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Duijnisveld BJ, Henseler JF, Reijnierse M, Fiocco M, Kan HE, Nelissen RGHH. Quantitative Dixon MRI sequences to relate muscle atrophy and fatty degeneration with range of motion and muscle force in brachial plexus injury. Magn Reson Imaging 2016; 36:98-104. [PMID: 27989913 DOI: 10.1016/j.mri.2016.10.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 10/14/2016] [Accepted: 10/26/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Assessment of muscle atrophy and fatty degeneration in brachial plexus injury (BPI) could yield valuable insight into pathophysiology and could be used to predict clinical outcome. The objective of this study was to quantify and relate fat percentage and cross-sectional area (CSA) of the biceps to range of motion and muscle force of traumatic brachial plexus injury (BPI) patients. METHODS T1-weighted TSE sequence and three-point Dixon images of the affected and non-affected biceps brachii were acquired on a 3 Tesla magnetic resonance scanner to determine the fat percentage, total and contractile CSA of 20 adult BPI patients. Regions of interest were drawn by two independent investigators to determine the inter-observer reliability. Paired Students' t-test and multivariate analysis were used to relate fat percentage, total and contractile CSA to active flexion and biceps muscle force. RESULTS The mean fat percentage 12±5.1% of affected biceps was higher than 6±1.0% of the non-affected biceps (p<0.001). The mean contractile CSA 8.1±5.1cm2 of the affected biceps was lower than 19.4±4.9cm2 of the non-affected biceps (p<0.001). The inter-observer reliability was excellent (ICC 0.82 to 0.96). The contractile CSA contributed most to the reduction in active flexion and muscle force. CONCLUSION Quantitative measurement of fat percentage, total and contractile CSA using three-point Dixon sequences provides an excellent reliability and relates with active flexion and muscle force in BPI.
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Affiliation(s)
- Bouke J Duijnisveld
- Department of Orthopaedics, Leiden University Medical Center, The Netherlands.
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, The Netherlands
| | - Marta Fiocco
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, The Netherlands; Mathematica institute Leiden University, Leiden University Medical Center, The Netherlands
| | - Hermien E Kan
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, The Netherlands
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102
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Ricotti V, Evans MRB, Sinclair CDJ, Butler JW, Ridout DA, Hogrel JY, Emira A, Morrow JM, Reilly MM, Hanna MG, Janiczek RL, Matthews PM, Yousry TA, Muntoni F, Thornton JS. Upper Limb Evaluation in Duchenne Muscular Dystrophy: Fat-Water Quantification by MRI, Muscle Force and Function Define Endpoints for Clinical Trials. PLoS One 2016; 11:e0162542. [PMID: 27649492 PMCID: PMC5029878 DOI: 10.1371/journal.pone.0162542] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 08/24/2016] [Indexed: 01/16/2023] Open
Abstract
Objective A number of promising experimental therapies for Duchenne muscular dystrophy (DMD) are emerging. Clinical trials currently rely on invasive biopsies or motivation-dependent functional tests to assess outcome. Quantitative muscle magnetic resonance imaging (MRI) could offer a valuable alternative and permit inclusion of non-ambulant DMD subjects. The aims of our study were to explore the responsiveness of upper-limb MRI muscle-fat measurement as a non-invasive objective endpoint for clinical trials in non-ambulant DMD, and to investigate the relationship of these MRI measures to those of muscle force and function. Methods 15 non-ambulant DMD boys (mean age 13.3 y) and 10 age-gender matched healthy controls (mean age 14.6 y) were recruited. 3-Tesla MRI fat-water quantification was used to measure forearm muscle fat transformation in non-ambulant DMD boys compared with healthy controls. DMD boys were assessed at 4 time-points over 12 months, using 3-point Dixon MRI to measure muscle fat-fraction (f.f.). Images from ten forearm muscles were segmented and mean f.f. and cross-sectional area recorded. DMD subjects also underwent comprehensive upper limb function and force evaluation. Results Overall mean baseline forearm f.f. was higher in DMD than in healthy controls (p<0.001). A progressive f.f. increase was observed in DMD over 12 months, reaching significance from 6 months (p<0.001, n = 7), accompanied by a significant loss in pinch strength at 6 months (p<0.001, n = 9) and a loss of upper limb function and grip force observed over 12 months (p<0.001, n = 8). Conclusions These results support the use of MRI muscle f.f. as a biomarker to monitor disease progression in the upper limb in non-ambulant DMD, with sensitivity adequate to detect group-level change over time intervals practical for use in clinical trials. Clinical validity is supported by the association of the progressive fat transformation of muscle with loss of muscle force and function.
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Affiliation(s)
- Valeria Ricotti
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
- * E-mail:
| | - Matthew R. B. Evans
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
- Neuroradiological Academic Unit, UCL Institute of Neurology, London, United Kingdom
| | - Christopher D. J. Sinclair
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
- Neuroradiological Academic Unit, UCL Institute of Neurology, London, United Kingdom
| | - Jordan W. Butler
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| | - Deborah A. Ridout
- Population, Policy and Practice Programme, UCL Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| | | | - Ahmed Emira
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
- Neuroradiological Academic Unit, UCL Institute of Neurology, London, United Kingdom
| | - Jasper M. Morrow
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
| | - Mary M. Reilly
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
| | - Michael G. Hanna
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
| | | | - Paul M. Matthews
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
- Division of Brain Sciences and Centre for Neurotechnology, Imperial College London, United Kingdom
| | - Tarek A. Yousry
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
- Neuroradiological Academic Unit, UCL Institute of Neurology, London, United Kingdom
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
| | - John S. Thornton
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, United Kingdom
- Neuroradiological Academic Unit, UCL Institute of Neurology, London, United Kingdom
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103
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Simon NG, Noto YI, Zaidman CM. Skeletal muscle imaging in neuromuscular disease. J Clin Neurosci 2016; 33:1-10. [PMID: 27612670 DOI: 10.1016/j.jocn.2016.01.041] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/04/2016] [Indexed: 02/06/2023]
Abstract
Skeletal muscle imaging is increasingly used as a complement to clinical and electrophysiological examination in neuromuscular disease. Ultrasound and MRI have developed as the modalities of choice, each with strengths and limitations. Characteristic changes of muscle denervation and myopathy are seen on imaging which may delineate the nature of the disease process or help guide muscle biopsy. Identifying patterns of muscle involvement in hereditary myopathies may inform genetic testing. This review discusses skeletal muscle imaging in neuromuscular disease focusing on practical applications of current and emerging ultrasound and MRI techniques.
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Affiliation(s)
- Neil G Simon
- St Vincent's Clinical School, University of New South Wales, Level 5 deLacy Building, St Vincent's Hospital, Victoria Street, Darlinghurst, NSW 2010, Australia; Department of Neurology, St Vincent's Hospital, Darlinghurst, NSW, Australia.
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Brain and Mind Centre, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Craig M Zaidman
- Department of Neurology, Washington University in St. Louis, St Louis, MO, USA
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104
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Siracusano G, La Corte A, Milazzo C, Anastasi GP, Finocchio G, Gaeta M. On the R 2⁎ relaxometry in complex multi-peak multi-Echo chemical shift-based water-fat quantification: Applications to the neuromuscular diseases. Magn Reson Imaging 2016; 35:4-14. [PMID: 27569370 DOI: 10.1016/j.mri.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/03/2016] [Accepted: 08/20/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Investigation of the feasibility of the R2⁎ mapping techniques by using latest theoretical models corrected for confounding factors and optimized for signal to noise ratio. THEORY AND METHODS The improvement of the performance of state of the art magnetic resonance imaging (MRI) relaxometry algorithms is challenging because of a non-negligible bias and still unresolved numerical instabilities. Here, R2⁎ mapping reconstructions, including complex fitting with multi-spectral fat-correction by using single-decay and double-decay formulation, are deeply studied in order to investigate and identify optimal configuration parameters and minimize the occurrence of numerical artifacts. The effects of echo number, echo spacing, and fat/water relaxation model type are evaluated through both simulated and in-vivo data. We also explore the stability and feasibility of the fat/water relaxation model by analyzing the impact of high percentage of fat infiltrations and local transverse relaxation differences among biological species. RESULTS The main limits of the MRI relaxometry are the presence of bias and the occurrence of artifacts, which significantly affect its accuracy. Chemical-shift complex R2⁎-correct single-decay reconstructions exhibit a large bias in presence of a significant difference in the relaxation rates of fat and water and with fat concentration larger than 30%. We find that for fat-dominated tissues or in patients affected by extensive iron deposition, MRI reconstructions accounting for multi-exponential relaxation time provide accurate R2⁎ measurements and are less prone to numerical artifacts. CONCLUSIONS Complex fitting and fat-correction with multi-exponential decay formulation outperforms the conventional single-decay approximation in various diagnostic scenarios. Although it still lacks of numerical stability, which requires model enhancement and support from spectroscopy, it offers promising perspectives for the development of relaxometry as a reliable tool to improve tissue characterization and monitoring of neuromuscular disorders.
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Affiliation(s)
- Giulio Siracusano
- Department of Mathematical and Computer Sciences, Physical Sciences and Earth Sciences, University of Messina, V.le F. D'alcontres, 31, 98166, Messina, Italy; Department of Computer Engineering and Telecommunications, University of Catania, Viale Andrea Doria 6, 95125, Catania, Italy.
| | - Aurelio La Corte
- Department of Computer Engineering and Telecommunications, University of Catania, Viale Andrea Doria 6, 95125, Catania, Italy
| | - Carmelo Milazzo
- Department of Biomedical sciences, Dental and of Morphological and Functional images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Giuseppe Pio Anastasi
- Department of Biomedical sciences, Dental and of Morphological and Functional images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Giovanni Finocchio
- Department of Mathematical and Computer Sciences, Physical Sciences and Earth Sciences, University of Messina, V.le F. D'alcontres, 31, 98166, Messina, Italy; Istituto Nazionale di Geofisica e Vulcanologia (INGV), Via Vigna Murata 605, 00143, Roma, Italy
| | - Michele Gaeta
- Department of Biomedical sciences, Dental and of Morphological and Functional images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
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105
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Løkken N, Hedermann G, Thomsen C, Vissing J. Contractile properties are disrupted in Becker muscular dystrophy, but not in limb girdle type 2I. Ann Neurol 2016; 80:466-71. [PMID: 27463532 DOI: 10.1002/ana.24743] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/14/2016] [Accepted: 07/24/2016] [Indexed: 12/16/2022]
Abstract
We investigated whether a linear relationship between muscle strength and cross-sectional area (CSA) is preserved in calf muscles of patients with Becker muscular dystrophy (BMD, n = 14) and limb-girdle type 2I muscular dystrophy (LGMD2I, n = 11), before and after correcting for muscle fat infiltration. The Dixon magnetic resonance imaging technique was used to quantify fat and calculate a fat-free contractile CSA. Strength was assessed by dynamometry. Muscle strength/CSA relationships were significantly lower in patients versus controls. The strength/contractile-CSA relationship was still severely lowered in BMD, but was almost normalized in LGMD2I. Our findings suggest close to intact contractile properties in LGMD2I, which are severely disrupted in BMD. Ann Neurol 2016;80:466-471.
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Affiliation(s)
| | | | - Carsten Thomsen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Copenhagen, Denmark.
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Willcocks RJ, Rooney WD, Triplett WT, Forbes SC, Lott DJ, Senesac CR, Daniels MJ, Wang DJ, Harrington AT, Tennekoon GI, Russman BS, Finanger EL, Byrne BJ, Finkel RS, Walter GA, Sweeney HL, Vandenborne K. Multicenter prospective longitudinal study of magnetic resonance biomarkers in a large duchenne muscular dystrophy cohort. Ann Neurol 2016; 79:535-47. [PMID: 26891991 DOI: 10.1002/ana.24599] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/11/2015] [Accepted: 01/02/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to describe Duchenne muscular dystrophy (DMD) disease progression in the lower extremity muscles over 12 months using quantitative magnetic resonance (MR) biomarkers, collected across three sites in a large cohort. METHODS A total of 109 ambulatory boys with DMD (8.7 ± 2.0 years; range, 5.0-12.9) completed baseline and 1-year follow-up quantitative MR imaging (transverse relaxation time constant; MRI-T2 ), MR spectroscopy (fat fraction and (1) H2 O T2 ), and 6-minute walk test (6MWT) measurements. A subset of boys completed additional measurements after 3 or 6 months. RESULTS MRI-T2 and fat fraction increased significantly over 12 months in all age groups, including in 5- to 6.9-year-old boys. Significant increases in vastus lateralis (VL) fat fraction were observed in 3 and 6 months. Even in boys whose 6MWT performance improved or remained stable over 1 year, significant increases in MRI-T2 and fat fraction were found. Of all the muscles examined, the VL and biceps femoris long head were the most responsive to disease progression in boys with DMD. INTERPRETATION MR biomarkers are responsive to disease progression in 5- to 12.9-year-old boys with DMD and able to detect subclinical disease progression in DMD, even within short (3-6 months) time periods. The measured sensitivity of MR biomarkers in this multicenter study may be critically important to future clinical trials, allowing for smaller sample sizes and/or shorter study windows in this fatal rare disease.
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Affiliation(s)
| | - William D Rooney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR
| | | | - Sean C Forbes
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - Donovan J Lott
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - Claudia R Senesac
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - Michael J Daniels
- Department of Statistics & Data Sciences and Department of Integrative Biology, University of Texas at Austin, Austin, TX
| | - Dah-Jyuu Wang
- Division of Neurology and Department of Radiology, the Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Barry S Russman
- Departments of Pediatrics and Neurology, Oregon Health & Science University, Shriners Hospital for Children, Portland, OR
| | - Erika L Finanger
- Departments of Pediatrics and Neurology, Oregon Health & Science University, Shriners Hospital for Children, Portland, OR
| | - Barry J Byrne
- Department of Pediatrics and Molecular Genetics and Microbiology, Powell Gene Therapy Center University of Florida, Gainesville, FL
| | - Richard S Finkel
- Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, FL
| | - Glenn A Walter
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL
| | - H Lee Sweeney
- Department of Physiology, University of Pennsylvania, Philadelphia, PA
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107
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Hogrel JY, Wary C, Moraux A, Azzabou N, Decostre V, Ollivier G, Canal A, Lilien C, Ledoux I, Annoussamy M, Reguiba N, Gidaro T, Le Moing AG, Cardas R, Voit T, Carlier PG, Servais L. Longitudinal functional and NMR assessment of upper limbs in Duchenne muscular dystrophy. Neurology 2016; 86:1022-30. [PMID: 26888987 DOI: 10.1212/wnl.0000000000002464] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 12/03/2015] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To explore the value of nuclear magnetic resonance (NMR) and functional assessments for follow-up of ambulatory and nonambulatory patients with Duchenne muscular dystrophy (DMD). METHODS Twenty-five 53-skippable patients with DMD were included in this study; 15 were nonambulatory at baseline. All patients underwent clinical and functional assessments every 6 months using the Motor Function Measure (MFM), hand grip and key pinch strength, MoviPlate, and NMR spectroscopy and imaging studies. RESULTS Upper limb distal strength decreased in nonambulatory patients over the period of 1 year; ambulatory patients showed improvement during the same period. The same applied for several NMRS indices, such as phosphocreatine/adenosine triphosphate, which decreased in older patients but increased in younger ambulatory patients. Fat infiltration in the upper limbs increased linearly with age. Almost all NMR and functional assessment results correlated. CONCLUSIONS Our results underscore complementarity of functional and NMR assessments in patients with DMD. Sensitivity to change of various indices may differ according to disease stage.
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Affiliation(s)
- Jean-Yves Hogrel
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France.
| | - Claire Wary
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Amélie Moraux
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Noura Azzabou
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Valérie Decostre
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Gwenn Ollivier
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Aurélie Canal
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Charlotte Lilien
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Isabelle Ledoux
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | | | - Nacera Reguiba
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Teresa Gidaro
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | | | - Ruxandra Cardas
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Thomas Voit
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Pierre G Carlier
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Laurent Servais
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
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Wokke BH, Van Den Bergen JC, Hooijmans MT, Verschuuren JJ, Niks EH, Kan HE. T2 relaxation times are increased in Skeletal muscle of DMD but not BMD patients. Muscle Nerve 2015; 53:38-43. [PMID: 25847364 DOI: 10.1002/mus.24679] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Exon-skipping drugs in Duchenne muscular dystrophy (DMD) aim to restore truncated dystrophin expression, which is present in the milder Becker muscular dystrophy (BMD). MRI skeletal muscle T2 relaxation times as a representation of edema/inflammation could be quantitative outcome parameters for such trials. METHODS We studied T2 relaxation times, adjusted for muscle fat fraction using Dixon MRI, in lower leg muscles of DMD and BMD patients and healthy controls. RESULTS T2 relaxation times correlated significantly with fat fractions in patients only (P < 0.001). After adjusting for muscle fat, T2 relaxation times were significantly increased in 6 muscles of DMD patients (P < 0.01), except for the extensor digitorum longus. In BMD, T2 relaxation times were unchanged. CONCLUSIONS T2 relaxation times could be a useful outcome parameter in exon-skipping trials in DMD but are influenced by fat despite fat suppression. This should be accounted for when using quantitative T2 mapping to investigate edema/inflammation.
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Affiliation(s)
- Beatrijs H Wokke
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Melissa T Hooijmans
- C.J. Gorter Centre for high field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan J Verschuuren
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik H Niks
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hermien E Kan
- C.J. Gorter Centre for high field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Quantitative Skeletal Muscle MRI: Part 1, Derived T2 Fat Map in Differentiation Between Boys With Duchenne Muscular Dystrophy and Healthy Boys. AJR Am J Roentgenol 2015. [PMID: 26204309 DOI: 10.2214/ajr.14.13754] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to validate derived T2 maps as an objective measure of muscular fat for discrimination between boys with Duchenne muscular dystrophy (DMD) and healthy boys. SUBJECTS AND METHODS Forty-two boys with DMD (mean age, 9.9 years) and 31 healthy boys (mean age, 11.4 years) were included in the study. Age, body mass index, and clinical function scale grade were evaluated. T1-weighted MR images and T2 maps with and without fat suppression were obtained. Fatty infiltration was graded 0-4 on T1-weighted images, and derived T2 fat values (difference between mean T2 values from T2 maps with and without fat suppression) of the gluteus maximus and vastus lateralis muscles were calculated. Group comparisons were performed. The upper limit of the 95% reference interval of T2 fat values from the control group was applied. RESULTS There was no significant difference in age or body mass index between groups. All healthy boys and 19 boys (45.2%) with DMD had a normal clinical function scale grade. Grade 1 fatty infiltration was seen in 90.3% (gluteus maximus) and 71.0% (vastus lateralis) of healthy boys versus 33.3% (gluteus maximus) and 52.4% (vastus lateralis) of boys with DMD. T2 fat values of boys with DMD were significantly longer than in the control group (p < 0.001). Using a 95% reference interval for healthy boys for the gluteus maximus (28.3 milliseconds) allowed complete separation from boys with DMD (100% sensitivity, 100% specificity), whereas the values for the vastus lateralis (7.28 milliseconds) resulted in 83.3% sensitivity and 100% specificity. CONCLUSION Measurement of muscular fat with T2 maps is accurate for differentiating boys with DMD from healthy boys.
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Wary C, Azzabou N, Giraudeau C, Le Louër J, Montus M, Voit T, Servais L, Carlier P. Quantitative NMRI and NMRS identify augmented disease progression after loss of ambulation in forearms of boys with Duchenne muscular dystrophy. NMR IN BIOMEDICINE 2015; 28:1150-1162. [PMID: 26215733 DOI: 10.1002/nbm.3352] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 04/27/2015] [Accepted: 06/03/2015] [Indexed: 05/27/2023]
Abstract
Quantitative NMRI and (31)P NMRS indices are reported in the forearms of 24 patients with Duchenne muscular dystrophy (DMD) (6-18 years, 14 non-ambulant) amenable to exon 53 skipping therapy and in 12 age-matched male controls (CONT). Examinations carried out at 3 T comprised multi-slice 17-echo measurements of muscle water T2 and heterogeneity, three-point Dixon imaging of fat fraction in flexor and extensor muscles (FLEX, EXT), and non-localised spectroscopy of phosphate metabolites. We studied four imaging indices, eight metabolic ratios combining ATP, phosphocreatine, phosphomonoesters and phosphodiesters, the cytosolic inorganic phosphate (Pia ) and an alkaline (Pib) pool present in dystrophic muscle, and average pH. All indices differed between DMD and CONT, except for muscle water T2 . Measurements were outside the 95th percentile of age-matched CONT values in over 65% of cases for percentage fat signal (%F), and in 78-100% of cases for all spectroscopic indices. T2 was elevated in one-third of FLEX measurements, whereas %pixels > 39 ms and T2 heterogeneity were abnormal in one-half of the examinations. The FLEX muscles had higher fat infiltration and T2 than EXT muscle groups. All indices, except pH, correlated with patient age, although the correlation was negative for T2 . However, in non-ambulant patients, the correlation with years since loss of ambulation was stronger than the correlation with age, and the slope of evolution per year was steeper after loss of ambulation. All indices except Pi/gATP differed between ambulant and non-ambulant patients; however, T2 and %pixels > 39 ms were highest in ambulant patients, possibly owing to the greater extent of inflammatory processes earlier in the disease. All other indices were worse in non-ambulant subjects. Quantitative measurements obtained from patients at different disease stages covered a broad range of abnormalities that evolved with the disease, and metabolic indices were up to 10-fold above normal from the onset, thus establishing a variety of potential markers for future therapy.
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Affiliation(s)
- Claire Wary
- AIM-CEA, Institute of Myology, NMR Laboratory, Paris, France
- CEA, I2BM, MIRCen, IdM NMR Laboratory, Paris, France
- UPMC University, Paris 06, Paris, France
| | - Noura Azzabou
- AIM-CEA, Institute of Myology, NMR Laboratory, Paris, France
- CEA, I2BM, MIRCen, IdM NMR Laboratory, Paris, France
- UPMC University, Paris 06, Paris, France
| | - Céline Giraudeau
- AIM-CEA, Institute of Myology, NMR Laboratory, Paris, France
- CEA, I2BM, MIRCen, IdM NMR Laboratory, Paris, France
- UPMC University, Paris 06, Paris, France
| | - Julien Le Louër
- AIM-CEA, Institute of Myology, NMR Laboratory, Paris, France
- CEA, I2BM, MIRCen, IdM NMR Laboratory, Paris, France
- UPMC University, Paris 06, Paris, France
| | | | - Thomas Voit
- Institute of Myology, UPMC-INSERM U974, CNRS FRE 3617, Paris, France
| | - Laurent Servais
- Institute of Myology, Clinical Trial and Database Unit, Paris, France
| | - Pierre Carlier
- AIM-CEA, Institute of Myology, NMR Laboratory, Paris, France
- CEA, I2BM, MIRCen, IdM NMR Laboratory, Paris, France
- UPMC University, Paris 06, Paris, France
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111
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Quantitative muscle MRI: A powerful surrogate outcome measure in Duchenne muscular dystrophy. Neuromuscul Disord 2015; 25:679-85. [DOI: 10.1016/j.nmd.2015.05.006] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/11/2015] [Accepted: 05/15/2015] [Indexed: 02/04/2023]
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Hu X, Blemker SS. Musculoskeletal simulation can help explain selective muscle degeneration in Duchenne muscular dystrophy. Muscle Nerve 2015; 52:174-82. [DOI: 10.1002/mus.24607] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Xiao Hu
- Department of Biomedical Engineering; University of Virginia; 415 Lane Road Charlottesville Virginia USA 22908
| | - Silvia S. Blemker
- Department of Biomedical Engineering; University of Virginia; 415 Lane Road Charlottesville Virginia USA 22908
- Department of Mechanical and Aerospace Engineering; University of Virginia; Charlottesville Virginia USA
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Leung DG, Carrino JA, Wagner KR, Jacobs MA. Whole-body magnetic resonance imaging evaluation of facioscapulohumeral muscular dystrophy. Muscle Nerve 2015; 52:512-20. [PMID: 25641525 DOI: 10.1002/mus.24569] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 12/22/2014] [Accepted: 01/07/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Facioscapulohumeral muscular dystrophy (FSHD) is a hereditary disorder that causes progressive muscle wasting. Increasing knowledge of the pathophysiology of FSHD has stimulated interest in developing biomarkers of disease severity. METHODS Two groups of MRI scans were analyzed: whole-body scans from 13 subjects with FSHD; and upper and lower extremity scans from 34 subjects with FSHD who participated in the MYO-029 clinical trial. Muscles were scored for fat infiltration and edema-like changes. Fat infiltration scores were compared with muscle strength and function. RESULTS The analysis revealed a distinctive pattern of both frequent muscle involvement and frequent sparing in FSHD. Averaged fat infiltration scores for muscle groups in the legs correlated with quantitative muscle strength and 10-meter walk times. CONCLUSIONS Advances in MRI technology allow for acquisition of rapid, high-quality, whole-body imaging in diffuse muscle disease. This technique offers a promising disease biomarker in FSHD and other muscle diseases.
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Affiliation(s)
- Doris G Leung
- Center for Genetic Muscle Disorders, The Hugo W. Moser Research Institute, Kennedy Krieger Institute, 707 North Broadway, 400A, Baltimore, Maryland, 21205, USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John A Carrino
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Kathryn R Wagner
- Center for Genetic Muscle Disorders, The Hugo W. Moser Research Institute, Kennedy Krieger Institute, 707 North Broadway, 400A, Baltimore, Maryland, 21205, USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael A Jacobs
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Sidney Kimmel Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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114
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Akagi R, Iwanuma S, Hashizume S, Kanehisa H, Fukunaga T, Kawakami Y. Determination of contraction-induced changes in elbow flexor cross-sectional area for evaluating muscle size-strength relationship during contraction. J Strength Cond Res 2015; 29:1741-7. [PMID: 25719914 DOI: 10.1519/jsc.0000000000000793] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aims of this study were to determine contraction-induced changes in the elbow flexor cross-sectional area (CSA) and to examine whether the maximal CSA during a high-intensity contraction is more closely related to the strength than that at rest in the elbow flexors. Fourteen young male subjects participated in this study. The elbow flexor CSAs were measured at sites from 1 cm proximal to 6 cm distal to the reference site (60% of the upper arm length from the acromial process of the scapula to the lateral epicondyle of the humerus) (every 1 cm; 8 sampling sites) using magnetic resonance imaging, at rest and during 10, 20, 40, 60, and 80% of maximal voluntary contraction (MVC) of isometric elbow flexion. The elbow flexor CSA changed greatly during low-intensity contractions, and this contraction-induced change was small over 60%MVC. Compared with at rest, greater CSA around the muscle belly and smaller CSA in the distal portion of the elbow flexors were found in contracted conditions. The MVC strength was significantly correlated with the maximal CSAs at rest and each contraction level, but stepwise multiple regression analysis selected only that during 80%MVC as a significant contributor for estimating the MVC strength. These results suggest that, in the elbow flexors, the contraction-induced change in the CSA reaches its peak under high contractile level and that the maximal CSA during 80%MVC is more closely related to the MVC strength than that at rest.
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Affiliation(s)
- Ryota Akagi
- 1College of Systems Engineering and Science, Shibaura Institute of Technology, Saitama, Japan; 2Center for Fundamental Education, Teikyo University of Science, Tokyo, Japan; 3Research Fellow of the Japan Society for the Promotion of Science, Tokyo, Japan; 4Faculty of Health and Sports Science, Juntendo University, Chiba, Japan; 5National Institute of Fitness and Sports in Kanoya, Kagoshima, Japan; and 6Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Loughran T, Higgins DM, McCallum M, Coombs A, Straub V, Hollingsworth KG. Improving highly accelerated fat fraction measurements for clinical trials in muscular dystrophy: origin and quantitative effect of R2* changes. Radiology 2015; 275:570-8. [PMID: 25575118 DOI: 10.1148/radiol.14141191] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose To investigate the effect of R2* modeling in conventional and accelerated measurements of skeletal muscle fat fraction in control subjects and patients with muscular dystrophy. Materials and Methods Eight patients with Becker muscular dystrophy and eight matched control subjects were recruited with approval from the Newcastle and North Tyneside 2 Research Ethics Committee and with written consent. Chemical-shift images with six widely spaced echo times (in 3.5-msec increments) were acquired to correlate R2* and muscle fat fraction. The effect of incorporating or neglecting R2* modeling on fat fraction magnitude and variance was evaluated in a typical three-echo protocol (with 0.78-msec increments). Accelerated acquisitions with this protocol with 3.65×, 4.94×, and 6.42× undersampling were reconstructed by using combined compressed sensing and parallel imaging and fat fraction maps produced with R2* modeling. Results Muscle R2* at 3.0 T (33-125 sec(-1)) depended on the morphology of fat replacement, the highest values occurring with the greatest interdigitation of fat. The inclusion of R2* modeling removed bias, which was greatest at low fat fraction, but did not increase variance. The 95% limits of agreement of the accelerated acquisitions were tight and not degraded by R2* modeling (1.65%, 1.95%, and 2.22% for 3.65×, 4.94×, and 6.42× acceleration, respectively). Conclusion Incorporating R2* modeling prevents systematic errors in muscle fat fraction by up to 3.5% without loss of precision and should be incorporated into all muscular dystrophy studies. Fat fraction measurements can be accelerated fivefold by using combined compressed sensing and parallel imaging, modeling for R2* without loss of fidelity.
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Affiliation(s)
- Thomas Loughran
- From the Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL, England (T.L., A.C., K.G.H.); Philips Healthcare, Guildford, Surrey, England (D.M.H.); and The John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, England (M.M., V.S.)
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Simultaneous quantification of naproxcinod and its active metabolite naproxen in rat plasma using LC–MS/MS: Application to a pharmacokinetic study. J Chromatogr B Analyt Technol Biomed Life Sci 2015; 978-979:157-62. [DOI: 10.1016/j.jchromb.2014.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/21/2014] [Accepted: 12/03/2014] [Indexed: 02/06/2023]
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117
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Lacourpaille L, Hug F, Guével A, Péréon Y, Magot A, Hogrel JY, Nordez A. Non-invasive assessment of muscle stiffness in patients with duchenne muscular dystrophy. Muscle Nerve 2014; 51:284-6. [DOI: 10.1002/mus.24445] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 01/22/2023]
Affiliation(s)
- Lilian Lacourpaille
- Laboratory “Motricité, Interactions, Performance” (EA 4334), University of Nantes; UFR STAPS, 25 bis boulevard Guy Mollet, BP 72206, 44322 Nantes cedex 3 France
| | - François Hug
- Laboratory “Motricité, Interactions, Performance” (EA 4334), University of Nantes; UFR STAPS, 25 bis boulevard Guy Mollet, BP 72206, 44322 Nantes cedex 3 France
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, School of Health and Rehabilitation Sciences; Brisbane Australia
| | - Arnaud Guével
- Laboratory “Motricité, Interactions, Performance” (EA 4334), University of Nantes; UFR STAPS, 25 bis boulevard Guy Mollet, BP 72206, 44322 Nantes cedex 3 France
| | - Yann Péréon
- Centre de Référence Maladies Neuromusculaires Nantes-Angers, University of Nantes, Centre Hospitalier Universitaire; Nantes France
- Atlantic Gene Therapies; Nantes France
| | - Armelle Magot
- Centre de Référence Maladies Neuromusculaires Nantes-Angers, University of Nantes, Centre Hospitalier Universitaire; Nantes France
- Atlantic Gene Therapies; Nantes France
| | | | - Antoine Nordez
- Laboratory “Motricité, Interactions, Performance” (EA 4334), University of Nantes; UFR STAPS, 25 bis boulevard Guy Mollet, BP 72206, 44322 Nantes cedex 3 France
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118
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Calf muscle involvement in Becker muscular dystrophy: When size does not matter. J Neurol Sci 2014; 347:301-4. [DOI: 10.1016/j.jns.2014.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/08/2014] [Accepted: 10/16/2014] [Indexed: 11/18/2022]
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119
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Forbes SC, Willcocks RJ, Triplett WT, Rooney WD, Lott DJ, Wang DJ, Pollaro J, Senesac CR, Daniels MJ, Finkel RS, Russman BS, Byrne BJ, Finanger EL, Tennekoon GI, Walter GA, Sweeney HL, Vandenborne K. Magnetic resonance imaging and spectroscopy assessment of lower extremity skeletal muscles in boys with Duchenne muscular dystrophy: a multicenter cross sectional study. PLoS One 2014; 9:e106435. [PMID: 25203313 PMCID: PMC4159278 DOI: 10.1371/journal.pone.0106435] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/29/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder that results in functional deficits. However, these functional declines are often not able to be quantified in clinical trials for DMD until after age 7. In this study, we hypothesized that 1H2O T2 derived using 1H-MRS and MRI-T2 will be sensitive to muscle involvement at a young age (5–7 years) consistent with increased inflammation and muscle damage in a large cohort of DMD subjects compared to controls. Methods MR data were acquired from 123 boys with DMD (ages 5–14 years; mean 8.6 SD 2.2 years) and 31 healthy controls (age 9.7 SD 2.3 years) using 3-Tesla MRI instruments at three institutions (University of Florida, Oregon Health & Science University, and Children’s Hospital of Philadelphia). T2-weighted multi-slice spin echo (SE) axial images and single voxel 1H-MRS were acquired from the lower leg and thigh to measure lipid fraction and 1H2O T2. Results MRI-T2, 1H2O T2, and lipid fraction were greater (p<0.05) in DMD compared to controls. In the youngest age group, DMD values were different (p<0.05) than controls for the soleus MRI-T2, 1H2O T2 and lipid fraction and vastus lateralis MRI-T2 and 1H2O T2. In the boys with DMD, MRI-T2 and lipid fraction were greater (p<0.05) in the oldest age group (11–14 years) than the youngest age group (5–6.9 years), while 1H2O T2 was lower in the oldest age group compared to the young age group. Discussion Overall, MR measures of T2 and lipid fraction revealed differences between DMD and Controls. Furthermore, MRI-T2 was greater in the older age group compared to the young age group, which was associated with higher lipid fractions. Overall, MR measures of T2 and lipid fraction show excellent sensitivity to DMD disease pathologies and potential therapeutic interventions in DMD, even in the younger boys.
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Affiliation(s)
- Sean C. Forbes
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
- * E-mail:
| | - Rebecca J. Willcocks
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
| | - William T. Triplett
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
| | - William D. Rooney
- Oregon Health & Science University, Portland, OR, United States of America
| | - Donovan J. Lott
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
| | - Dah-Jyuu Wang
- The Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Jim Pollaro
- Oregon Health & Science University, Portland, OR, United States of America
| | - Claudia R. Senesac
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
| | - Michael J. Daniels
- Department of Statistics & Data Sciences and Department of Integrative Biology, the University of Texas at Austin, Austin, TX, United States of America
| | - Richard S. Finkel
- The Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Nemours Children’s Hospital, Orlando, Florida, United States of America
| | - Barry S. Russman
- Oregon Health & Science University, Portland, OR, United States of America
| | - Barry J. Byrne
- Department of Pediatrics and Molecular Genetics & Microbiology, Powell Gene Therapy Center, University of Florida, Gainesville, FL, United States of America
| | - Erika L. Finanger
- Oregon Health & Science University, Portland, OR, United States of America
| | - Gihan I. Tennekoon
- The Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Glenn A. Walter
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, United States of America
| | - H. Lee Sweeney
- Department of Physiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Krista Vandenborne
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
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Global T2 versus water T2 in NMR imaging of fatty infiltrated muscles: different methodology, different information, and different implications. Neuromuscul Disord 2014; 24:1120-1. [PMID: 25153266 DOI: 10.1016/j.nmd.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 07/14/2014] [Indexed: 11/20/2022]
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121
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Lacourpaille L, Hug F, Guével A, Péréon Y, Magot A, Hogrel JY, Nordez A. New insights on contraction efficiency in patients with Duchenne muscular dystrophy. J Appl Physiol (1985) 2014; 117:658-62. [PMID: 25103971 DOI: 10.1152/japplphysiol.00544.2014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The decrease in muscle strength in patients with Duchenne muscular dystrophy (DMD) is mainly explained by a decrease in the number of active contractile elements. Nevertheless, it is possible that other electrochemical and force transmission processes may contribute. The present study aimed to quantify the effect of DMD on the relative contribution of electrochemical and force transmission components of the electromechanical delay (i.e., time lag between the onset of muscle activation and force production) in humans using very high frame rate ultrasound. Fourteen patients with DMD and thirteen control subjects underwent two electrically evoked contractions of the biceps brachii with the ultrasound probe over the muscle belly. The electromechanical delay was significantly longer in DMD patients compared with controls (18.5 ± 3.9 vs. 12.5 ± 1.4 ms, P < 0.0001). More precisely, DMD patients exhibited a longer delay between the onset of muscle fascicles motion and force production (13.6 ± 3.1 vs. 7.9 ± 2.0 ms, P < 0.0001). This delay was correlated to the chronological age of the DMD patients (r = 0.66; P = 0.01), but not of the controls (r = -0.45; P = 0.10). No significant difference was found for the delay between the onset of muscle stimulation and the onset of muscle fascicle motion. These results highlight the role of the alteration of muscle force transmission (delay between the onset of fascicle motion and force production) in the impairments of the contraction efficiency in patients with DMD.
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Affiliation(s)
- Lilian Lacourpaille
- Laboratory Motricité, Interactions, Performance (EA 4334), Unite de Formation et de Recherche Sciences et Techniques des Activités Physiques et Sportives, University of Nantes, Nantes, France
| | - François Hug
- Laboratory Motricité, Interactions, Performance (EA 4334), Unite de Formation et de Recherche Sciences et Techniques des Activités Physiques et Sportives, University of Nantes, Nantes, France; National Health and Medical Research Council, Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia;
| | - Arnaud Guével
- Laboratory Motricité, Interactions, Performance (EA 4334), Unite de Formation et de Recherche Sciences et Techniques des Activités Physiques et Sportives, University of Nantes, Nantes, France
| | - Yann Péréon
- Centre de Référence Maladies Neuromusculaires Nantes-Angers, University of Nantes, Centre Hospitalier Universitaire, Nantes, France; Atlantic Gene Therapies, Nantes, France; and
| | - Armelle Magot
- Centre de Référence Maladies Neuromusculaires Nantes-Angers, University of Nantes, Centre Hospitalier Universitaire, Nantes, France; Atlantic Gene Therapies, Nantes, France; and
| | | | - Antoine Nordez
- Laboratory Motricité, Interactions, Performance (EA 4334), Unite de Formation et de Recherche Sciences et Techniques des Activités Physiques et Sportives, University of Nantes, Nantes, France
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