Neuromuscular Physiology and Evaluation Laboratory, Neuromuscular Investigation CenterInstitute of MyologyParisFrance
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et CliniqueSorbonne UniversitéParisFrance
| | - Jean‐Marc Boisserie
- NMR Laboratory, Neuromuscular Investigation CenterInstitute of MyologyParisFrance
| | - Kubéraka Mariampillai
- Department of Internal Medicine and Clinical Immunology, Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique‐Hôpitaux de ParisPitié‐Salpêtrière University HospitalParisFrance
- I‐MotionInstitute of MyologyParisFrance
| | | | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique‐Hôpitaux de ParisPitié‐Salpêtrière University HospitalParisFrance
| | - Jean‐Yves Hogrel
- Neuromuscular Physiology and Evaluation Laboratory, Neuromuscular Investigation CenterInstitute of MyologyParisFrance
| | | | - Benjamin Marty
- NMR Laboratory, Neuromuscular Investigation CenterInstitute of MyologyParisFrance
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique‐Hôpitaux de ParisPitié‐Salpêtrière University HospitalParisFrance
| |
Collapse
|
11
|
Fortanier E, Hostin MA, Michel C, Delmont E, Bellemare ME, Guye M, Bendahan D, Attarian S. One-Year Longitudinal Assessment of Patients With CMT1A Using Quantitative MRI. Neurology 2024; 102:e209277. [PMID: 38630962 DOI: 10.1212/wnl.0000000000209277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Intramuscular fat fraction (FF) assessed using quantitative MRI (qMRI) has emerged as one of the few responsive outcome measures in CMT1A suitable for future clinical trials. This study aimed to identify the relevance of multiple qMRI biomarkers for tracking longitudinal changes in CMT1A and to assess correlations between MRI metrics and clinical parameters. METHODS qMRI was performed in CMT1A patients at 2 time points, a year apart, and various metrics were extracted from 3-dimensional volumes of interest at thigh and leg levels. A semiautomated segmentation technique was used, enabling the analysis of central slices and a larger 3D muscle volume. Metrics included proton density (PD), magnetization transfer ratio (MTR), and intramuscular FF. The sciatic and tibial nerves were also assessed. Disease severity was gauged using Charcot Marie Tooth Neurologic Score (CMTNSv2), Charcot Marie Tooth Examination Score, Overall Neuropathy Limitation Scale scores, and Medical Research Council (MRC) muscle strength. RESULTS Twenty-four patients were included. FF significantly rose in the 3D volume at both thigh (+1.04% ± 2.19%, p = 0.041) and leg (+1.36% ± 1.87%, p = 0.045) levels. The 3D analyses unveiled a length-dependent gradient in FF, ranging from 22.61% ± 10.17% to 26.17% ± 10.79% at the leg level. There was noticeable variance in longitudinal changes between muscles: +3.17% ± 6.86% (p = 0.028) in the tibialis anterior compared with 0.37% ± 4.97% (p = 0.893) in the gastrocnemius medialis. MTR across the entire thigh volume showed a significant decline between the 2 time points -2.75 ± 6.58 (p = 0.049), whereas no significant differences were noted for the 3D muscle volume and PD. No longitudinal changes were observed in any nerve metric. Potent correlations were identified between FF and primary clinical measures: CMTNSv2 (ρ = 0.656; p = 0.001) and MRC in the lower limbs (ρ = -0.877; p < 0.001). DISCUSSION Our results further support that qMRI is a promising tool for following up longitudinal changes in CMT1A patients, FF being the paramount MRI metric for both thigh and leg regions. It is crucial to scrutinize the postimaging data extraction methods considering that annual changes are minimal (around +1.5%). Given the varied FF distribution, the existence of a length-dependent gradient, and the differential fatty involution across muscles, 3D volume analysis appeared more suitable than single slice analysis.
Collapse
Affiliation(s)
- Etienne Fortanier
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| | - Marc Adrien Hostin
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| | - Constance Michel
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| | - Emilien Delmont
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| | - Marc-Emmanuel Bellemare
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| | - Maxime Guye
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| | - David Bendahan
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| | - Shahram Attarian
- From the Reference Center for Neuromuscular Diseases and ALS (E.F., E.D., S.A.), La Timone University Hospital, Center for Magnetic Resonance in Biology and Medicine (M.A.H., C.M., M.G., D.B.), UMR CNRS 7339, UMR 7286 (E.D.), Medicine Faculty, CNRS, LIS (M.A.H.,M.-E.B.), and Inserm (S.A.), GMGF, Aix-Marseille University, France
| |
Collapse
|
12
|
Yoon BA, Kim YH, Nam SH, Lee HJ, Oh SI, Kim N, Kim KH, Jo YR, Kim JK, Choi BO, Park HT. p62/sequestosome-1 as a severity-reflecting plasma biomarker in Charcot-Marie-Tooth disease type 1A. Sci Rep 2024; 14:10972. [PMID: 38745059 PMCID: PMC11094036 DOI: 10.1038/s41598-024-61794-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/09/2024] [Indexed: 05/16/2024] Open
Abstract
Autophagy is a self-degradation system for recycling to maintain homeostasis. p62/sequestosome-1 (p62) is an autophagy receptor that accumulates in neuroglia in neurodegenerative diseases. The objective of this study was to determine the elevation of plasma p62 protein levels in patients with Charcot-Marie-Tooth disease 1A (CMT1A) for its clinical usefulness to assess disease severity. We collected blood samples from 69 CMT1A patients and 59 healthy controls. Plasma concentrations of p62 were analyzed by ELISA, and we compared them with Charcot-Marie-Tooth neuropathy score version 2 (CMTNSv2). A mouse CMT1A model (C22) was employed to determine the source and mechanism of plasma p62 elevation. Plasma p62 was detected in healthy controls with median value of 1978 pg/ml, and the levels were significantly higher in CMT1A (2465 pg/ml, p < 0.001). The elevated plasma p62 levels were correlated with CMTNSv2 (r = 0.621, p < 0.0001), motor nerve conduction velocity (r = - 0.490, p < 0.0001) and disease duration (r = 0.364, p < 0.01). In C22 model, increased p62 expression was observed not only in pathologic Schwann cells but also in plasma. Our findings indicate that plasma p62 measurement could be a valuable tool for evaluating CMT1A severity and Schwann cell pathology.
Collapse
Affiliation(s)
- Byeol-A Yoon
- Peripheral Neuropathy Research Center (PNRC), Department of Translational Biomedical Sciences, Graduate School of Dong-A University, Busan, 49201, Republic of Korea
- Department of Neurology, Dong-A University College of Medicine, Busan, 49201, Republic of Korea
| | - Young Hee Kim
- Peripheral Neuropathy Research Center (PNRC), Department of Translational Biomedical Sciences, Graduate School of Dong-A University, Busan, 49201, Republic of Korea
- Department of Molecular Neuroscience and Translational Biomedical Sciences, Dong-A University College of Medicine, Busan, 49201, Republic of Korea
| | - Soo Hyun Nam
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06351, Republic of Korea
| | - Hye-Jin Lee
- Peripheral Neuropathy Research Center (PNRC), Department of Translational Biomedical Sciences, Graduate School of Dong-A University, Busan, 49201, Republic of Korea
- Department of Molecular Neuroscience and Translational Biomedical Sciences, Dong-A University College of Medicine, Busan, 49201, Republic of Korea
| | - Seong-Il Oh
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, 02447, Republic of Korea
| | - Namhee Kim
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, 49201, Republic of Korea
| | - Kyeong-Hee Kim
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, 49201, Republic of Korea
| | - Young Rae Jo
- Department of Molecular Neuroscience and Translational Biomedical Sciences, Dong-A University College of Medicine, Busan, 49201, Republic of Korea
| | - Jong Kuk Kim
- Peripheral Neuropathy Research Center (PNRC), Department of Translational Biomedical Sciences, Graduate School of Dong-A University, Busan, 49201, Republic of Korea
- Department of Neurology, Dong-A University College of Medicine, Busan, 49201, Republic of Korea
| | - Byung-Ok Choi
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06351, Republic of Korea.
- Department of Neurology, Samsung Medical Center, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
| | - Hwan Tae Park
- Peripheral Neuropathy Research Center (PNRC), Department of Translational Biomedical Sciences, Graduate School of Dong-A University, Busan, 49201, Republic of Korea.
- Department of Molecular Neuroscience and Translational Biomedical Sciences, Dong-A University College of Medicine, Busan, 49201, Republic of Korea.
| |
Collapse
|
13
|
O'Donnell LF, Pipis M, Thornton JS, Kanber B, Wastling S, McDowell A, Zafeiropoulos N, Laura M, Skorupinska M, Record CJ, Doherty CM, Herrmann DN, Zetterberg H, Heslegrave AJ, Laban R, Rossor AM, Morrow JM, Reilly MM. Quantitative MRI outcome measures in CMT1A using automated lower limb muscle segmentation. J Neurol Neurosurg Psychiatry 2024; 95:500-503. [PMID: 37979968 DOI: 10.1136/jnnp-2023-332454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/25/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Lower limb muscle magnetic resonance imaging (MRI) obtained fat fraction (FF) can detect disease progression in patients with Charcot-Marie-Tooth disease 1A (CMT1A). However, analysis is time-consuming and requires manual segmentation of lower limb muscles. We aimed to assess the responsiveness, efficiency and accuracy of acquiring FF MRI using an artificial intelligence-enabled automated segmentation technique. METHODS We recruited 20 CMT1A patients and 7 controls for assessment at baseline and 12 months. The three-point-Dixon fat water separation technique was used to determine thigh-level and calf-level muscle FF at a single slice using regions of interest defined using Musclesense, a trained artificial neural network for lower limb muscle image segmentation. A quality control (QC) check and correction of the automated segmentations was undertaken by a trained observer. RESULTS The QC check took on average 30 seconds per slice to complete. Using QC checked segmentations, the mean calf-level FF increased significantly in CMT1A patients from baseline over an average follow-up of 12.5 months (1.15%±1.77%, paired t-test p=0.016). Standardised response mean (SRM) in patients was 0.65. Without QC checks, the mean FF change between baseline and follow-up, at 1.15%±1.68% (paired t-test p=0.01), was almost identical to that seen in the corrected data, with a similar overall SRM at 0.69. CONCLUSIONS Using automated image segmentation for the first time in a longitudinal study in CMT, we have demonstrated that calf FF has similar responsiveness to previously published data, is efficient with minimal time needed for QC checks and is accurate with minimal corrections needed.
Collapse
Affiliation(s)
- Luke F O'Donnell
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Menelaos Pipis
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - John S Thornton
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Baris Kanber
- UCL Centre for Medical Image Computing, London, UK
| | - Stephen Wastling
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Amy McDowell
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Nick Zafeiropoulos
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Matilde Laura
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Mariola Skorupinska
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Christopher J Record
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Carolynne M Doherty
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - David N Herrmann
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | - Amanda J Heslegrave
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | | | - Alexander M Rossor
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Jasper M Morrow
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Mary M Reilly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| |
Collapse
|
14
|
Nava S, Conte G, Triulzi FM, Comi GP, Magri F, Velardo D, Cinnante CM. Diffusion tensor imaging reveals subclinical alterations in muscles of patients with Becker muscular dystrophy. Br J Radiol 2024; 97:947-953. [PMID: 38574384 DOI: 10.1093/bjr/tqae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/21/2023] [Accepted: 03/27/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVES Becker muscular dystrophy (BMD) is a relatively less investigated neuromuscular disease, partially overlapping the phenotype of Duchenne dystrophy (DMD). Physiopathological and anatomical patterns are still not comprehensively known, despite recent effort in the search of early biomarkers. Aim of this study was to selectively compare normal appearing muscles of BMD with healthy controls. METHODS Among a pool of 40 BMD patients and 20 healthy controls, Sartorius and gracilis muscles were selected on the basis of a blinded clinical quantitative/qualitative evaluation, if classified as normal (0 or 1 on Mercuri scale) and subsequently segmented on diffusion tensor MRI scans with a tractographic approach. Diffusion derived parameters were extracted. RESULTS Non-parametric testing revealed significant differences between normal and normal appearing BMD derived parameters in both muscles, the difference being more evident in sartorius. Bonferroni-corrected P-values (<.05) of Mann-Whitney test could discriminate between BMD and controls for standard deviation of all diffusion parameters (mean diffusivity, fractional anisotropy, axial and radial diffusivity) in both sartorius and gracilis, while in sartorius the significant difference was found also in the average values of the same parameters (with exception of RD). CONCLUSIONS This method could identify microstructural alterations in BMD normal appearing sartorius and gracilis. ADVANCES IN KNOWLEDGE Diffusion based MRI could be able to identify possible early or subclinical microstructural alterations in dystrophic patients with BMD.
Collapse
Affiliation(s)
- Simone Nava
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy
| | - Giorgio Conte
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy
| | - Fabio M Triulzi
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy
| | - Giacomo P Comi
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, via Francesco Sforza 35, 20122 MilanItaly
| | - Francesca Magri
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, via Francesco Sforza 35, 20122 MilanItaly
| | - Daniele Velardo
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, via Francesco Sforza 35, 20122 MilanItaly
| | - Claudia M Cinnante
- Radiology Department, Istituto Auxologico Italiano IRCCS, Piazzale Brescia 20, 20149 Milan, Italy
| |
Collapse
|
15
|
Wu M, Liu C, Sun D. Glucocorticoid-Induced Myopathy: Typology, Pathogenesis, Diagnosis, and Treatment. Horm Metab Res 2024; 56:341-349. [PMID: 38224966 DOI: 10.1055/a-2246-2900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Glucocorticoid-induced myopathy is a non-inflammatory toxic myopathy typified by proximal muscle weakness, muscle atrophy, fatigue, and easy fatigability. These vague symptoms coupled with underlying disorders may mask the signs of glucocorticoid-induced myopathy, leading to an underestimation of the disease's impact. This review briefly summarizes the classification, pathogenesis, and treatment options for glucocorticoid-induced muscle wasting. Additionally, we discuss current diagnostic measures in clinical research and routine care used for diagnosing and monitoring glucocorticoid-induced myopathy, which includes gait speed tests, muscle strength tests, hematologic tests, bioelectrical impedance analysis (BIA), dual-energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI), electromyography, quantitative muscle ultrasound, histological examination, and genetic analysis. Continuous monitoring of patients receiving glucocorticoid therapy plays an important role in enabling early detection of glucocorticoid-induced myopathy, allowing physicians to modify treatment plans before significant clinical weakness arises.
Collapse
Affiliation(s)
- Mengmeng Wu
- Department of Nephrology, Xuzhou Medical University Affiliated Hospital, Xuzhou, China
- Graduate School, Xuzhou Medical University, Xuzhou, China
| | - Caixia Liu
- Department of Nephrology, Xuzhou Medical University Affiliated Hospital, Xuzhou, China
| | - Dong Sun
- Department of Nephrology, Xuzhou Medical University Affiliated Hospital, Xuzhou, China
- Department of Internal Medicine and Diagnostics, Xuzhou Medical University, Xuzhou, China
| |
Collapse
|
16
|
Schlaffke L, Rehmann R, Güttsches AK, Vorgerd M, Meyer-Frießem CH, Dinse HR, Enax-Krumova E, Froeling M, Forsting J. Evaluation of Neuromuscular Diseases and Complaints by Quantitative Muscle MRI. J Clin Med 2024; 13:1958. [PMID: 38610723 PMCID: PMC11012431 DOI: 10.3390/jcm13071958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Quantitative muscle MRI (qMRI) is a promising tool for evaluating and monitoring neuromuscular disorders (NMD). However, the application of different imaging protocols and processing pipelines restricts comparison between patient cohorts and disorders. In this qMRI study, we aim to compare dystrophic (limb-girdle muscular dystrophy), inflammatory (inclusion body myositis), and metabolic myopathy (Pompe disease) as well as patients with post-COVID-19 conditions suffering from myalgia to healthy controls. Methods: Ten subjects of each group underwent a 3T lower extremity muscle MRI, including a multi-echo, gradient-echo, Dixon-based sequence, a multi-echo, spin-echo (MESE) T2 mapping sequence, and a spin-echo EPI diffusion-weighted sequence. Furthermore, the following clinical assessments were performed: Quick Motor Function Measure, patient questionnaires for daily life activities, and 6-min walking distance. Results: Different involvement patterns of conspicuous qMRI parameters for different NMDs were observed. qMRI metrics correlated significantly with clinical assessments. Conclusions: qMRI metrics are suitable for evaluating patients with NMD since they show differences in muscular involvement in different NMDs and correlate with clinical assessments. Still, standardisation of acquisition and processing is needed for broad clinical use.
Collapse
Affiliation(s)
- Lara Schlaffke
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr University Bochum, 44789 Bochum, Germany
| | - Robert Rehmann
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr University Bochum, 44789 Bochum, Germany
- Department of Neurology, Klinikum Dortmund, University Witten-Herdecke, 44137 Dortmund, Germany
| | - Anne-Katrin Güttsches
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr University Bochum, 44789 Bochum, Germany
| | - Matthias Vorgerd
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr University Bochum, 44789 Bochum, Germany
- Heimer Institute for Muscle Research, BG-University Hospital Bergmannsheil, 44789 Bochum, Germany
| | - Christine H. Meyer-Frießem
- Department of Anaesthesiology, Intensive Care and Pain Management, St. Marien Hospital, 44534 Lünen, Germany
- Department of Anaesthesiology, Intensive Care Medicine and Pain Management, BG-University Hospital Bergmannsheil, Faculty of Medicine, Ruhr University Bochum, 44789 Bochum, Germany
| | - Hubert R. Dinse
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr University Bochum, 44789 Bochum, Germany
| | - Elena Enax-Krumova
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr University Bochum, 44789 Bochum, Germany
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Johannes Forsting
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr University Bochum, 44789 Bochum, Germany
| |
Collapse
|
17
|
Sivera Mascaró R, García Sobrino T, Horga Hernández A, Pelayo Negro AL, Alonso Jiménez A, Antelo Pose A, Calabria Gallego MD, Casasnovas C, Cemillán Fernández CA, Esteban Pérez J, Fenollar Cortés M, Frasquet Carrera M, Gallano Petit MP, Giménez Muñoz A, Gutiérrez Gutiérrez G, Gutiérrez Martínez A, Juntas Morales R, Ciano-Petersen NL, Martínez Ulloa PL, Mederer Hengstl S, Millet Sancho E, Navacerrada Barrero FJ, Navarrete Faubel FE, Pardo Fernández J, Pascual Pascual SI, Pérez Lucas J, Pino Mínguez J, Rabasa Pérez M, Sánchez González M, Sotoca J, Rodríguez Santiago B, Rojas García R, Turon-Sans J, Vicent Carsí V, Sevilla Mantecón T. Clinical practice guidelines for the diagnosis and management of Charcot-Marie-Tooth disease. Neurologia 2024:S2173-5808(24)00047-6. [PMID: 38431252 DOI: 10.1016/j.nrleng.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/03/2023] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Charcot-Marie-Tooth (CMT) disease is classified considering the neurophysiological and histological findings, the inheritance pattern and the underlying genetic defect. In recent years, with the advent of next generation sequencing, genetic complexity has increased exponentially, expanding the knowledge about disease pathways, and having an impact in clinical management. The aim of this guide is to offer recommendations for the diagnosis, prognosis, monitoring and treatment of this disease in Spain. MATERIAL AND METHODS This consensus guideline has been developed by a multidisciplinary panel encompassing a broad group of professionals including neurologists, neuropediatricians, geneticists, rehabilitators, and orthopaedic surgeons. RECOMMENDATIONS The diagnosis is based in the clinical characterization, usually presenting with a common phenotype. It should be followed by an appropriate neurophysiological study that allows for a correct classification, specific recommendations are established for the parameters that should be included. Genetic diagnosis must be approached in sequentially, once the PMP22 duplication has been ruled out if appropriate, a next generation sequencing should be considered taking into account the limitations of the available techniques. To date, there is no pharmacological treatment that modifies the course of the disease, but symptomatic management is important, as are the rehabilitation and orthopaedic considerations. The latter should be initiated early to identify and improve the patient's functional impairments, including individualised exercise guidelines, orthotic adaptation, and assessment of conservative surgeries such as tendon transpositions. The follow-up of patients with CMT is exclusively clinical, ancillary testing are not necessary in routine clinical practice.
Collapse
Affiliation(s)
- R Sivera Mascaró
- Servicio de Neurología, Hospital Universitari i Politécnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; CIBER de Enfermedades Raras (CIBERER), Madrid, Spain
| | - T García Sobrino
- Servicio de Neurología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain.
| | - A Horga Hernández
- Servicio de Neurología, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - A L Pelayo Negro
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Center for Biomedical Research in the Neurodegenerative Diseases (CIBERNED) Network, Madrid, Spain
| | - A Alonso Jiménez
- Neuromuscular Reference Center, Neurology Department, University Hospital of Antwerp, Amberes, Belgium
| | - A Antelo Pose
- Servicio de Rehabilitación, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | | | - C Casasnovas
- Unitat de Neuromuscular, Servicio de Neurología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | - J Esteban Pérez
- Servicio de Neurología, Unidad de ELA y Enfermedades Neuromusculares, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Fenollar Cortés
- Genética Clínica, Servicio de Análisis Clínicos, Instituto de Medicina del Laboratorio, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - M Frasquet Carrera
- CIBER de Enfermedades Raras (CIBERER), Madrid, Spain; Servicio de Neurología, Hospital Universitari Dr. Peset, Valencia, Spain
| | - M P Gallano Petit
- CIBER de Enfermedades Raras (CIBERER), Madrid, Spain; Servicio de Genética, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Giménez Muñoz
- Servicio de Neurología, Hospital Royo Villanova, Zaragoza, Spain
| | - G Gutiérrez Gutiérrez
- CIBER de Enfermedades Raras (CIBERER), Madrid, Spain; Servicio de Neurología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Facultad de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - A Gutiérrez Martínez
- Servicio de Neurología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - R Juntas Morales
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - N L Ciano-Petersen
- Servicio de Neurología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - P L Martínez Ulloa
- Servicio de Neurología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - S Mederer Hengstl
- Servicio de Neurología, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | - E Millet Sancho
- CIBER de Enfermedades Raras (CIBERER), Madrid, Spain; Servicio de Neurofisiología, Hospital Universitari i Politécnic La Fe, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - F J Navacerrada Barrero
- Servicio de Neurología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - F E Navarrete Faubel
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - J Pardo Fernández
- Servicio de Neurología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | | | - J Pérez Lucas
- Servicio de Neurología, Hospital del Tajo, Aranjuez, Madrid, Spain
| | - J Pino Mínguez
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - M Rabasa Pérez
- Servicio de Neurología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - M Sánchez González
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - J Sotoca
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - R Rojas García
- CIBER de Enfermedades Raras (CIBERER), Madrid, Spain; Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Departamento de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - J Turon-Sans
- CIBER de Enfermedades Raras (CIBERER), Madrid, Spain; Servicio de Neurofisiología, Hospital de la Santa Creu i Sant Pau, Departamento de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - V Vicent Carsí
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - T Sevilla Mantecón
- Servicio de Neurología, Hospital Universitari i Politécnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; CIBER de Enfermedades Raras (CIBERER), Madrid, Spain; Universidad de Valencia, Valencia, Spain
| |
Collapse
|
18
|
Dudziec MM, Lee LE, Massey C, Tropman D, Skorupinska M, Laurá M, Reilly MM, Ramdharry GM. Home-based multi-sensory and proximal strengthening program to improve balance in Charcot-Marie-Tooth disease Type 1A: A proof of concept study. Muscle Nerve 2024; 69:354-361. [PMID: 38156498 DOI: 10.1002/mus.28032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/29/2023] [Accepted: 12/10/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION/AIMS People with Charcot-Marie-Tooth Disease (CMT) frequently report problems with balance, which lead to an increased risk of falls. Evidence is emerging of training interventions to improve balance for people with CMT, but to date all have relied on clinic-based treatment and equipment. This proof-of-concept study explored whether a multi-modal program of proprioceptive rehabilitation and strength training can be delivered at home, to improve balance performance in people with CMT Type 1A. METHODS Fourteen participants with CMT Type 1A were recruited into this randomized, two-arm study. Baseline assessments included measures of disease severity, posturography, physical function, and patient-reported outcome measurements. All participants received one falls education session. Participants were randomized to either 12 weeks of balance training or 12 weeks of usual activities. The intervention comprised a home-based, multi-sensory balance training and proximal strengthening program, supported by three home visits from a physiotherapist. RESULTS Thirteen participants completed the study. The intervention was successfully implemented and well tolerated, with high participation levels. Functional measures of balance and walking showed strong effect sizes in favor of the training group. Posturography testing demonstrated moderate improvements in postural stability favoring the intervention group. Inconsistent changes were seen in lower limb strength measures. DISCUSSION The intervention was feasible to implement and safe, with some evidence of improvement in balance performance. This supports future studies to expand this intervention to larger trials of pragmatic, home-delivered programs through current community rehabilitation services and supported self-management pathways.
Collapse
Affiliation(s)
- Magdalena M Dudziec
- Department of Neuromuscular Diseases, University College London: Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College Hospitals, NHS Foundation Trust, London, UK
- School of Rehabilitation Sciences, Faculty of Health, Social Care and Education, Kingston University and St Georges University of London, London, UK
| | - Laurence E Lee
- Department of Neuromuscular Diseases, University College London: Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College Hospitals, NHS Foundation Trust, London, UK
| | - Charlotte Massey
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College Hospitals, NHS Foundation Trust, London, UK
| | - David Tropman
- Purchasing and Stores Department, The London Clinic, London, UK
| | - Mariola Skorupinska
- Department of Neuromuscular Diseases, University College London: Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College Hospitals, NHS Foundation Trust, London, UK
| | - Matilde Laurá
- Department of Neuromuscular Diseases, University College London: Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College Hospitals, NHS Foundation Trust, London, UK
| | - Mary M Reilly
- Department of Neuromuscular Diseases, University College London: Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College Hospitals, NHS Foundation Trust, London, UK
| | - Gita M Ramdharry
- Department of Neuromuscular Diseases, University College London: Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College Hospitals, NHS Foundation Trust, London, UK
| |
Collapse
|
19
|
Doherty CM, Morrow JM, Zuccarino R, Howard P, Wastling S, Pipis M, Zafeiropoulos N, Stephens KJ, Grider T, Feely SME, Nopoulous P, Skorupinska M, Milev E, Nicolaisen E, Dudzeic M, McDowell A, Dilek N, Muntoni F, Rossor AM, Shah S, Laura M, Yousry TA, Thedens D, Thornton J, Shy ME, Reilly MM. Lower limb muscle MRI fat fraction is a responsive outcome measure in CMT X1, 1B and 2A. Ann Clin Transl Neurol 2024; 11:607-617. [PMID: 38173284 DOI: 10.1002/acn3.51979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE With potential therapies for many forms of Charcot-Marie-Tooth disease (CMT), responsive outcome measures are urgently needed for clinical trials. Quantitative lower limb MRI demonstrated progressive calf intramuscular fat accumulation in the commonest form, CMT1A with large responsiveness. In this study, we evaluated the responsiveness and validity in the three other common forms, due to variants in GJB1 (CMTX1), MPZ (CMT1B) and MFN2 (CMT2A). METHODS 22 CMTX1, 21 CMT1B and 21 CMT2A patients and matched controls were assessed at a 1-year interval. Intramuscular fat fraction (FF) was evaluated using three-point Dixon MRI at thigh and calf level along with clinical measures including CMT examination score, clinical strength assessment, CMT-HI and plasma neurofilament light chain. RESULTS All patient groups had elevated muscle fat fraction at thigh and calf levels, with highest thigh FF and atrophy in CMT2A. There was moderate correlation between calf muscle FF and clinical measures (CMTESv2 rho = 0.405; p = 0.001, ankle MRC strength rho = -0.481; p < 0.001). Significant annualised progression in calf muscle FF was seen in all patient groups (CMTX1 2.0 ± 2.0%, p < 0.001, CMT1B 1.6 ± 2.1% p = 0.004 and CMT2A 1.6 ± 2.1% p = 0.002). Greatest increase was seen in patients with 10-70% FF at baseline (calf 2.7 ± 2.3%, p < 0.0001 and thigh 1.7 ± 2.1%, p = 0.01). INTERPRETATION Our results confirm that calf muscle FF is highly responsive over 12 months in three additional common forms of CMT which together with CMT1A account for 90% of genetically confirmed cases. Calf muscle MRI FF should be a valuable outcome measure in upcoming CMT clinical trials.
Collapse
Affiliation(s)
- Carolynne M Doherty
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Jasper M Morrow
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Riccardo Zuccarino
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Fondazione Serena Onlus, Centro Clinico NeMO Trento, Pergine Valsugana, Italy
| | - Paige Howard
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Stephen Wastling
- Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Menelaos Pipis
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Nick Zafeiropoulos
- Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Katherine J Stephens
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Tiffany Grider
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Shawna M E Feely
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Peggy Nopoulous
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Mariola Skorupinska
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | | | - Emma Nicolaisen
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Magdalena Dudzeic
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Amy McDowell
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
- Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Nuran Dilek
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Alexander M Rossor
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Sachit Shah
- Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Matilde Laura
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Tarek A Yousry
- Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Daniel Thedens
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - John Thornton
- Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Michael E Shy
- Roy and Lucille Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Mary M Reilly
- Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| |
Collapse
|
20
|
Chen Y, Baraz J, Xuan SY, Yang X, Castoro R, Xuan Y, Roth AR, Dortch RD, Li J. Multiparametric Quantitative MRI of Peripheral Nerves in the Leg: A Reliability Study. J Magn Reson Imaging 2024; 59:563-574. [PMID: 37191075 PMCID: PMC11188919 DOI: 10.1002/jmri.28778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Patients with polyneuropathies typically have demyelination and/or axonal degeneration in peripheral nerves. Currently, there is a lack of imaging biomarkers to track the changes in these pathologies. PURPOSE To develop and evaluate the reliability of a multiparametric quantitative magnetic resonance imaging (qMRI) method of peripheral nerves in the leg. STUDY TYPE Prospective. SUBJECTS Seventeen healthy volunteers (36.2 ± 13.8 years old, 9 males) with 10 of them scanned twice for test-retest. FIELD STRENGTH/SEQUENCE 3 T, three-dimensional gradient echo and diffusion tensor imaging. ASSESSMENT A qMRI protocol and processing pipeline was established for quantifying the following nerve parameters that are sensitive to myelin and axonal pathologies: magnetization transfer (MT) ratio (MTR), MT saturation index (MTsat), T2 *, T1 , proton density (PD), fractional anisotropy (FA), and mean/axial/radial diffusivities (MD, AD, and RD). The qMRI protocol also measures the volume of nerve fascicles (fVOL) and the fat fraction (FF) of muscles. STATISTICAL TESTS The intersession reproducibility and inter-rater reliability of each qMRI parameter were assessed by Bland-Altman analysis and intraclass correlation coefficient (ICC). Pairwise Pearson correlation analyses were performed to investigate the intrinsic association between qMRI parameters. Distal-to-proximal variations were evaluated by paired t-tests with Bonferroni-Holm multiple comparison corrections. P < 0.05 was considered statistically significant. RESULTS The MTR, MTsat, T2 *, T1 , PD, FA, AD, and fVOL of the sciatic and tibial nerves, and the FF of leg muscles, had an overall good-to-excellent test-retest agreement (ICC varying from 0.78 to 0.99). All the qMRI parameters had good-to-excellent inter-rater reliability (ICC > 0.80). The data demonstrated a pattern of distal-to-proximal changes of an increased nerve MTsat and FA, and a decreased nerve T1 , PD, MD, and RD, as well as a significantly increased muscle FF. DATA CONCLUSION The proposed multiparametric qMRI method of the peripheral nerves is highly reproducible and provided healthy control data which will be used in developing monitoring biomarkers in patients with polyneuropathies. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Yongsheng Chen
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jacob Baraz
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Stephanie Yan Xuan
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xue Yang
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ryan Castoro
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Yang Xuan
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Alison R. Roth
- Department of Translational Neuroscience, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Richard D. Dortch
- Department of Translational Neuroscience, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Jun Li
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Houston Methodist Research Institute, Houston, TX, USA
| |
Collapse
|
21
|
Sun X, Liu X, Zhao Q, Zhang L, Yuan H. Quantified fat fraction as biomarker assessing disease severity in rare Charcot-Marie-Tooth subtypes. Front Neurol 2024; 14:1334976. [PMID: 38348112 PMCID: PMC10859536 DOI: 10.3389/fneur.2023.1334976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/21/2023] [Indexed: 02/15/2024] Open
Abstract
Objective Charcot-Marie-Tooth (CMT) disease is the most common inherited neuromuscular disorder. Multi-echo Dixon MRI technique is a highly sensitive method for quantifying muscle fatty infiltration, which may provide excellent value for the assessment of CMT. Due to the rareness of the disease, its use in CMT disease has been rarely evaluated, especially in subtypes. Methods Thirty-four CMT1 patients, 25 CMT2 patients, and 10 healthy controls were recruited. All of the recruited CMT1 patients are CMT1A with PMP22 duplication. Among CMT2 patients, 7 patients are CMT2A with MFN2 mutation, and 7 patients have SORD mutations. Multi-echo Dixon MRI imaging was performed. The fat fractions (FFs) of 5 muscle compartments of the leg were measured at proximal, middle, and distal levels by two specialized musculoskeletal radiologists. Comparisons between CMT1, CMT2, and genetically defined subtypes were conducted. Results A proximal-distal gradient (27.6 ± 15.9, 29.9 ± 19.7, and 40.5 ± 21.4, p = 0.015) with a peroneal predominance (p = 0.001) in fat distribution was observed in CMT1. Significant differences in the soleus muscle FFs at proximal (19.1 ± 14.7 vs. 34.8 ± 25.1, p = 0.034) and medial levels (23.5 ± 21 vs. 38.0 ± 25.6, p = 0.044) were observed between CMT1 and CMT2 patients. Between PMP2 duplication and MFN2 mutation group, a significant difference in the soleus muscle FF was also observed (23.5 ± 21.0 vs. 54.7 ± 20.2, p = 0.039). Prominent correlations of calf muscle FFs with functional scores were observed. Discussion Multi-echo Dixon MRI imaging is a valuable tool for assessing disease severity in CMT. The difference in patterns of fatty infiltration of CMT subtypes is first reported, which could provide references when making targeted training plans.
Collapse
Affiliation(s)
- Xingwen Sun
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Xiaoxuan Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Qiang Zhao
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Lihua Zhang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
| |
Collapse
|
22
|
Mooshage CM, Schimpfle L, Tsilingiris D, Kender Z, Aziz-Safaie T, Hohmann A, Szendroedi J, Nawroth P, Sturm V, Heiland S, Bendszus M, Kopf S, Jende JME, Kurz FT. Magnetization transfer ratio of the sciatic nerve differs between patients in type 1 and type 2 diabetes. Eur Radiol Exp 2024; 8:6. [PMID: 38191821 PMCID: PMC10774497 DOI: 10.1186/s41747-023-00405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/07/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Previous studies on magnetic resonance neurography (MRN) found different patterns of structural nerve damage in type 1 diabetes (T1D) and type 2 diabetes (T2D). Magnetization transfer ratio (MTR) is a quantitative technique to analyze the macromolecular tissue composition. We compared MTR values of the sciatic nerve in patients with T1D, T2D, and healthy controls (HC). METHODS 3-T MRN of the right sciatic nerve at thigh level was performed in 14 HC, 10 patients with T1D (3 with diabetic neuropathy), and 28 patients with T2D (10 with diabetic neuropathy). Results were subsequently correlated with clinical and electrophysiological data. RESULTS The sciatic nerve's MTR was lower in patients with T2D (0.211 ± 0.07, mean ± standard deviation) compared to patients with T1D (T1D 0.285 ± 0.03; p = 0.015) and HC (0.269 ± 0.05; p = 0.039). In patients with T1D, sciatic MTR correlated positively with tibial nerve conduction velocity (NCV; r = 0.71; p = 0.021) and negatively with hemoglobin A1c (r = - 0.63; p < 0.050). In patients with T2D, we found negative correlations of sciatic nerve's MTR peroneal NCV (r = - 0.44; p = 0.031) which remained significant after partial correlation analysis controlled for age and body mass index (r = 0.51; p = 0.016). CONCLUSIONS Lower MTR values of the sciatic nerve in T2D compared to T1D and HC and diametrical correlations of MTR values with NCV in T1D and T2D indicate that there are different macromolecular changes and pathophysiological pathways underlying the development of neuropathic nerve damage in T1D and T2D. TRIAL REGISTRATION https://classic. CLINICALTRIALS gov/ct2/show/NCT03022721 . 16 January 2017. RELEVANCE STATEMENT Magnetization transfer ratio imaging may serve as a non-invasive imaging method to monitor the diseases progress and to encode the pathophysiology of nerve damage in patients with type 1 and type 2 diabetes. KEY POINTS • Magnetization transfer imaging detects distinct macromolecular nerve lesion patterns in diabetes patients. • Magnetization transfer ratio was lower in type 2 diabetes compared to type 1 diabetes. • Different pathophysiological mechanisms drive nerve damage in type 1 and 2 diabetes.
Collapse
Affiliation(s)
- Christoph M Mooshage
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
| | - Lukas Schimpfle
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, Neuherberg, Germany
| | - Dimitrios Tsilingiris
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, Neuherberg, Germany
| | - Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, Neuherberg, Germany
| | - Taraneh Aziz-Safaie
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
| | - Anja Hohmann
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Julia Szendroedi
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Joint Heidelberg-IDC Translational Diabetes Program, Inner Medicine 1, Heidelberg University Hospital, Heidelberg, Germany
| | - Volker Sturm
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research, associated partner in the DZD, Munich-Neuherberg, Germany
- Institute for Diabetes and Cancer (IDC), Helmholtz Diabetes Center, Helmholtz Center, Munich, Neuherberg, Germany
| | - Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany.
- German Cancer Research Center, Heidelberg, Germany.
| |
Collapse
|
23
|
Gorijavolu M, Bairwa D, Ganapathy S, Dunga S, Gopal A, Ananthakrishnan R, Thabah MM, Negi VS, Kavadichanda CG. Semi-quantitative thigh magnetic resonance imaging scores in assessing disease activity and determining long-term clinical outcome in idiopathic inflammatory myopathies: a causal mediation analysis. Rheumatology (Oxford) 2024; 63:111-118. [PMID: 37079733 DOI: 10.1093/rheumatology/kead174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 03/03/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES To evaluate the relationship of thigh MRI (t-MRI) with manual muscle testing-8 (MMT-8), muscle enzymes and autoantibodies. To determine the causal and mediating factors resulting in poor recovery of MMT-8 in inflammatory myositis (IIM). METHODS This was a single-centre retrospective study in IIM patients. t-MRI was semi-quantitatively scored for muscle oedema, fascial oedema, muscle atrophy and fatty infiltration. Spearman correlation of t-MRI scores was done with muscle enzymes at baseline, and MMT-8 at baseline and on follow-up. Causal mediation analysis was performed with age, sex, symptom duration, autoantibodies, diabetes and BMI as independent variables, follow-up MMT-8 as dependent and t-MRI scores as mediating variables. RESULTS Baseline evaluation was done on 59 and follow-up on 38 patients. Median follow-up of the cohort was 31 (10-57) months. Baseline MMT-8 negatively correlated with muscle oedema (r = -0755), fascial oedema (r = -0.443) and muscle atrophy (r = -0.343). Creatinine kinase (r = 0.422) and aspartate transaminase (r = 0.480) positively correlated with muscle oedema. Follow-up MMT-8 correlated negatively with baseline atrophy (r = -0.497) and fatty infiltration (r = -0.531). On follow-up, MMT-8 males had positive total effect (estimate (95%CI)) via atrophy [2.93 (0.44, 4.89)] and fatty infiltration [2.08 (0.54, 3.71)]. Antisynthetase antibody had a positive total effect via fatty infiltration [4.50 (0.37, 7.59)]. Age had a negative total effect via atrophy [-0.09 (0.19, -0.01)] and fatty infiltration [-0.07 (-0.15, -0.01)]. Disease duration had a negative total effect via fatty infiltration [-0.18 (-0.27, -0.02)]. CONCLUSION Baseline fatty infiltration and muscle atrophy resulting from older age, female sex, longer disease duration and absent anti-synthetase antibodies, partly mediate muscle recovery in IIM.
Collapse
Affiliation(s)
- Mamatha Gorijavolu
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Devender Bairwa
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Sachit Ganapathy
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Saikumar Dunga
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Aishwarya Gopal
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Ramesh Ananthakrishnan
- Department of Radiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Molly Mary Thabah
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Vir Singh Negi
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Chengappa G Kavadichanda
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| |
Collapse
|
24
|
Schlaffke L, Rehmann R, Froeling M, Güttsches AK, Vorgerd M, Enax-Krumova E, Forsting J. Quantitative muscle MRI in sporadic inclusion body myositis (sIBM): A prospective cohort study. J Neuromuscul Dis 2024; 11:997-1009. [PMID: 39031378 PMCID: PMC11380292 DOI: 10.3233/jnd-240053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
Background Sporadic inclusion body myositis (sIBM) is the predominant idiopathic inflammatory myopathy (IIM) in older people. Limitations of classical clinical assessments have been discussed as possible explanations for failed clinical trials, underlining the need for more sensitive outcome measures. Quantitative muscle MRI (qMRI) is a promising candidate for evaluating and monitoring sIBM. Objective Longitudinal assessment of qMRI in sIBM patients. Methods We evaluated fifteen lower extremity muscles of 12 sIBM patients (5 females, mean age 69.6, BMI 27.8) and 12 healthy age- and gender-matched controls. Seven patients and matched controls underwent a follow-up evaluation after one year. Clinical assessment included testing for muscle strength with Quick Motor Function Measure (QMFM), IBM functional rating scale (IBM-FRS), and gait analysis (6-minute walking distance). 3T-MRI scans of the lower extremities were performed, including a Dixon-based sequence, T2 mapping and Diffusion Tensor Imaging. The qMRI-values fat-fraction (FF), water T2 relaxation time (wT2), fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ1), and radial diffusivity (RD) were analysed. Results Compared to healthy controls, significant differences for all qMRI parameters averaged over all muscles were found in sIBM using a MANOVA (p < 0.001). In low-fat muscles (FF < 10%), a significant increase of wT2 and FA with an accompanying decrease of MD, λ1, and RD was observed (p≤0.020). The highest correlation with clinical assessments was found for wT2 values in thigh muscles (r≤-0.634). Significant changes of FF (+3.0%), wT2 (+0.6 ms), MD (-0.04 10-3mm2/s), λ1 (-0.05 10-3mm2/s), and RD (-0.03 10-3mm2/s) were observed in the longitudinal evaluation of sIBM patients (p≤0.001). FA showed no significant change (p = 0.242). Conclusion qMRI metrics correlate with clinical findings and can reflect different ongoing pathophysiological mechanisms. While wT2 is an emerging marker of disease activity, the role of diffusion metrics, possibly reflecting changes in fibre size and intracellular deposits, remains subject to further investigations.
Collapse
Affiliation(s)
- Lara Schlaffke
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Robert Rehmann
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, Klinikum Dortmund, University Witten-Herdecke, Dortmund, Germany
| | - Martijn Froeling
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anne-Katrin Güttsches
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Matthias Vorgerd
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
- Heimer Institute for Muscle Research, BG-University Hospital Bergmannsheil, Bochum, Germany
| | - Elena Enax-Krumova
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Johannes Forsting
- Department of Neurology, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
25
|
Hostin MA, Ogier AC, Michel CP, Le Fur Y, Guye M, Attarian S, Fortanier E, Bellemare ME, Bendahan D. The Impact of Fatty Infiltration on MRI Segmentation of Lower Limb Muscles in Neuromuscular Diseases: A Comparative Study of Deep Learning Approaches. J Magn Reson Imaging 2023; 58:1826-1835. [PMID: 37025028 DOI: 10.1002/jmri.28708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Deep learning methods have been shown to be useful for segmentation of lower limb muscle MRIs of healthy subjects but, have not been sufficiently evaluated on neuromuscular disease (NDM) patients. PURPOSE Evaluate the influence of fat infiltration on convolutional neural network (CNN) segmentation of MRIs from NMD patients. STUDY TYPE Retrospective study. SUBJECTS Data were collected from a hospital database of 67 patients with NMDs and 14 controls (age: 53 ± 17 years, sex: 48 M, 33 F). Ten individual muscles were segmented from the thigh and six from the calf (20 slices, 200 cm section). FIELD STRENGTH/SEQUENCE A 1.5 T. Sequences: 2D T1 -weighted fast spin echo. Fat fraction (FF): three-point Dixon 3D GRE, magnetization transfer ratio (MTR): 3D MT-prepared GRE, T2: 2D multispin-echo sequence. ASSESSMENT U-Net 2D, U-Net 3D, TransUNet, and HRNet were trained to segment thigh and leg muscles (101/11 and 95/11 training/validation images, 10-fold cross-validation). Automatic and manual segmentations were compared based on geometric criteria (Dice coefficient [DSC], outlier rate, absence rate) and reliability of measured MRI quantities (FF, MTR, T2, volume). STATISTICAL TESTS Bland-Altman plots were chosen to describe agreement between manual vs. automatic estimated FF, MTR, T2 and volume. Comparisons were made between muscle populations with an FF greater than 20% (G20+) and lower than 20% (G20-). RESULTS The CNNs achieved equivalent results, yet only HRNet recognized every muscle in the database, with a DSC of 0.91 ± 0.08, and measurement biases reaching -0.32% ± 0.92% for FF, 0.19 ± 0.77 for MTR, -0.55 ± 1.95 msec for T2, and - 0.38 ± 3.67 cm3 for volume. The performances of HRNet, between G20- and G20+ decreased significantly. DATA CONCLUSION HRNet was the most appropriate network, as it did not omit any muscle. The accuracy obtained shows that CNNs could provide fully automated methods for studying NMDs. However, the accuracy of the methods may be degraded on the most infiltrated muscles (>20%). EVIDENCE LEVEL 4. TECHNICAL EFFICACY Stage 1.
Collapse
Affiliation(s)
- Marc-Adrien Hostin
- Aix Marseille University, CNRS, CRMBM, Marseille, France
- Aix Marseille University, CNRS, LIS, Marseille, France
| | - Augustin C Ogier
- Aix Marseille University, CNRS, LIS, Marseille, France
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | | | - Yann Le Fur
- Aix Marseille University, CNRS, CRMBM, Marseille, France
| | - Maxime Guye
- APHM, Hopital Universitaire Timone, CEMEREM, Marseille, France
| | - Shahram Attarian
- Reference Center for Neuromuscular Diseases and ALS, APHM, University Hospital of Marseille/Timone University Hospital, Marseille, France
| | - Etienne Fortanier
- Reference Center for Neuromuscular Diseases and ALS, APHM, University Hospital of Marseille/Timone University Hospital, Marseille, France
| | | | - David Bendahan
- Aix Marseille University, CNRS, CRMBM, Marseille, France
| |
Collapse
|
26
|
Reyngoudt H, Baudin PY, Carlier PG, Lopez Kolkovsky AL, de Almeida Araujo EC, Marty B. New Insights into the Spread of MRS-Based Water T2 Values Observed in Highly Fatty Replaced Muscles. J Magn Reson Imaging 2023; 58:1557-1568. [PMID: 36877200 DOI: 10.1002/jmri.28669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND The reference standard for assessing water T2 (T2,H2O ) at high fat fraction (FF) is 1 H MRS. T2,H2O (T2,H2O,MRS ) dependence on FF (FFMRS ) has recently been demonstrated in muscle at high FF (i.e. ≥60%). PURPOSE To investigate the relationship between T2,H2O,MRS and FFMRS in the thigh/leg muscles of patients with neuromuscular diseases and to compare with quantitative MRI. STUDY TYPE Retrospective case-control study. POPULATION A total of 151 patients with neuromuscular disorders (mean age ± standard deviation = 52.5 ± 22.6 years, 54% male), 44 healthy volunteers (26.5 ± 13.0 years, 57% male). FIELD STRENGTH/SEQUENCE A 3-T; single-voxel stimulated echo acquisition mode (STEAM) MRS, multispin echo (MSE) imaging (for T2 mapping, T2,H2O,MRI ), three-point Dixon imaging (for FFMRI andR 2 * mapping). ASSESSMENT Mono-exponential and bi-exponential models were fitted to water T2 decay curves to extract T2,H2O,MRS and FFMRS . Water resonance full-width-at-half-maximum (FWHM) and B0 spread (∆B0 ) values were calculated. T2,H2O,MRI (mean), FFMRI (mean, kurtosis, and skewness), andR 2 * (mean) values were estimated in the MRS voxel. STATISTICAL TESTS Mann-Whitney U tests, Kruskal-Wallis tests. A P-value <0.05 was considered statistically significant. RESULTS Normal T2,H2O,MRS threshold was defined as the 90th percentile in healthy controls: 30.3 msec. T2,H2O,MRS was significantly higher in all patients with FFMRS < 60% compared to healthy controls. We discovered two subgroups in patients with FFMRS ≥ 60%: one with T2,H2O,MRS ≥ 30.3 msec and one with T2,H2O,MRS < 30.3 msec including abnormally low T2,H2O,MRS . The latter subgroup had significantly higher water resonance FWHM, ∆B0 , FFMRI kurtosis, and skewness values but nonsignificantly differentR 2 * (P = 1.00) and long T2,H2O,MRS component and its fraction (P > 0.11) based on the bi-exponential analysis. DATA CONCLUSION The findings suggest that the cause for (abnormally) T2,H2O,MRS at high FFMRS is biophysical, due to differences in susceptibility between muscle and fat (increased FWHM and ∆B0 ), rather than pathophysiological such as compartmentation changes, which would be reflected by the bi-exponential analysis. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
Collapse
Affiliation(s)
- Harmen Reyngoudt
- NMR Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Pierre-Yves Baudin
- NMR Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Pierre G Carlier
- Université Paris Saclay, CEA, Service Hospitalier Frédéric Joliot, Orsay, France
| | | | | | - Benjamin Marty
- NMR Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| |
Collapse
|
27
|
Record CJ, Skorupinska M, Laura M, Rossor AM, Pareyson D, Pisciotta C, Feely SME, Lloyd TE, Horvath R, Sadjadi R, Herrmann DN, Li J, Walk D, Yum SW, Lewis RA, Day J, Burns J, Finkel RS, Saporta MA, Ramchandren S, Weiss MD, Acsadi G, Fridman V, Muntoni F, Poh R, Polke JM, Zuchner S, Shy ME, Scherer SS, Reilly MM. Genetic analysis and natural history of Charcot-Marie-Tooth disease CMTX1 due to GJB1 variants. Brain 2023; 146:4336-4349. [PMID: 37284795 PMCID: PMC10545504 DOI: 10.1093/brain/awad187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/05/2023] [Accepted: 05/20/2023] [Indexed: 06/08/2023] Open
Abstract
Charcot-Marie-Tooth disease (CMT) due to GJB1 variants (CMTX1) is the second most common form of CMT. It is an X-linked disorder characterized by progressive sensory and motor neuropathy with males affected more severely than females. Many reported GJB1 variants remain classified as variants of uncertain significance (VUS). In this large, international, multicentre study we prospectively collected demographic, clinical and genetic data on patients with CMT associated with GJB1 variants. Pathogenicity for each variant was defined using adapted American College of Medical Genetics criteria. Baseline and longitudinal analyses were conducted to study genotype-phenotype correlations, to calculate longitudinal change using the CMT Examination Score (CMTES), to compare males versus females, and pathogenic/likely pathogenic (P/LP) variants versus VUS. We present 387 patients from 295 families harbouring 154 variants in GJB1. Of these, 319 patients (82.4%) were deemed to have P/LP variants, 65 had VUS (16.8%) and three benign variants (0.8%; excluded from analysis); an increased proportion of patients with P/LP variants compared with using ClinVar's classification (74.6%). Male patients (166/319, 52.0%, P/LP only) were more severely affected at baseline. Baseline measures in patients with P/LP variants and VUS showed no significant differences, and regression analysis suggested the disease groups were near identical at baseline. Genotype-phenotype analysis suggested c.-17G>A produces the most severe phenotype of the five most common variants, and missense variants in the intracellular domain are less severe than other domains. Progression of disease was seen with increasing CMTES over time up to 8 years follow-up. Standard response mean (SRM), a measure of outcome responsiveness, peaked at 3 years with moderate responsiveness [change in CMTES (ΔCMTES) = 1.3 ± 2.6, P = 0.00016, SRM = 0.50]. Males and females progressed similarly up to 8 years, but baseline regression analysis suggested that over a longer period, females progress more slowly. Progression was most pronounced for mild phenotypes (CMTES = 0-7; 3-year ΔCMTES = 2.3 ± 2.5, P = 0.001, SRM = 0.90). Enhanced variant interpretation has yielded an increased proportion of GJB1 variants classified as P/LP and will aid future variant interpretation in this gene. Baseline and longitudinal analysis of this large cohort of CMTX1 patients describes the natural history of the disease including the rate of progression; CMTES showed moderate responsiveness for the whole group at 3 years and higher responsiveness for the mild group at 3, 4 and 5 years. These results have implications for patient selection for upcoming clinical trials.
Collapse
Affiliation(s)
- Christopher J Record
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Mariola Skorupinska
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Matilde Laura
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Alexander M Rossor
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Davide Pareyson
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Chiara Pisciotta
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Shawna M E Feely
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Thomas E Lloyd
- Departments of Neurology and Neuroscience, John Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Rita Horvath
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0PY, UK
| | - Reza Sadjadi
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - David N Herrmann
- Department of Neurology, University of Rochester, Rochester, NY 14618, USA
| | - Jun Li
- Department of Neurology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - David Walk
- Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Sabrina W Yum
- Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Richard A Lewis
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - John Day
- Department of Neurology, Stanford University, Stanford, CA 94304, USA
| | - Joshua Burns
- University of Sydney School of Health Sciences, Faculty of Medicine and Health; Paediatric Gait Analysis Service of New South Wales, Sydney Children’s Hospitals Network, Sydney, 2145Australia
| | - Richard S Finkel
- Department of Neurology, Nemours Children’s Hospital, Orlando, FL 32827, USA
| | - Mario A Saporta
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Sindhu Ramchandren
- Department of Neurology, Wayne State University, Detroit, MI 48201, USA
- The Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, NJ 08560, USA
| | - Michael D Weiss
- Department of Neurology, University of Washington, Seattle, WA, 98195USA
| | - Gyula Acsadi
- Connecticut Children’s Medical Center, Hartford, CT 06106, USA
| | - Vera Fridman
- Department of Neurology, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA
| | - Francesco Muntoni
- The Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College London, and Great Ormond Street Hospital Trust, London, WC1N 1EH, UK
| | - Roy Poh
- Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, London, WC1N 3BG, UK
| | - James M Polke
- Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, London, WC1N 3BG, UK
| | - Stephan Zuchner
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Michael E Shy
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Steven S Scherer
- Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mary M Reilly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| |
Collapse
|
28
|
Durelle C, Delmont E, Michel C, Trabelsi A, Hostin MA, Ogier A, Bendahan D, Attarian S. Quantification of muscle involvement in familial amyloid polyneuropathy using MRI. Eur J Neurol 2023; 30:3286-3295. [PMID: 37422895 DOI: 10.1111/ene.15970] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/09/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND AND PURPOSE Transthyretin familial amyloid polyneuropathy (TTR-FAP) is a rare genetic disease with autosomal-dominant inheritance. In this study, we aimed to quantify fatty infiltration (fat fraction [FF]) and magnetization transfer ratio (MTR) in individual muscles of patients with symptomatic and asymptomatic TTR-FAP using magnetic resonance imaging. Secondarily, we aimed to assess correlations with clinical and electrophysiological variables. METHODS A total of 39 patients with a confirmed mutation in the TTR gene (25 symptomatic and 14 asymptomatic) and 14 healthy volunteers were included. A total of 16 muscles were manually delineated in the nondominant lower limb from T1-weighted anatomical images. The corresponding masks were propagated on the MTR and FF maps. Detailed neurological and electrophysiological examinations were conducted in each group. RESULTS The MTR was decreased (42.6 AU; p = 0.001) and FF was elevated (14%; p = 0.003) in the lower limbs of the symptomatic group, with preferential posterior and lateral involvement. In the asymptomatic group, elevated FF was quantified in the gastrocnemius lateralis muscle (11%; p = 0.021). FF was significantly correlated with disease duration (r = 0.49, p = 0.015), neuropathy impairment score for the lower limb (r = 0.42, p = 0.041), Overall Neuropathy Limitations Scale score (r = 0.49, p = 0.013), polyneuropathy disability score (r = 0.57, p = 0.03) and the sum of compound muscle action potential (r = 0.52, p = 0.009). MTR was strongly correlated to FF (r = 0.78, p < 0.0001), and a few muscles with an FF within the normal range had a reduced MTR. CONCLUSION These observations suggest that FF and MTR could be interesting biomarkers in TTR-FAP. In asymptomatic patients, FF in the gastrocnemius lateralis muscle could be a good indicator of the transition from an asymptomatic to a symptomatic form of the disease. MTR could be an early biomarker of muscle alterations.
Collapse
Affiliation(s)
- Clémence Durelle
- Centre de référence des maladies neuromusculaires et de la SLA, hôpitaux universitaires de Marseille, Marseille, France
| | - Emilien Delmont
- Centre de référence des maladies neuromusculaires et de la SLA, hôpitaux universitaires de Marseille, Marseille, France
| | - Constance Michel
- Centre de résonance magnétique biologique et médicale (Crmbm), Marseille, France
| | - Amira Trabelsi
- Aix-Marseille Univ, CNRS, Centrale Marseille, Institute Fresnel, Marseille, France
| | - Marc-Adrien Hostin
- Centre de résonance magnétique biologique et médicale (Crmbm), Marseille, France
| | - Augustin Ogier
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - David Bendahan
- Centre de résonance magnétique biologique et médicale (Crmbm), Marseille, France
| | - Shahram Attarian
- Centre de référence des maladies neuromusculaires et de la SLA, hôpitaux universitaires de Marseille, Marseille, France
| |
Collapse
|
29
|
de Visser M, Carlier P, Vencovský J, Kubínová K, Preusse C. 255th ENMC workshop: Muscle imaging in idiopathic inflammatory myopathies. 15th January, 16th January and 22nd January 2021 - virtual meeting and hybrid meeting on 9th and 19th September 2022 in Hoofddorp, The Netherlands. Neuromuscul Disord 2023; 33:800-816. [PMID: 37770338 DOI: 10.1016/j.nmd.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023]
Abstract
The 255th ENMC workshop on Muscle Imaging in Idiopathic Inflammatory myopathies (IIM) aimed at defining recommendations concerning the applicability of muscle imaging in IIM. The workshop comprised of clinicians, researchers and people living with myositis. We aimed to achieve consensus on the following topics: a standardized protocol for the evaluation of muscle images in various types of IIMs; the exact parameters, anatomical localizations and magnetic resonance imaging (MRI) techniques; ultrasound as assessment tool in IIM; assessment methods; the pattern of muscle involvement in IIM subtypes; the application of MRI as biomarker in follow-up studies and clinical trials, and the place of MRI in the evaluation of swallowing difficulty and cardiac manifestations. The following recommendations were formulated: In patients with suspected IIM, muscle imaging is highly recommended to be part of the initial diagnostic workup and baseline assessment. MRI is the preferred imaging modality due to its sensitivity to both oedema and fat accumulation. Ultrasound may be used for suspected IBM. Repeat imaging should be considered if patients do not respond to treatment, if there is ongoing diagnostic uncertainty or there is clinical or laboratory evidence of disease relapse. Quantitative MRI is established as a sensitive biomarker in IBM and could be included as a primary or secondary outcome measure in early phase clinical trials, or as a secondary outcome measure in late phase clinical trials. Finally, a research agenda was drawn up.
Collapse
Affiliation(s)
- Marianne de Visser
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centre, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Jiří Vencovský
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Kateřina Kubínová
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Corinna Preusse
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Department of Neuropathology, Berlin, Germany
| |
Collapse
|
30
|
Lapp HS, Freigang M, Hagenacker T, Weiler M, Wurster CD, Günther R. Biomarkers in 5q-associated spinal muscular atrophy-a narrative review. J Neurol 2023; 270:4157-4178. [PMID: 37289324 PMCID: PMC10421827 DOI: 10.1007/s00415-023-11787-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023]
Abstract
5q-associated spinal muscular atrophy (SMA) is a rare genetic disease caused by mutations in the SMN1 gene, resulting in a loss of functional SMN protein and consecutive degeneration of motor neurons in the ventral horn. The disease is clinically characterized by proximal paralysis and secondary skeletal muscle atrophy. New disease-modifying drugs driving SMN gene expression have been developed in the past decade and have revolutionized SMA treatment. The rise of treatment options led to a concomitant need of biomarkers for therapeutic guidance and an improved disease monitoring. Intensive efforts have been undertaken to develop suitable markers, and numerous candidate biomarkers for diagnostic, prognostic, and predictive values have been identified. The most promising markers include appliance-based measures such as electrophysiological and imaging-based indices as well as molecular markers including SMN-related proteins and markers of neurodegeneration and skeletal muscle integrity. However, none of the proposed biomarkers have been validated for the clinical routine yet. In this narrative review, we discuss the most promising candidate biomarkers for SMA and expand the discussion by addressing the largely unfolded potential of muscle integrity markers, especially in the context of upcoming muscle-targeting therapies. While the discussed candidate biomarkers hold potential as either diagnostic (e.g., SMN-related biomarkers), prognostic (e.g., markers of neurodegeneration, imaging-based markers), predictive (e.g., electrophysiological markers) or response markers (e.g., muscle integrity markers), no single measure seems to be suitable to cover all biomarker categories. Hence, a combination of different biomarkers and clinical assessments appears to be the most expedient solution at the time.
Collapse
Affiliation(s)
- H S Lapp
- Department of Neurology, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - M Freigang
- Department of Neurology, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - T Hagenacker
- Department of Neurology and Center for Translational Neuro- and Behavioral Science (C-TNBS), University Medicine Essen, Essen, Germany
| | - M Weiler
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - C D Wurster
- Department of Neurology, University Hospital Ulm, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE) Ulm, Ulm, Germany
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
- German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany.
| |
Collapse
|
31
|
Ghaderi S, Fatehi F, Kalra S, Batouli SAH. MRI biomarkers for memory-related impairment in amyotrophic lateral sclerosis: a systematic review. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-17. [PMID: 37469125 DOI: 10.1080/21678421.2023.2236651] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/06/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
Introduction: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder associated with cognitive and behavioral impairments and motor symptoms. Magnetic resonance imaging (MRI) biomarkers have been investigated as potential tools for detecting and monitoring memory-related impairment in ALS. Our objective was to examine the importance of identifying MRI biomarkers for memory-related impairment in ALS, motor neuron disease (MND), and ALS frontotemporal dementia (FTD) (ALS-FTD) patients. Methods: PubMed and Scopus databases were searched. Keywords covering magnetic resonance imaging, ALS, MND, and memory impairments were searched. There were a total of 25 studies included in our work here. Results: The structural MRI (sMRI) studies reported gray matter (GM) atrophy in the regions associated with memory processing, such as the hippocampus and parahippocampal gyrus (PhG), in ALS patients. The diffusion tensor imaging (DTI) studies showed white matter (WM) alterations in the corticospinal tract (CST) and other tracts that are related to motor and extra-motor functions, and these alterations were associated with memory and executive function impairments in ALS. The functional MRI (fMRI) studies also demonstrated an altered activation in the prefrontal cortex, limbic system, and other brain regions involved in memory and emotional processing in ALS patients. Conclusion: MRI biomarkers show promise in uncovering the neural mechanisms of memory-related impairment in ALS. Nonetheless, addressing challenges such as sample sizes, imaging protocols, and longitudinal studies is crucial for future research. Ultimately, MRI biomarkers have the potential to be a tool for detecting and monitoring memory-related impairments in ALS.
Collapse
Affiliation(s)
- Sadegh Ghaderi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Neurology Department, Neuromuscular Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- Neurology Department, Neuromuscular Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanjay Kalra
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Seyed Amir Hossein Batouli
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
32
|
Zeppelin Z, Vaeggemose M, Witt A, Hvid LG, Tankisi H. Exploring the peripheral mechanisms of lower limb immobilisation on muscle function using novel electrophysiological methods. Clin Neurophysiol 2023; 151:18-27. [PMID: 37141780 DOI: 10.1016/j.clinph.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/02/2023] [Accepted: 04/06/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To explore the effects of short-term immobilisation and subsequent retraining on peripheral nervous system (PNS) measures using two novel electrophysiological methods, muscle velocity recovery cycles (MVRC) and MScanFit motor unit number estimation (MUNE) alongside lower limb muscle strength, muscle imaging and walking capacity. METHODS Twelve healthy participants underwent 1-week of ankle immobilisation and 2-weeks of retraining. Assessments before and after immobilisation, and after retraining, included MVRC [muscle membrane properties; muscle relative refractory period (MRRP), early and late supernormality], MScanFit, MRI-scans [muscle contractile cross-sectional area (cCSA)], isokinetic dynamometry [dorsal and plantar flexor muscle strength], and 2-minute maximal walk test [physical function]. RESULTS After immobilisation, compound muscle action potential (CMAP) amplitude reduced (-1.35[-2.00;-0.69]mV); mean change [95%CI]) alongside reductions in plantar (but not dorsal) flexor muscle cCSA (-124[-246;3]mm2), dorsal flexor muscle strength (isometric -0.06[-0.10;-0.02]Nm/kg, dynamicslow -0.08[-0.11;-0.04]Nm/kg, dynamicfast no changes), plantar flexor muscle strength (isometric -0.20[-0.30;-0.10]Nm/kg, dynamicslow -0.19[-0.28;-0.09]Nm/kg, dynamicfast -0.12[-0.19;-0.05]Nm/kg) and walking capacity (-31[-39;-23]m). After retraining, all immobilisation-affected parameters returned to baseline levels. In contrast, neither MScanFit nor MVRC were affected apart from slightly prolonged MRRP in gastrocnemius. CONCLUSIONS PNS do not contribute to the changes observed in muscle strength and walking capacity. SIGNIFICANCE Further studies should include both corticospinal and peripheral mechanisms.
Collapse
Affiliation(s)
- Zennia Zeppelin
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark
| | - Michael Vaeggemose
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Agnes Witt
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Denmark; The Danish MS Hospitals, Ry and Haslev, Denmark
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Denmark; Institute of Clinical Medicine, Aarhus University, Denmark.
| |
Collapse
|
33
|
Roy B, Peck A, Evangelista T, Pfeffer G, Wang L, Diaz‐Manera J, Korb M, Wicklund MP, Milone M, Freimer M, Kushlaf H, Villar‐Quiles R, Stojkovic T, Needham M, Palmio J, Lloyd TE, Keung B, Mozaffar T, Weihl CC, Kimonis V. Provisional practice recommendation for the management of myopathy in VCP-associated multisystem proteinopathy. Ann Clin Transl Neurol 2023; 10:686-695. [PMID: 37026610 PMCID: PMC10187720 DOI: 10.1002/acn3.51760] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
Valosin-containing protein (VCP)-associated multisystem proteinopathy (MSP) is a rare genetic disorder with abnormalities in the autophagy pathway leading to various combinations of myopathy, bone diseases, and neurodegeneration. Ninety percent of patients with VCP-associated MSP have myopathy, but there is no consensus-based guideline. The goal of this working group was to develop a best practice set of provisional recommendations for VCP myopathy which can be easily implemented across the globe. As an initiative by Cure VCP Disease Inc., a patient advocacy organization, an online survey was initially conducted to identify the practice gaps in VCP myopathy. All prior published literature on VCP myopathy was reviewed to better understand the different aspects of management of VCP myopathy, and several working group sessions were conducted involving international experts to develop this provisional recommendation. VCP myopathy has a heterogeneous clinical phenotype and should be considered in patients with limb-girdle muscular dystrophy phenotype, or any myopathy with an autosomal dominant pattern of inheritance. Genetic testing is the only definitive way to diagnose VCP myopathy, and single-variant testing in the case of a known familial VCP variant, or multi-gene panel sequencing in undifferentiated cases can be considered. Muscle biopsy is important in cases of diagnostic uncertainty or lack of a definitive pathogenic genetic variant since rimmed vacuoles (present in ~40% cases) are considered a hallmark of VCP myopathy. Electrodiagnostic studies and magnetic resonance imaging can also help rule out disease mimics. Standardized management of VCP myopathy will optimize patient care and help future research initiatives.
Collapse
Affiliation(s)
- Bhaskar Roy
- Department of NeurologyYale School of MedicineNew HavenConnecticutUSA
| | | | - Teresinha Evangelista
- GH Pitié‐Salpêtrière, Sorbonne Université‐Inserm UMRS97, Institut de MyologieParisFrance
| | - Gerald Pfeffer
- Hotchkiss Brain Institute, Department of Clinical NeurosciencesUniversity of Calgary Cumming School of MedicineCalgaryAlbertaCanada
| | - Leo Wang
- Department of NeurologyUniversity of WashingtonSeattleWashingtonUSA
| | - Jordi Diaz‐Manera
- John Walton Muscular Dystrophy Research CentreNewcastle UniversityNewcastle upon TyneUK
| | - Manisha Korb
- Department of NeurologyUniversity of California—Irvine School of MedicineOrangeCaliforniaUSA
| | | | | | - Miriam Freimer
- Department of NeurologyOhio State UniversityColumbusOhioUSA
| | - Hani Kushlaf
- Department of Neurology and Rehabilitation MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Rocio‐Nur Villar‐Quiles
- APHP, Reference Center for Neuromuscular Disorders, Center of Research in MyologySorbonne Université‐Inserm UMRS974, Pitié‐Salpêtrière HospitalParisFrance
| | - Tanya Stojkovic
- APHP, Reference Center for Neuromuscular Disorders, Center of Research in MyologySorbonne Université‐Inserm UMRS974, Pitié‐Salpêtrière HospitalParisFrance
| | - Merrilee Needham
- University of Notre Dame, Murdoch University and Fiona Stanley HospitalPerthAustralia
| | - Johanna Palmio
- Neuromuscular Research CenterTampere University HospitalTampereFinland
| | - Thomas E. Lloyd
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMassachusettsUSA
- Department of Neuroscience and PathologyJohns Hopkins University School of MedicineBaltimoreMassachusettsUSA
| | - Benison Keung
- Department of NeurologyYale School of MedicineNew HavenConnecticutUSA
| | - Tahseen Mozaffar
- Department of NeurologyUniversity of California—Irvine School of MedicineOrangeCaliforniaUSA
| | - Conrad Chris Weihl
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Virginia Kimonis
- Department of NeurologyUniversity of California—Irvine School of MedicineOrangeCaliforniaUSA
- Department of PediatricsUniversity of California—Irvine School of MedicineOrangeCaliforniaUSA
| |
Collapse
|
34
|
Reilly MM, Herrmann DN, Pareyson D, Scherer SS, Finkel RS, Züchner S, Burns J, Shy ME. Trials for Slowly Progressive Neurogenetic Diseases Need Surrogate Endpoints. Ann Neurol 2023; 93:906-910. [PMID: 36891823 PMCID: PMC10192108 DOI: 10.1002/ana.26633] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/10/2023]
Abstract
Heritable neurological disorders provide insights into disease mechanisms that permit development of novel therapeutic approaches including antisense oligonucleotides, RNA interference, and gene replacement. Many neurogenetic diseases are rare and slowly progressive making it challenging to measure disease progression within short time frames. We share our experience developing clinical outcome assessments and disease biomarkers in the inherited peripheral neuropathies. We posit that carefully developed biomarkers from imaging, plasma, or skin can predict meaningful progression in functional and patient reported outcome assessments such that clinical trials of less than 2 years will be feasible for these rare and ultra-rare disorders. ANN NEUROL 2023;93:906-910.
Collapse
Affiliation(s)
- Mary M Reilly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | | | - Davide Pareyson
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Steven S Scherer
- Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Richard S Finkel
- Center for Experimental Neurotherapeutics, St. Jude Children's Research Hospital, Memphis, TN
| | - Stephan Züchner
- Dr. John T. Macdonald Foundation Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL
| | - Joshua Burns
- Sydney School of Health Sciences, University of Sydney, Sydney, Australia
| | - Michael E Shy
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa, IA
| |
Collapse
|
35
|
Zubair AS, Salam S, Dimachkie MM, Machado PM, Roy B. Imaging biomarkers in the idiopathic inflammatory myopathies. Front Neurol 2023; 14:1146015. [PMID: 37181575 PMCID: PMC10166883 DOI: 10.3389/fneur.2023.1146015] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Idiopathic inflammatory myopathies (IIMs) are a group of acquired muscle diseases with muscle inflammation, weakness, and other extra-muscular manifestations. IIMs can significantly impact the quality of life, and management of IIMs often requires a multi-disciplinary approach. Imaging biomarkers have become an integral part of the management of IIMs. Magnetic resonance imaging (MRI), muscle ultrasound, electrical impedance myography (EIM), and positron emission tomography (PET) are the most widely used imaging technologies in IIMs. They can help make the diagnosis and assess the burden of muscle damage and treatment response. MRI is the most widely used imaging biomarker of IIMs and can assess a large volume of muscle tissue but is limited by availability and cost. Muscle ultrasound and EIM are easy to administer and can even be performed in the clinical setting, but they need further validation. These technologies may complement muscle strength testing and laboratory studies and provide an objective assessment of muscle health in IIMs. Furthermore, this is a rapidly progressing field, and new advances are going to equip care providers with a better objective assessment of IIMS and eventually improve patient management. This review discusses the current state and future direction of imaging biomarkers in IIMs.
Collapse
Affiliation(s)
- Adeel S. Zubair
- Division of Neuromuscular Diseases, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Sharfaraz Salam
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Mazen M. Dimachkie
- Department of Neurology, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Pedro M. Machado
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Centre for Rheumatology, Division of Medicine, University College London, London, United Kingdom
| | - Bhaskar Roy
- Division of Neuromuscular Diseases, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| |
Collapse
|
36
|
Waldman LE, Michalski MP, Giaconi JC, Pfeffer GB, Learch TJ. Charcot-Marie-Tooth Disease of the Foot and Ankle: Imaging Features and Pathophysiology. Radiographics 2023; 43:e220114. [PMID: 36862083 DOI: 10.1148/rg.220114] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Charcot-Marie-Tooth disease (CMT) is the most common inherited peripheral polyneuropathy, resulting in length-dependent motor and sensory deficiencies. Asymmetric nerve involvement in the lower extremities creates a muscle imbalance, which manifests as a characteristic cavovarus deformity of the foot and ankle. This deformity is widely considered to be the most debilitating symptom of the disease, causing the patient to feel unstable and limiting mobility. Foot and ankle imaging in patients with CMT is critical for evaluation and treatment, as there is a wide range of phenotypic variation. Both radiography and weight-bearing CT should be used for assessment of this complex rotational deformity. Multimodality imaging including MRI and US is also important to help identify changes in the peripheral nerves, diagnose complications of abnormal alignment, and evaluate patients in the perioperative setting. The cavovarus foot is susceptible to distinctive pathologic conditions including soft-tissue calluses and ulceration, fractures of the fifth metatarsal, peroneal tendinopathy, and accelerated arthrosis of the tibiotalar joint. An externally applied brace can assist with balance and distribution of weight but may be appropriate for only a subset of patients. Many patients will require surgical correction, which may include soft-tissue releases, tendon transfers, osteotomies, and arthrodesis when necessary, with the goal of creating a more stable plantigrade foot. The authors focus on the cavovarus deformity of CMT. However, much of the information discussed may also be applied to a similar deformity that may result from idiopathic causes or other neuromuscular conditions. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
Collapse
Affiliation(s)
- Leah E Waldman
- From the Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27705 (L.E.W.); and Departments of Orthopedic Surgery (M.P.M., G.B.P.) and Radiology (J.C.G., T.J.L.), Cedars Sinai Medical Center, Los Angeles, Calif
| | - Max P Michalski
- From the Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27705 (L.E.W.); and Departments of Orthopedic Surgery (M.P.M., G.B.P.) and Radiology (J.C.G., T.J.L.), Cedars Sinai Medical Center, Los Angeles, Calif
| | - Joseph C Giaconi
- From the Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27705 (L.E.W.); and Departments of Orthopedic Surgery (M.P.M., G.B.P.) and Radiology (J.C.G., T.J.L.), Cedars Sinai Medical Center, Los Angeles, Calif
| | - Glenn B Pfeffer
- From the Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27705 (L.E.W.); and Departments of Orthopedic Surgery (M.P.M., G.B.P.) and Radiology (J.C.G., T.J.L.), Cedars Sinai Medical Center, Los Angeles, Calif
| | - Thomas J Learch
- From the Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27705 (L.E.W.); and Departments of Orthopedic Surgery (M.P.M., G.B.P.) and Radiology (J.C.G., T.J.L.), Cedars Sinai Medical Center, Los Angeles, Calif
| |
Collapse
|
37
|
Henson WH, Mazzá C, Dall’Ara E. Deformable image registration based on single or multi-atlas methods for automatic muscle segmentation and the generation of augmented imaging datasets. PLoS One 2023; 18:e0273446. [PMID: 36897869 PMCID: PMC10004495 DOI: 10.1371/journal.pone.0273446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
Muscle segmentation is a process relied upon to gather medical image-based muscle characterisation, useful in directly assessing muscle volume and geometry, that can be used as inputs to musculoskeletal modelling pipelines. Manual or semi-automatic techniques are typically employed to segment the muscles and quantify their properties, but they require significant manual labour and incur operator repeatability issues. In this study an automatic process is presented, aiming to segment all lower limb muscles from Magnetic Resonance (MR) imaging data simultaneously using three-dimensional (3D) deformable image registration (single inputs or multi-atlas). Twenty-three of the major lower limb skeletal muscles were segmented from five subjects, with an average Dice similarity coefficient of 0.72, and average absolute relative volume error (RVE) of 12.7% (average relative volume error of -2.2%) considering the optimal subject combinations. The multi-atlas approach showed slightly better accuracy (average DSC: 0.73; average RVE: 1.67%). Segmented MR imaging datasets of the lower limb are not widely available in the literature, limiting the potential of new, probabilistic methods such as deep learning to be used in the context of muscle segmentation. In this work, Non-linear deformable image registration is used to generate 69 manually checked, segmented, 3D, artificial datasets, allowing access for future studies to use these new methods, with a large amount of reliable reference data.
Collapse
Affiliation(s)
- William H. Henson
- Department of Mechanical Engineering, The University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, The University of Sheffield, Sheffield, United Kingdom
| | - Claudia Mazzá
- Department of Mechanical Engineering, The University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, The University of Sheffield, Sheffield, United Kingdom
| | - Enrico Dall’Ara
- INSIGNEO Institute for in Silico Medicine, The University of Sheffield, Sheffield, United Kingdom
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
38
|
Fridman V, Sillau S, Bockhorst J, Smith K, Moroni I, Pagliano E, Pisciotta C, Piscosquito G, Laurá M, Muntoni F, Bacon C, Feely S, Grider T, Gutmann L, Shy R, Wilcox J, Herrmann DN, Li J, Ramchandren S, Sumner CJ, Lloyd TE, Day J, Siskind CE, Yum SW, Sadjadi R, Finkel RS, Scherer SS, Pareyson D, Reilly MM, Shy ME. Disease Progression in Charcot-Marie-Tooth Disease Related to MPZ Mutations: A Longitudinal Study. Ann Neurol 2023; 93:563-576. [PMID: 36203352 PMCID: PMC9977145 DOI: 10.1002/ana.26518] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/29/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The paucity of longitudinal natural history studies in MPZ neuropathy remains a barrier to clinical trials. We have completed a longitudinal natural history study in patients with MPZ neuropathies across 13 sites of the Inherited Neuropathies Consortium. METHODS Change in Charcot-Marie-Tooth Examination Score (CMTES) and Rasch modified CMTES (CMTES-R) were evaluated using longitudinal regression over a 5-year period in subjects with MPZ neuropathy. Data from 139 patients with MPZ neuropathy were examined. RESULTS The average baseline CMTES and CMTES-R were 10.84 (standard deviation [SD] = 6.0, range = 0-28) and 14.60 (SD = 7.56, range = 0-32), respectively. A mixed regression model showed significant change in CMTES at years 2-5 (mean change from baseline of 0.87 points at 2 years, p = 0.008). Subgroup analysis revealed greater change in CMTES at 2 years in subjects with axonal as compared to demyelinating neuropathy (mean change of 1.30 points [p = 0.016] vs 0.06 points [p = 0.889]). Patients with a moderate baseline neuropathy severity also showed more notable change, by estimate, than those with mild or severe neuropathy (mean 2-year change of 1.14 for baseline CMTES 8-14 [p = 0.025] vs -0.03 for baseline CMTES 0-7 [p = 0.958] and 0.25 for baseline CMTES ≥ 15 [p = 0.6897]). The progression in patients harboring specific MPZ mutations was highly variable. INTERPRETATION CMTES is sensitive to change over time in adult patients with axonal but not demyelinating forms of MPZ neuropathy. Change in CMTES was greatest in patients with moderate baseline disease severity. These findings will inform future clinical trials of MPZ neuropathies. ANN NEUROL 2023;93:563-576.
Collapse
Affiliation(s)
- Vera Fridman
- Department of Neurology, University of Colorado Denver, Aurora, Colorado, USA
| | - Stefan Sillau
- Department of Neurology, University of Colorado Denver, Aurora, Colorado, USA
| | - Jacob Bockhorst
- Department of Neurology, University of Colorado Denver, Aurora, Colorado, USA
| | - Kaitlin Smith
- Department of Neurology, University of Colorado Denver, Aurora, Colorado, USA
| | - Isabella Moroni
- Department of Child Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Emanuela Pagliano
- Department of Child Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Pisciotta
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Guiseppe Piscosquito
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Istituti Clinici Scientifici Maugeri, Neurorehabilitation Unit, Scientific Institute of Telese Terme (BN), Italy
| | - Matilde Laurá
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health & Great Ormond Street Hospital, London, UK
| | - Chelsea Bacon
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Shawna Feely
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Neurology, Wayne State University, Detroit, Michigan, USA
| | - Tiffany Grider
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Laurie Gutmann
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Rosemary Shy
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Neurology, Wayne State University, Detroit, Michigan, USA
| | - Janel Wilcox
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - David N. Herrmann
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Jun Li
- Department of Neurology, Wayne State University, Detroit, Michigan, USA
- Department of Neurology, Vanderbilt University, Nashville, Tennessee, USA
| | - Sindhu Ramchandren
- Department of Neurology, Wayne State University, Detroit, Michigan, USA
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
- PRA Health Sciences, Raleigh, North Carolina, USA
| | - Charlotte J. Sumner
- Departments of Neurology and Neuroscience, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas E. Lloyd
- Departments of Neurology and Neuroscience, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John Day
- Department of Neurology, Stanford University, Stanford, California, USA
| | - Carly E. Siskind
- Department of Neurology, Stanford University, Stanford, California, USA
| | - Sabrina W. Yum
- Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Reza Sadjadi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richard S. Finkel
- Department of Neurology, Nemours Children’s Hospital, Orlando, Florida, USA
| | - Steven S. Scherer
- Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Davide Pareyson
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mary M Reilly
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Michael E. Shy
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Neurology, Wayne State University, Detroit, Michigan, USA
| | | |
Collapse
|
39
|
Peng F, Xu H, Song Y, Xu K, Li S, Cai X, Guo Y, Gong L. Longitudinal study of multi-parameter quantitative magnetic resonance imaging in Duchenne muscular dystrophy: hyperresponsiveness of gluteus maximus and detection of subclinical disease progression in functionally stable patients. J Neurol 2023; 270:1439-1451. [PMID: 36385201 DOI: 10.1007/s00415-022-11470-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the disease progression of Duchenne muscular dystrophy (DMD) in the pelvic and thigh muscles over 1-year using multiple-parameter quantitative magnetic resonance imaging (qMRI), and to determine the most responsive muscle and predict subclinical disease progression in functionally stable patients. METHODS Fifty-four DMD patients (mean age 8.9 ± 2.5, range 5-15 years) completed baseline and 1-year follow-up qMRI examinations/biomarkers [3-point Dixon/fat fraction (FF); T1 mapping/T1; T2 mapping/T2]. Meanwhile, clinical assessments [NorthStar ambulatory assessment (NSAA) score] and timed function tests were performed in DMD patients. Twenty-four healthy male controls (range 5-15 years) accomplished baseline qMRI examinations. Group differences were compared using the Wilcoxon test. The standardized response mean (SRM) was taken as the responsiveness to the disease progression index. RESULTS FF, T1, and T2 in all DMD age subgroups changed significantly over 1-year (P < 0.05). Even in functionally stable patients (NSAA score increased, unchanged, or decreased by 1-point) over 1-year, significant increases in FF and T2 and decreases in T1 were observed in gluteus maximus (GMa), gluteus medius, vastus lateralis, and adductor magnus (P < 0.05). Overall, the SRM of FF, T1, and T2 was all the highest in GMa, which were 1.25, - 0.92, and 0.93, respectively. CONCLUSIONS qMRI biomarkers are responsive to disease progression and can also detect subclinical disease progression in functionally stable DMD patients over 1-year. GMa is the most responsive to disease progression of all the muscles analyzed. TRIAL REGISTRATION Chinese Clinical Trial Registry ( http://www.chictr.org.cn/index.aspx ) ChiCTR1800018340, 09/12/2018, prospectively registered.
Collapse
Affiliation(s)
- Fei Peng
- Department of Medical Imaging Center, The Second Affiliated Hospital of Nanchang University, Minde Road No. 1, Nanchang, 330006, Jiangxi Province, China
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, Sichuan Province, China
| | - Huayan Xu
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, Sichuan Province, China
| | - Yu Song
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, Sichuan Province, China
| | - Ke Xu
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, Sichuan Province, China
| | - Shuhao Li
- Department of Medical Imaging Center, The Second Affiliated Hospital of Nanchang University, Minde Road No. 1, Nanchang, 330006, Jiangxi Province, China
| | - Xiaotang Cai
- Department of Pediatrics Neurology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, Sichuan Province, China.
| | - Yingkun Guo
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, Sichuan Province, China.
| | - Lianggeng Gong
- Department of Medical Imaging Center, The Second Affiliated Hospital of Nanchang University, Minde Road No. 1, Nanchang, 330006, Jiangxi Province, China.
| |
Collapse
|
40
|
Taira K, Mori-Yoshimura M, Yamamoto T, Oya Y, Nishino I, Takahashi Y. Clinical characteristics of dysphagic inclusion body myositis. Neuromuscul Disord 2023; 33:133-138. [PMID: 36575104 DOI: 10.1016/j.nmd.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
This study aimed to characterize dysphagic patients with inclusion body myositis (IBM) with cricopharyngeal bar (CPB) (n = 17; IBM-CPB(+)) by comparing their swallowing function and muscle magnetic resonance imaging data with IBM patients without CPB (n = 28; IBM-CPB(-)). IBM-CPB(+) patients were older at diagnosis and had more frequent obstruction-related dysphagia and stronger knee extension than IBM-CPB(-) patients. IBM-CPB(+) patients also had less intramuscular fatty infiltration than IBM-CPB(-) patients on T1-weighted magnetic resonance images of the rectus femoris (2.6% versus 10.3%, p < 0.05), vastus lateralis (27.8% versus 57.1%, p < 0.01), vastus intermedius (17.6% versus 43.5%, p < 0.01), vastus medialis (14.1% versus 39.1%, p < 0.01), deltoid (5.5% versus 18.7%, p < 0.05), biceps (6.6% versus 21.1%, p < 0.001), and triceps (12.9% versus 33.0%, p < 0.05). These findings suggest that IBM-CPB(+) patients were older, frequently exhibited obstruction-related dysphagia, had stronger knee extension, and had less fatty infiltration of the limb muscles compared to IBM-CPB(-) patients, and provide valuable information on the clinical subset of IBM-CBP(+) patients in order to expand the knowledge of the clinical heterogeneity in IBM.
Collapse
Affiliation(s)
- Kenichiro Taira
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Japan.
| | - Madoka Mori-Yoshimura
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Japan.
| | - Toshiyuki Yamamoto
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Japan; Dysphagia Research Center, National Center of Neurology and Psychiatry, Japan
| | - Yasushi Oya
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Health, National Center of Neurology and Psychiatry, Japan; Medical Genome Center, National Center of Neurology and Psychiatry, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Japan
| |
Collapse
|
41
|
Vegezzi E, Cortese A, Bergsland N, Mussinelli R, Paoletti M, Solazzo F, Currò R, Ascagni L, Callegari I, Quartesan I, Lozza A, Deligianni X, Santini F, Marchioni E, Cosentino G, Alfonsi E, Tassorelli C, Bastianello S, Merlini G, Palladini G, Obici L, Pichiecchio A. Muscle quantitative MRI as a novel biomarker in hereditary transthyretin amyloidosis with polyneuropathy: a cross-sectional study. J Neurol 2023; 270:328-339. [PMID: 36064814 DOI: 10.1007/s00415-022-11336-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The development of reproducible and sensitive outcome measures has been challenging in hereditary transthyretin (ATTRv) amyloidosis. Recently, quantification of intramuscular fat by magnetic resonance imaging (MRI) has proven as a sensitive marker in patients with other genetic neuropathies. The aim of this study was to investigate the role of muscle quantitative MRI (qMRI) as an outcome measure in ATTRv. METHODS Calf- and thigh-centered multi-echo T2-weighted spin-echo and gradient-echo sequences were obtained in patients with ATTRv amyloidosis with polyneuropathy (n = 24) and healthy controls (n = 12). Water T2 (wT2) and fat fraction (FF) were calculated. Neurological assessment was performed in all ATTRv subjects. Quantitative MRI parameters were correlated with clinical and neurophysiological measures of disease severity. RESULTS Quantitative imaging revealed significantly higher FF in lower limb muscles in patients with ATTRv amyloidosis compared to controls. In addition, wT2 was significantly higher in ATTRv patients. There was prominent involvement of the posterior compartment of the thighs. Noticeably, FF and wT2 did not exhibit a length-dependent pattern in ATTRv patients. MRI biomarkers correlated with previously validated clinical outcome measures, Polyneuropathy Disability scoring system, Neuropathy Impairment Score (NIS) and NIS-lower limb, and neurophysiological parameters of axonal damage regardless of age, sex, treatment and TTR mutation. CONCLUSIONS Muscle qMRI revealed significant difference between ATTRv and healthy controls. MRI biomarkers showed high correlation with clinical and neurophysiological measures of disease severity making qMRI as a promising tool to be further investigated in longitudinal studies to assess its role at monitoring onset, progression, and therapy efficacy for future clinical trials on this treatable condition.
Collapse
Affiliation(s)
- Elisa Vegezzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Andrea Cortese
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. .,Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
| | - Niels Bergsland
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Roberta Mussinelli
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Matteo Paoletti
- Neuroradiology Department, Advanced Imaging and Radiomics Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Francesca Solazzo
- Specialization School in Occupational Medicine, University of Pavia, Pavia, Italy
| | - Riccardo Currò
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Lucia Ascagni
- Neuroscience Department, Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Ilaria Callegari
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031, Basel, Switzerland
| | - Ilaria Quartesan
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Alessandro Lozza
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Xeni Deligianni
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, Basel Muscle MRI Group, University of Basel, Allschwil, Switzerland
| | - Francesco Santini
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, Basel Muscle MRI Group, University of Basel, Allschwil, Switzerland
| | - Enrico Marchioni
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Enrico Alfonsi
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefano Bastianello
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Neuroradiology Department, Advanced Imaging and Radiomics Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Giovanni Palladini
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Laura Obici
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Neuroradiology Department, Advanced Imaging and Radiomics Center, IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
42
|
Glascock J, Darras BT, Crawford TO, Sumner CJ, Kolb SJ, DiDonato C, Elsheikh B, Howell K, Farwell W, Valente M, Petrillo M, Tingey J, Jarecki J. Identifying Biomarkers of Spinal Muscular Atrophy for Further Development. J Neuromuscul Dis 2023; 10:937-954. [PMID: 37458045 PMCID: PMC10578234 DOI: 10.3233/jnd-230054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is caused by bi-allelic, recessive mutations of the survival motor neuron 1 (SMN1) gene and reduced expression levels of the survival motor neuron (SMN) protein. Degeneration of alpha motor neurons in the spinal cord causes progressive skeletal muscle weakness. The wide range of disease severities, variable rates of decline, and heterogenous clinical responses to approved disease-modifying treatment remain poorly understood and limit the ability to optimize treatment for patients. Validation of a reliable biomarker(s) with the potential to support early diagnosis, inform disease prognosis and therapeutic suitability, and/or confirm response to treatment(s) represents a significant unmet need in SMA. OBJECTIVES The SMA Multidisciplinary Biomarkers Working Group, comprising 11 experts in a variety of relevant fields, sought to determine the most promising candidate biomarker currently available, determine key knowledge gaps, and recommend next steps toward validating that biomarker for SMA. METHODS The Working Group engaged in a modified Delphi process to answer questions about candidate SMA biomarkers. Members participated in six rounds of reiterative surveys that were designed to build upon previous discussions. RESULTS The Working Group reached a consensus that neurofilament (NF) is the candidate biomarker best poised for further development. Several important knowledge gaps were identified, and the next steps toward filling these gaps were proposed. CONCLUSIONS NF is a promising SMA biomarker with the potential for prognostic, predictive, and pharmacodynamic capabilities. The Working Group has identified needed information to continue efforts toward the validation of NF as a biomarker for SMA.
Collapse
Affiliation(s)
| | - Basil T. Darras
- Boston Children’s Hospital/Harvard Medical School, Boston, MA, USA
| | - Thomas O. Crawford
- Johns Hopkins University School of Medicine Departments of Neurology and Neuroscience, Department of Neurology and Pediatrics, Baltimore, MD, USA
| | - Charlotte J. Sumner
- Johns Hopkins University School of Medicine Departments of Neurology and Neuroscience, Department of Neurology and Pediatrics, Baltimore, MD, USA
| | - Stephen J. Kolb
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Biological Chemistry & Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Bakri Elsheikh
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kelly Howell
- Spinal Muscular Atrophy Foundation, Jackson, WY, USA
| | | | | | | | | | | |
Collapse
|
43
|
Monforte M, Attarian S, Vissing J, Diaz-Manera J, Tasca G. 265th ENMC International Workshop: Muscle imaging in Facioscapulohumeral Muscular Dystrophy (FSHD): relevance for clinical trials. 22-24 April 2022, Hoofddorp, The Netherlands. Neuromuscul Disord 2023; 33:65-75. [PMID: 36369218 DOI: 10.1016/j.nmd.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Mauro Monforte
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Shahram Attarian
- Reference Center for Neuromuscular Disorders and ALS, CHU La Timone Aix-Marseille Hospital University Marseille, France
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jordi Diaz-Manera
- John Walton Muscular Dystrophy Research Center, University of Newcastle, Newcastle upon Tyne, United Kingdom
| | - Giorgio Tasca
- Unità Operativa Complessa di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, Rome 00168, Italy.
| |
Collapse
|
44
|
Wei XJ, Sun H, Miao J, Qiu RQ, Jiang ZZ, Ma ZW, Sun W, Yu XF. Clinical-pathological features and muscle imaging findings in 36 Chinese patients with rimmed vacuolar myopathies: case series study and review of literature. Front Neurol 2023; 14:1152738. [PMID: 37188302 PMCID: PMC10175607 DOI: 10.3389/fneur.2023.1152738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Rimmed vacuolar myopathies (RVMs) are a group of genetically heterogeneous diseases that share histopathological characteristics on muscle biopsy, including the aberrant accumulation of autophagic vacuoles. However, the presence of non-coding sequences and structural mutations, some of which remain undetectable, confound the identification of pathogenic mutations responsible for RVMs. Therefore, we assessed the clinical profiles and muscle magnetic resonance imaging (MRI) changes in 36 Chinese patients with RVMs, emphasizing the role of muscle MRI in disease identification and differential diagnosis to propose a comprehensive literature-based imaging pattern to facilitate improved diagnostic workup. Methods All patients presented with rimmed vacuoles with varying degrees of muscular dystrophic changes and underwent a comprehensive evaluation using clinical, morphological, muscle MRI and molecular genetic analysis. We assessed muscle changes in the Chinese RVMs and provided an overview of the RVMs, focusing on the patterns of muscle involvement on MRI. Results A total of 36 patients, including 24 with confirmed distal myopathy and 12 with limb-girdle phenotype, had autophagic vacuoles with RVMs. Hierarchical clustering of patients according to the predominant effect of the distal or proximal lower limbs revealed that most patients with RVMs could be distinguished. GNE myopathy was the most prevalent form of RVMs observed in this study. Moreover, MRI helped identify the causative genes in some diseases (e.g., desminopathy and hereditary myopathy with early respiratory failure) and confirmed the pathogenicity of a novel mutation (e.g., adult-onset proximal rimmed vacuolar titinopathy) detected using next-generation sequencing. Discussion Collectively, our findings expand our knowledge of the genetic spectrum of RVMs in China and suggest that muscle imaging should be an integral part of assisting genetic testing and avoiding misdiagnosis in the diagnostic workup of RVM.
Collapse
|
45
|
Keene KR, Kan HE, van der Meeren S, Verbist BM, Tannemaat MR, Beenakker JM, Verschuuren JJ. Clinical and imaging clues to the diagnosis and follow-up of ptosis and ophthalmoparesis. J Cachexia Sarcopenia Muscle 2022; 13:2820-2834. [PMID: 36172973 PMCID: PMC9745561 DOI: 10.1002/jcsm.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022] Open
Abstract
Ophthalmoparesis and ptosis can be caused by a wide range of rare or more prevalent diseases, several of which can be successfully treated. In this review, we provide clues to aid in the diagnosis of these diseases, based on the clinical symptoms, the involvement pattern and imaging features of extra-ocular muscles (EOM). Dysfunction of EOM including the levator palpebrae can be due to muscle weakness, anatomical restrictions or pathology affecting the innervation. A comprehensive literature review was performed to find clinical and imaging clues for the diagnosis and follow-up of ptosis and ophthalmoparesis. We used five patterns as a framework for differential diagnostic reasoning and for pattern recognition in symptomatology, EOM involvement and imaging results of individual patients. The five patterns were characterized by the presence of combination of ptosis, ophthalmoparesis, diplopia, pain, proptosis, nystagmus, extra-orbital symptoms, symmetry or fluctuations in symptoms. Each pattern was linked to anatomical locations and either hereditary or acquired diseases. Hereditary muscle diseases often lead to ophthalmoparesis without diplopia as a predominant feature, while in acquired eye muscle diseases ophthalmoparesis is often asymmetrical and can be accompanied by proptosis and pain. Fluctuation is a hallmark of an acquired synaptic disease like myasthenia gravis. Nystagmus is indicative of a central nervous system lesion. Second, specific EOM involvement patterns can also provide valuable diagnostic clues. In hereditary muscle diseases like chronic progressive external ophthalmoplegia (CPEO) and oculo-pharyngeal muscular dystrophy (OPMD) the superior rectus is often involved. In neuropathic disease, the pattern of involvement of the EOM can be linked to specific cranial nerves. In myasthenia gravis this pattern is variable within patients over time. Lastly, orbital imaging can aid in the diagnosis. Fat replacement of the EOM is commonly observed in hereditary myopathic diseases, such as CPEO. In contrast, inflammation and volume increases are often observed in acquired muscle diseases such as Graves' orbitopathy. In diseases with ophthalmoparesis and ptosis specific patterns of clinical symptoms, the EOM involvement pattern and orbital imaging provide valuable information for diagnosis and could prove valuable in the follow-up of disease progression and the understanding of disease pathophysiology.
Collapse
Affiliation(s)
- Kevin R. Keene
- CJ Gorter MRI Center, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Hermien E. Kan
- CJ Gorter MRI Center, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
- Duchenne CenterThe Netherlands
| | - Stijn van der Meeren
- Department of OphthalmologyLeiden University Medical CenterLeidenThe Netherlands
- Orbital Center, Department of OphthalmologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Berit M. Verbist
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Jan‐Willem M. Beenakker
- CJ Gorter MRI Center, Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of OphthalmologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Radiation OncologyLeiden University Medical CenterLeidenThe Netherlands
| | - Jan J.G.M. Verschuuren
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
- Duchenne CenterThe Netherlands
| |
Collapse
|
46
|
Goyal NA. Inclusion Body Myositis. Continuum (Minneap Minn) 2022; 28:1663-1677. [PMID: 36537974 DOI: 10.1212/con.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW This article highlights the clinical and diagnostic features of inclusion body myositis (IBM) and provides recent insights into the pathomechanisms and therapeutic strategies of the disease. RECENT FINDINGS IBM is an often-misdiagnosed myopathy subtype. Due to the insidious onset and slow progression of muscle weakness, it can often be dismissed as a sign of aging as it commonly presents in older adults. While challenging to recognize upon initial clinical evaluation, the recent recognition of specialized stains highlighting features seen on muscle pathology, the use of diagnostic tools such as the anti-cytosolic 5'-nucleotidase 1A antibody biomarker, and the ability of muscle imaging to detect patterns of preferential muscle involvement seen in IBM has allowed for earlier diagnosis of the disease than was previously possible. While the pathogenesis of IBM has historically been poorly understood, several ongoing studies point toward mechanisms of autophagy and highly differentiated cytotoxic T cells that are postulated to be pathogenic in IBM. SUMMARY Overall advancements in our understanding of IBM have resulted in improvements in the management of the disease and are the foundation of several strategies for current and upcoming novel therapeutic drug trials in IBM.
Collapse
|
47
|
Elmansy M, Morrow JM, Shah S, Fischmann A, Wastling S, Reilly MM, Hanna MG, Helmy EM, El-Essawy SS, Thornton JS, Yousry TA. Evidence of nerve hypertrophy in patients with inclusion body myositis on lower limb MRI. Muscle Nerve 2022; 66:744-749. [PMID: 36151728 DOI: 10.1002/mus.27728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/AIMS Inclusion body myositis (IBM) is a myopathic condition but in some patients has been associated with an axonal length-dependent polyneuropathy. In this study, we quantified the cross-sectional area of the sciatic and tibial nerves in patients with IBM comparing with Charcot-Marie-Tooth disease type 1A (CMT1A) and healthy controls using magnetic resonance neurography (MRN). METHODS MRN of the sciatic and tibial nerves was performed at 3T using MPRAGE and Dixon acquisitions. Nerve cross-sectional area (CSA) was measured at the mid-thigh and upper third calf regions by an observer blinded to the diagnosis. Correlations were performed between these measurements and clinical data. RESULTS A total of 20 patients with IBM, 20 CMT1A and 29 healthy controls (age- and sex-matched) were studied. Sciatic nerve CSA was significantly enlarged in patients with IBM and CMT1A compared to controls (sciatic nerve mean CSA 62.3 ± 22.9 mm2 (IBM) vs. 35.5 ± 9.9 mm2 (controls), p < 0.001; and 96.9 ± 35.5 mm2 (CMT1A) vs. 35.5 ± 9.9 mm2 (controls); p < 0.001). Tibial nerve CSA was also enlarged in IBM and CMT1 patients compared to controls. DISCUSSION MRN reveals significant hypertrophy of the sciatic and tibial nerves in patients with IBM and CMT1A compared to controls. Further studies are needed to correlate with neurophysiological measures and assess whether this finding is useful diagnostically.
Collapse
Affiliation(s)
- Mostafa Elmansy
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, UK.,Department of Radiology, Mansoura University Hospitals, Mansoura, Egypt
| | - Jasper M Morrow
- Queen Square Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Sachit Shah
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, UK
| | - Arne Fischmann
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Stephen Wastling
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, UK
| | - Mary M Reilly
- Queen Square Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Michael G Hanna
- Queen Square Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | | | | | - John S Thornton
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Tarek A Yousry
- Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| |
Collapse
|
48
|
Moore U, Caldas de Almeida Araújo E, Reyngoudt H, Gordish‐Dressman H, Smith FE, Wilson I, James M, Mayhew A, Rufibach L, Day JW, Jones KJ, Bharucha‐Goebel DX, Salort‐Campana E, Pestronk A, Walter MC, Paradas C, Stojkovic T, Mori‐Yoshimura M, Bravver E, Pegoraro E, Mendell JR, Bushby K, Blamire AM, Straub V, Carlier PG, Diaz‐Manera J. Water T2 could predict functional decline in patients with dysferlinopathy. J Cachexia Sarcopenia Muscle 2022; 13:2888-2897. [PMID: 36058852 PMCID: PMC9745487 DOI: 10.1002/jcsm.13063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/18/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Water T2 (T2H2O ) mapping is increasingly being used in muscular dystrophies to assess active muscle damage. It has been suggested as a surrogate outcome measure for clinical trials. Here, we investigated the prognostic utility of T2H2O to identify changes in muscle function over time in limb girdle muscular dystrophies. METHODS Patients with genetically confirmed dysferlinopathy were assessed as part of the Jain Foundation Clinical Outcomes Study in dysferlinopathy. The cohort included 18 patients from two sites, both equipped with 3-tesla magnetic resonance imaging (MRI) systems from the same vendor. T2H2O value was defined as higher or lower than the median in each muscle bilaterally. The degree of deterioration on four functional tests over 3 years was assessed in a linear model against covariates of high or low T2H2O at baseline, age, disease duration, and baseline function. RESULTS A higher T2H2O at baseline significantly correlated with a greater decline on functional tests in 21 out of 35 muscles and was never associated with slower decline. Higher baseline T2H2O in adductor magnus, vastus intermedius, vastus lateralis, and vastus medialis were the most sensitive, being associated bilaterally with greater decline in multiple timed tests. Patients with a higher than median baseline T2H2O (>40.6 ms) in the right vastus medialis deteriorated 11 points more on the North Star Ambulatory Assessment for Dysferlinopathy and lost an additional 86 m on the 6-min walk than those with a lower T2H2O (<40.6 ms). Optimum sensitivity and specificity thresholds for predicting decline were 39.0 ms in adductor magnus and vastus intermedius, 40.0 ms in vastus medialis, and 40.5 ms in vastus lateralis from different sites equipped with different MRI systems. CONCLUSIONS In dysferlinopathy, T2H2O did not correlate with current functional ability. However, T2H2O at baseline was higher in patients who worsened more rapidly on functional tests. This suggests that inter-patient differences in functional decline over time may be, in part, explained by different severities of the active muscle damage, assessed by T2H2O measure at baseline. Significant challenges remain in standardizing T2H2O values across sites to allow determining globally applicable thresholds. The results from the present work are encouraging and suggest that T2H2O could be used to improve prognostication, patient selection, and disease modelling for clinical trials.
Collapse
Affiliation(s)
- Ursula Moore
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research InstituteNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Ericky Caldas de Almeida Araújo
- NMR Laboratory, Neuromuscular Investigation CenterInstitute of MyologyParisFrance
- NMR LaboratoryCEA/DRF/IBFJ/MIRCenParisFrance
| | - Harmen Reyngoudt
- NMR Laboratory, Neuromuscular Investigation CenterInstitute of MyologyParisFrance
- NMR LaboratoryCEA/DRF/IBFJ/MIRCenParisFrance
| | - Heather Gordish‐Dressman
- Center for Translational Science, Division of Biostatistics and Study MethodologyChildren's National Health SystemWashingtonDCUSA
- Pediatrics, Epidemiology and BiostatisticsGeorge Washington UniversityWashingtonDCUSA
| | - Fiona E. Smith
- Magnetic Resonance Centre, Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Ian Wilson
- Magnetic Resonance Centre, Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Meredith James
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research InstituteNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Anna Mayhew
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research InstituteNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | | | - John W. Day
- Department of Neurology and Neurological SciencesStanford University School of MedicineStanfordCAUSA
| | - Kristi J. Jones
- The Children's Hospital at Westmead and The University of SydneySydneyNSWAustralia
| | - Diana X. Bharucha‐Goebel
- Department of NeurologyChildren's National Health SystemWashingtonDCUSA
- National Institutes of Health (NINDS)BethesdaMDUSA
| | | | - Alan Pestronk
- Department of NeurologyWashington University School of MedicineSt. LouisMOUSA
| | - Maggie C. Walter
- Friedrich‐Baur‐Institute, Department of NeurologyLudwig‐Maximilians‐University of MunichMunichGermany
| | - Carmen Paradas
- Neuromuscular Unit, Department of NeurologyHospital U. Virgen del Rocío/Instituto de Biomedicina de SevillaSevillaSpain
| | - Tanya Stojkovic
- Centre de référence des maladies neuromusculairesInstitut de Myologie, AP‐HP, Sorbonne Université, Hôpital Pitié‐SalpêtrièreParisFrance
| | - Madoka Mori‐Yoshimura
- Department of NeurologyNational Center Hospital, National Center of Neurology and PsychiatryTokyoJapan
| | - Elena Bravver
- Neuroscience InstituteCarolinas Neuromuscular/ALS‐MDA Center, Carolinas HealthCare SystemCharlotteNCUSA
| | - Elena Pegoraro
- Department of NeuroscienceUniversity of PadovaPaduaItaly
| | - Jerry R. Mendell
- The Abigail Wexner Research Institute at Nationwide Children's HospitalColumbusOHUSA
| | | | - Kate Bushby
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research InstituteNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Andrew M. Blamire
- Magnetic Resonance Centre, Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Volker Straub
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research InstituteNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Pierre G. Carlier
- Université Paris‐Saclay, CEA, DRF, Service Hospitalier Frederic JoliotOrsayFrance
| | - Jordi Diaz‐Manera
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research InstituteNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle upon TyneUK
- Neuromuscular Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
| |
Collapse
|
49
|
Kim YJ, Kim HS, Lee JH, Yoon YC, Choi BO. Magnetic resonance imaging-based lower limb muscle evaluation in Charcot-Marie-Tooth disease type 1A patients and its correlation with clinical data. Sci Rep 2022; 12:16622. [PMID: 36198750 PMCID: PMC9534835 DOI: 10.1038/s41598-022-21112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/22/2022] [Indexed: 11/25/2022] Open
Abstract
We aimed to derive comprehensive MRI parameters that reflect intramuscular fat infiltration severity for designated lower extremity levels, based on semiquantitative analyses in Charcot-Marie-Tooth disease type 1A (CMT1A) patients. We reviewed lower extremity MRIs of 116 CMT1A patients. Intramuscular fat infiltration grading using the Mercuri scale was performed for the non-dominant lower extremity at three levels (proximal, mid, and distal) for the thigh and at two levels (proximal and distal) for the lower leg. Based on MRI results, the following parameters were calculated for each level and for entire muscles: fat infiltration proportion (FIP), significant fat infiltration proportion (SigFIP), and severe fat infiltration proportion (SevFIP). The relationships between the MRI parameters and clinical data were evaluated using Spearman’s correlation analysis. FIP, SigFIP, and SevFIP measured for entire muscles significantly correlated with Charcot-Marie-Tooth Neuropathy Score (p < 0.001), functional disability scale (p < 0.001), 10-m walk test time (p = 0.0003, 0.0010, and 0.0011), and disease duration (p < 0.001). Similar correlations were demonstrated for FIP, SigFIP, and SevFIP acquired from the lower leg. Our MRI parameters obtained through semiquantitative analyses of muscles significantly correlated with clinical parameters in CMT1A patients, suggesting their potential applicability as imaging markers for clinical severity.
Collapse
Affiliation(s)
- Yeo Jin Kim
- Department of Radiology, Veterans Health Service Medical Center, Seoul, 05368, South Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Byung-Ok Choi
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| |
Collapse
|
50
|
Goyal NA, Greenberg SA, Cauchi J, Araujo N, Li V, Wencel M, Irani T, Wang LH, Palma AM, Villalta SA, Mozaffar T. Correlations of disease severity outcome measures in inclusion body myositis. Neuromuscul Disord 2022; 32:800-805. [PMID: 36050251 PMCID: PMC10069380 DOI: 10.1016/j.nmd.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/13/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022]
Abstract
This study aimed to evaluate the correlation between various outcome measures used to assess disease severity and progression in inclusion body myositis (IBM) clinical trials. A cross-sectional study, involving 51 IBM patients meeting the European Neuromuscular Center (ENMC) 2011 criteria for clinically defined or probable IBM, was completed at the University of California, Irvine. Clinical details, demographic data, and functional data including timed get up (TGU), manual muscle testing, hand grip, pinch dynamometry, as well as IBM functional rating scale (IBMFRS), modified Rankin score, forced vital capacity (FVC), and modified ocular bulbar facial respiratory scale (mOBFRS) were collected on all patients. Descriptive statistics and Pearson's r correlation were performed to analyze the data. Age of the patient did not correlate with any of the outcome measures. Greater severity of IBMFRS scores correlated with longer disease duration as well as greater severity for FVC, strength outcomes, TGU, modified Rankin, and mOBFRS. Additionally, TGU strongly correlated with muscle strength measurements, modified Rankin, and mOBFRS. mOBFRS moderately correlated with IBMFRS, muscle strength, FVC, TGU and modified Rankin score. We demonstrate moderate to strong correlations among the disease severity outcome measures in this study.
Collapse
Affiliation(s)
- Namita A Goyal
- Department of Neurology, University of California, Irvine, CA, United States.
| | - Steven A Greenberg
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jonathan Cauchi
- Department of Neurology, University of California, Irvine, CA, United States
| | - Nadia Araujo
- Department of Neurology, University of California, Irvine, CA, United States
| | - Vivian Li
- Department of Neurology, University of California, Irvine, CA, United States
| | - Marie Wencel
- Department of Neurology, University of California, Irvine, CA, United States
| | - Tyler Irani
- Department of Neurology, University of California, Irvine, CA, United States
| | - Leo H Wang
- Department of Neurology, University of Washington Medical Center, Seattle, WA, United States
| | - Anton M Palma
- Institute for Clinical and Translational Science, University of California, Irvine, CA, United States
| | - S Armando Villalta
- Department of Neurology, University of California, Irvine, CA, United States; Institute for Immunology, United States; Department of Physiology and Biophysics, United States
| | - Tahseen Mozaffar
- Department of Neurology, University of California, Irvine, CA, United States; Institute for Immunology, United States; Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, United States
| |
Collapse
|