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Lee YH, Bae H, Chun YH, Lee JW, Kim HJ. Ultrasonographic examination of masticatory muscles in patients with TMJ arthralgia and headache attributed to temporomandibular disorders. Sci Rep 2024; 14:8967. [PMID: 38637633 PMCID: PMC11026518 DOI: 10.1038/s41598-024-59316-9] [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: 12/23/2023] [Accepted: 04/09/2024] [Indexed: 04/20/2024] Open
Abstract
This study used ultrasonography to compare the thickness and cross-sectional area of the masticatory muscles in patients with temporomandibular joint arthralgia and investigated the differences according to sex and the co-occurrence of headache attributed to temporomandibular disorders (HATMD). The observational study comprised 100 consecutive patients with TMJ arthralgia (71 females and 29 males; mean age, 40.01 ± 17.67 years) divided into two groups: Group 1, including 86 patients with arthralgia alone (60 females; 41.15 ± 17.65 years); and Group 2, including 14 patients with concurrent arthralgia and HATMD (11 females; 33.00 ± 16.72 years). The diagnosis of TMJ arthralgia was based on the diagnostic criteria for temporomandibular disorders. The parameters of the masticatory muscles examined by ultrasonography were subjected to statistical analysis. The pain area (2.23 ± 1.75 vs. 5.79 ± 2.39, p-value = 0.002) and visual analog scale (VAS) score (3.41 ± 1.82 vs. 5.57 ± 12.14, p-value = 0.002) were significantly higher in Group 2 than in Group 1. Muscle thickness (12.58 ± 4.24 mm) and cross-sectional area (4.46 ± 2.57 cm2) were larger in the masseter muscle than in the other three masticatory muscles (p-value < 0.001). When examining sex-based differences, the thickness and area of the masseter and lower temporalis muscles were significantly larger in males (all p-value < 0.05). The area of the masseter muscle (4.67 ± 2.69 vs. 3.18 ± 0.92, p-value = 0.004) and lower temporalis muscle (3.76 ± 0.95 vs. 3.21 ± 1.02, p-value = 0.049) was significantly smaller in Group 2 than in Group 1. An increase in VAS was significantly negatively correlated with the thickness of the masseter (r = - 0.268) and lower temporalis (r = - 0.215), and the cross-sectional area of the masseter (r = - 0.329) and lower temporalis (r = - 0.293). The masseter and lower temporalis muscles were significantly thinner in females than in males, and their volumes were smaller in patients with TMJ arthralgia and HATMD than in those with TMJ arthralgia alone. HATMD and decreased masseter and lower temporalis muscle volume were associated with increased pain intensity.
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Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University, Kyung Hee University Dental Hospital, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Hyungkyu Bae
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - Yang-Hyun Chun
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University, Kyung Hee University Dental Hospital, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Jung-Woo Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, 02447, South Korea.
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea
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Alnajjar SA, Fathihelabad D, Abraham A, Daniyal L, Lovblom LE, Bril V. Systematic Comparison of Muscle Ultrasound Thickness in Polyneuropathies and Other Neuromuscular Diseases. Neurol Ther 2023; 12:1623-1630. [PMID: 37338783 PMCID: PMC10444740 DOI: 10.1007/s40120-023-00485-6] [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: 02/20/2023] [Accepted: 04/18/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND We have aimed to assess whether muscle thickness ultrasound (US) shows differences between patients with chronic inflammatory demyelinating polyneuropathy (CIDP), chronic axonal polyneuropathy (CAP), and other neuromuscular (NM) diseases compared to controls and to each other. METHODS We performed a cross-sectional study from September 2021 to June 2022. All subjects underwent quantitative sonographic evaluation of muscle thickness in eight relaxed muscles and four contracted muscles. Differences were assessed using multivariable linear regression, correcting for age and body mass index (BMI). RESULTS The study cohort consisted of 65 healthy controls, and 95 patients: 31 with CIDP, 34 with CAP, and 30 with other NM diseases. Both relaxed and contracted muscle thickness in all patient groups were lower than in the healthy controls, after controlling for age and body mass index (BMI). Regression confirmed that the differences persisted between patient groups and healthy controls. Differences between patient groups were not apparent. CONCLUSION The current study shows that muscle ultrasound thickness is not specific in NM disorders, but shows a global reduction in thickness compared with healthy controls after corrections for age and BMI.
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Affiliation(s)
- Sara A Alnajjar
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, Toronto, Canada
- University of Toronto, Toronto, Canada
- King Abdulaziz Hospital, Ministry of National Guard Health Affair, Al Ahsa, Saudi Arabia
| | - Davood Fathihelabad
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Alon Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lubna Daniyal
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | - Vera Bril
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, Toronto, Canada.
- University of Toronto, Toronto, Canada.
- 5EC-309, Toronto General Hospital, 200 Elizabeth St., Toronto, ON, Canada.
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Abraham A, Fainmesser Y, Drory VE, Bril V. Quantitative sonographic assessment of muscle thickness and fasciculations distribution is a sensitive tool for neuromuscular disorders. PLoS One 2023; 18:e0292123. [PMID: 37768998 PMCID: PMC10538738 DOI: 10.1371/journal.pone.0292123] [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: 12/19/2022] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Loss of muscle thickness can be demonstrated in a wide spectrum of neuromuscular disorders, while fasciculations are more frequent in amyotrophic lateral sclerosis (ALS). In the current study, we aimed to determine the sensitivity and specificity of quantitative sonographic assessment of muscle thickness and the presence of fasciculations for diagnosing various neuromuscular disorders. METHODS The thickness and the presence of fasciculations in eight muscles were determined by sonography in patients with myopathy (22), polyneuropathy (36), ALS (91), and spinal muscular atrophy (SMA) (31) and compared to normative values determined in 65 heathy control subjects. RESULTS Reduced muscle thickness in at least one relaxed muscle showed 92-100% sensitivity for diagnosing a neuromuscular disease, with a specificity of 85% for differentiating patients from heathy controls (AUC = 0.90). Subtracting distal from proximal muscle thickness may differentiate between myopathy and polyneuropathy. Fasciculations in ≥1 proximal muscle showed good diagnostic accuracy (AUC = 0.87) for diagnosing ALS. DISCUSSION Sonographic assessment of muscle thickness is a sensitive tool for diagnosing a wide spectrum of neuromuscular diseases, and may facilitate diagnosis even in patients with normal strength on neurological examination, while the presence of fasciculations in proximal muscles may facilitate ALS diagnosis.
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Affiliation(s)
- Alon Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaara Fainmesser
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Vivian E. Drory
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
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Avidan R, Fainmesser Y, Drory VE, Bril V, Abraham A. The Sensitivity of Quantitative Sonographic Assessment of Muscle Thickness for Amyotrophic Lateral Sclerosis Diagnosis. J Clin Neurophysiol 2023; 40:529-534. [PMID: 35066529 DOI: 10.1097/wnp.0000000000000917] [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: 11/26/2022] Open
Abstract
PURPOSE In the current proof-of-concept study, we aimed to examine the sensitivities and specificities of previously reported normal values for muscle ultrasound thickness in amyotrophic lateral sclerosis. METHODS Muscle ultrasound was performed in 65 healthy control subjects and 91 amyotrophic lateral sclerosis patients using a standardized assessment of eight relaxed muscles and four contracted muscles. Normal values for muscle thickness were determined as values above the 5th percentile stratified by age and gender using the weighted average method. Sensitivity for amyotrophic lateral sclerosis diagnosis was determined for muscles with and without the addition of muscle contraction. RESULTS Amyotrophic lateral sclerosis patients showed reduced muscle sum thickness both in relaxed and in contracted states compared with control subjects. Muscle ultrasound of muscles with and without contraction showed excellent diagnostic accuracy for differentiating amyotrophic lateral sclerosis patients from control subjects (area under curve = 0.96, sensitivity: 93%-95%, specificity: 84-87). Muscle ultrasound sensitivity was lower within 6 months of symptom onset (83%) compared with longer disease duration (>92%). CONCLUSIONS Quantitative sonographic assessment of muscle thickness can be complementary in the diagnosis of amyotrophic lateral sclerosis with excellent accuracy for differentiating patients from healthy subjects, and might be useful in other neuromuscular disorders, although additional studies are required.
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Affiliation(s)
| | - Yaara Fainmesser
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Vivian E Drory
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alon Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
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Yavuz K, Yurdakul FG, Guler T, Bodur H. Predictive value of ultrasonography in polyneuropathy diagnosis: electrophysiological and ultrasonographic analysis. Rheumatol Int 2023; 43:1733-1742. [PMID: 37318545 DOI: 10.1007/s00296-023-05356-9] [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: 05/02/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
Peripheral neuropathy may cause serious complications such as foot ulcers and Charcot joint which can prevent by early diagnosis. We aimed to analyze the diagnostic value of ultrasonographic measurements of nerves and muscles in distal symmetric axonal polyneuropathy (DSAP). Study included 51 DSAP patients and 51 controls. Nerve conduction studies were performed. Median, ulnar, tibial, superficial peroneal, and sural nerves and the abductor pollicis brevis (APB), abductor digiti minimi (ADM), first dorsal interosseous (FDI), extensor digitorum brevis (EDB), abductor hallucis (AH) and tibialis anterior (TA) muscles were evaluated with ultrasound. The Toronto clinical scoring system (TCSS) was used to assess the severity of neuropathy. The median, ulnar, and tibial nerve cross-sectional areas (CSA) were higher in the DSAP group (p = 0.025, p = 0.011, p < 0.001 respectively) while superficial peroneal and sural nerve CSAs were not differed. Only AH and EDB ultrasonographic findings from the muscles differed between the two groups. Effect of diabetes and DSAP on sonographic findings were assessed with two-way ANOVA. Results indicated that only DSAP had a significant effect on sonographic nerve and muscle examination. The area under the ROC curve was 0.831 ± 0.042 for tibial nerve CSA (p < 0.001) with a cut-off value of 15.5 mm2 (sensitivity 74% and specificity 83%). Median, ulnar and tibial nerve CSAs were found to be larger in polyneuropathy patients and they were associated with the clinical and electrophysiological severity of polyneuropathy. ROC analysis showed that tibial nerve CSA may have a predictive value in the diagnosis of DSAP.
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Affiliation(s)
- Kaan Yavuz
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, Ankara, Turkey
- Physical Therapy and Rehabilitation, Haymana State Hospital, Ankara, Turkey
| | - Fatma Gul Yurdakul
- Department of Physical Medicine and Rehabilitation Hospital, University of Health Sciences Ankara City Hospital, Üniversiteler Mah 1604. Cadde No: 9, 06800, Çankaya/Ankara, Turkey.
| | - Tuba Guler
- Department of Physical Medicine and Rehabilitation Hospital, University of Health Sciences Ankara City Hospital, Üniversiteler Mah 1604. Cadde No: 9, 06800, Çankaya/Ankara, Turkey
| | - Hatice Bodur
- Department of Physical Medicine and Rehabilitation, Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
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Moreira AL, Mendonça RH, Polido GJ, Oliveira MCB, Silva AMS, Zanoteli E. Muscle Ultrasound Changes Correlate With Functional Impairment in Spinal Muscular Atrophy. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1569-1574. [PMID: 37037685 DOI: 10.1016/j.ultrasmedbio.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/18/2023] [Accepted: 02/28/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE We investigated ultrasound patterns of muscle involvement in different types of spinal muscular atrophy (SMA) and their correlation with functional status to determine the pattern of muscle compromise in patients with SMA and the potential role of ultrasound to evaluate disease progression. METHODS We examined muscles (biceps brachii, rectus femoris, diaphragm, intercostals and thoracic multifidus) of 41 patients with SMA (types 1 to 4) and 46 healthy age- and sex-matched control individuals using B-mode ultrasound for gray-scale analysis (GSA), area (biceps brachii and rectus femoris) and diaphragm thickening ratio. Functional scales were applied to patients only. We analyzed ultrasound abnormalities in specific clinical subtypes and correlated findings with functional status. RESULTS Compared with controls, patients had reduced muscle area and increased mean GSA for all muscles (p < 0.001), with an established correlation between the increase in GSA and the severity of SMA for biceps brachii, rectus femoris and intercostals (p = 0.03, 0.01 and 0.004 respectively) when using the Hammersmith Functional Motor Scale Expanded. Diaphragm thickening ratio was normal in the majority of patients, and intercostal muscles had higher GSA than diaphragm in relation to the controls. CONCLUSION Ultrasound is useful for quantifying muscular changes in SMA and correlates with functional status. Diaphragm thickening ratio can be normal even with severe compromise of respiratory muscles in quantitative analysis, and intercostal muscles were more affected than diaphragm.
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Affiliation(s)
- Ana Lucila Moreira
- Departament of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | | | - Graziela Jorge Polido
- Departament of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Edmar Zanoteli
- Departament of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Hu J, Jiang L, Hong S, Cheng L, Wang Q, Peng X, Qin J, Zou L. Quantitative muscle ultrasound in children with Duchenne muscular dystrophy: Comparing to magnetic resonance imaging. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:674-679. [PMID: 36449321 DOI: 10.1002/jcu.23411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/05/2022] [Accepted: 11/11/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVE There is a need today for favorable biomarkers to follow up on the disease progression and therapeutic response in patients with Duchenne muscular dystrophy (DMD). This study evaluates whether quantitative muscle ultrasound (QMUS) or magnetic resonance imaging (MRI) is more suitable for the assessment of DMD in China. METHODS Thirty-six boys with DMD, who were treated with prednisone from baseline to month 12, were enrolled in this longitudinal, observational cohort study. Muscle thickness and echo intensity on QMUS and T1-weighted MRI grading were measured in the right rectus femoris. RESULTS Scores for muscle thickness and echo intensity in QMUS and T1-weighted MRI grading showed significant correlations with the clinical characteristics of muscle strength, timed testing, and quality of life (p < 0.05). Scores for muscle thickness and echo intensity on QMUS also showed good correlations with T1-weighted MRI grading (p < 0.05). However, 15 of 36 boys with DMD did not undergo MRI examinations for various reasons. CONCLUSIONS QMUS and MRI can be used as biomarkers for tracking DMD to some extent. Both have strengths and weaknesses and the specific needs and goals of the clinical or research project are what make one preferable to the other.
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Affiliation(s)
- Jun Hu
- Department of Pediatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Li Jiang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Chongqing, China
- Chongqing International Science, Technology Cooperations Center for Child Development and Disorders, Chongqing, China
- Department of Neurology, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Siqi Hong
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Chongqing, China
- Chongqing International Science, Technology Cooperations Center for Child Development and Disorders, Chongqing, China
- Department of Neurology, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Li Cheng
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Chongqing, China
- Chongqing International Science, Technology Cooperations Center for Child Development and Disorders, Chongqing, China
| | - Qiao Wang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Chongqing, China
- Chongqing International Science, Technology Cooperations Center for Child Development and Disorders, Chongqing, China
- Department of Ultrasound, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Xuehua Peng
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Chongqing, China
- Chongqing International Science, Technology Cooperations Center for Child Development and Disorders, Chongqing, China
- Department of Radiology, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Jiaqiang Qin
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Chongqing, China
- Chongqing International Science, Technology Cooperations Center for Child Development and Disorders, Chongqing, China
- Department of Orthopedics, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Lin Zou
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Chongqing, China
- Chongqing International Science, Technology Cooperations Center for Child Development and Disorders, Chongqing, China
- Molecular Medicine Center, Children's Hospital, Chongqing Medical University, Chongqing, China
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Preclinical Ultrasonography in Rodent Models of Neuromuscular Disorders: The State of the Art for Diagnostic and Therapeutic Applications. Int J Mol Sci 2023; 24:ijms24054976. [PMID: 36902405 PMCID: PMC10003358 DOI: 10.3390/ijms24054976] [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: 02/16/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Ultrasonography is a safe, non-invasive imaging technique used in several fields of medicine, offering the possibility to longitudinally monitor disease progression and treatment efficacy over time. This is particularly useful when a close follow-up is required, or in patients with pacemakers (not suitable for magnetic resonance imaging). By virtue of these advantages, ultrasonography is commonly used to detect multiple skeletal muscle structural and functional parameters in sports medicine, as well as in neuromuscular disorders, e.g., myotonic dystrophy and Duchenne muscular dystrophy (DMD). The recent development of high-resolution ultrasound devices allowed the use of this technique in preclinical settings, particularly for echocardiographic assessments that make use of specific guidelines, currently lacking for skeletal muscle measurements. In this review, we describe the state of the art for ultrasound skeletal muscle applications in preclinical studies conducted in small rodents, aiming to provide the scientific community with necessary information to support an independent validation of these procedures for the achievement of standard protocols and reference values useful in translational research on neuromuscular disorders.
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The Sensitivity and Specificity of Split-Hand Index Using Muscle Sonography. Can J Neurol Sci 2023; 50:228-233. [PMID: 35190003 DOI: 10.1017/cjn.2022.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The split-hand index (SHI) (first dorsal interosseous (FDI) × abductor pollicis brevis (APB)/abductor digiti minimi muscle (ADM)) has been suggested as a useful measure for amyotrophic lateral sclerosis (ALS) diagnosis, using electrophysiological and sonographic indices. In the present study, we aimed to explore the specificity of SHI derived by muscle ultrasound (MUS) for the diagnosis of ALS and spinal muscular atrophy (SMA). METHODS Healthy controls (n = 65) were prospectively recruited at the Prosserman Family Neuromuscular clinic at Toronto General Hospital, from October to December 2018. In addition, 181 patients with ALS (n = 91), SMA (n = 33), polyneuropathy (n = 35), and myopathy (n = 22) were prospectively recruited at the neuromuscular clinic at Tel Aviv Sourasky Medical Center, from December 2018 to December 2020. All subjects underwent quantitative sonographic evaluation of muscle thickness, including the right APB, FDI, and ADM muscles. Area under curve (AUC), sensitivity, and specificity were determined for differentiating between groups. RESULTS Although SHI showed good to excellent accuracy for differentiating each patient subgroup from controls (AUC 0.83-0.92), poorer diagnostic accuracy was shown for differentiating between different patient subgroups (AUC 0.54-0.74). CONCLUSIONS Sonographic SHI is useful for differentiating patients from healthy controls, but might be not specific for motor neuron disease.
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Hsieh PC, Chang CW, Ro LS, Huang CC, Chi JE, Kuo HC. Ultrasonography of abdominal muscles: Differential diagnosis of late-onset Pompe disease and myotonic dystrophy type 1. Front Neurol 2022; 13:944464. [PMID: 36147041 PMCID: PMC9488967 DOI: 10.3389/fneur.2022.944464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/15/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Axial muscles are involved earlier and to a greater extent in late-onset Pompe disease (LOPD) than in myotonic muscular dystrophy type 1 (DM1). We aimed to evaluate abdominal muscles in LOPD compared in DM1 using muscle ultrasonography. Methods Patients with LOPD (n = 3), DM1 (n = 10), and age- and gender-matched healthy subjects (n = 34) were enrolled for muscle ultrasonography. Patients with LOPD and DM1 were 20 to 59 years of age with a disease duration ranging between 7 and 30 years. A multifrequency linear transducer was used to evaluate quality and thickness in the abdominal muscles and extremities. Results The quantitative muscle echo score revealed a higher Z score in abdominal muscles in Patients with LOPD (scores were relatively normal for the biceps and flexor digitorum groups). Patients with LOPD had significantly lower abdominal muscle thickness than patients with DM1. Abdominal muscle strength was significantly correlated with the muscle echogenicity, trunk impairment scale, and trunk control test. The extremities' sum score was correlated with the total Medical Research Council score. Discussion The increased quantitative muscle score in abdominal muscles, sparing the biceps and flexor digitorum groups, may offer differential diagnosis between LOPD and DM1. Ultrasound can easily access abdominal muscles and investigate muscle echogenicity and thickness. A quantitative approach using muscle echogenicity rather than muscle thickness may provide a greater correlation with trunk muscle function.
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Affiliation(s)
- Pei-Chen Hsieh
- Department of Neurology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Wei Chang
- Department of Neurology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Long-Sun Ro
- Department of Neurology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Chang Huang
- Department of Neurology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jia-En Chi
- Department of Orthopedic Surgery, Bone and Joint Research Center, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chou Kuo
- Department of Neurology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Hung-Chou Kuo
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Klein CS, Liu H, Zhao CN, Yang X. Quantitative ultrasound imaging of intrinsic hand muscles after traumatic cervical spinal cord injury. Spinal Cord 2022; 60:199-209. [PMID: 34172926 DOI: 10.1038/s41393-021-00653-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN This is a cross-sectional descriptive study. OBJECTIVES To quantify differences in hand muscle morphology between persons with cervical spinal cord injury (SCI) and uninjured adults. SETTING The study was performed at the Guangdong Work Injury Rehabilitation Hospital. METHODS We quantified hand muscle cross-sectional area (CSA), thickness, and echo intensity (EI) in 18 persons with subacute to chronic SCI and 23 controls using ultrasound imaging. RESULTS Mean SCI abductor pollicis brevis (APB), abductor digiti minimi (ADM), and first dorsal interosseous (FDI) CSA were ~26%, 43%, and 37% smaller than the control means, the deficit in the APB being less than the ADM (P < 0.05). Muscle thickness was also smaller after SCI, but deficits in ADM (31%) and FDI (20%) thickness were less than the CSA deficits (P < 0.05). In five SCI persons, APB CSA and/or opponens pollicis (OP) thickness were normal despite complete motor paralysis. Mean longitudinal image EI was 40% higher in the OP and 15% higher in the flexor pollicis brevis (FPB) after SCI (P < 0.05), suggesting denervation-induced infiltration of fat and fibrous tissues. OP EI was related to OP thickness (r = -0.6, P = 0.007, n = 18). Mean axial image EI was 10% higher in the APB and ADM after SCI (P < 0.05). There were no significant correlations between muscle morphological properties and clinical features in the SCI participants. CONCLUSION Our results indicate significant SCI atrophy and elevated EI that are muscle dependent.
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Affiliation(s)
- Cliff S Klein
- Guangdong Work Injury Rehabilitation Center, Guangzhou, China.
| | - Hui Liu
- Guangdong Work Injury Rehabilitation Center, Guangzhou, China
| | - Chen Ning Zhao
- Guangdong Work Injury Rehabilitation Center, Guangzhou, China
| | - Xinghua Yang
- Guangdong Work Injury Rehabilitation Center, Guangzhou, China
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Introduction. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Winter N, Vittore D, Gess B, Schulz JB, Grimm A, Dohrn MF. New Keys to Early Diagnosis: Muscle Echogenicity, Nerve Ultrasound Patterns, Electrodiagnostic, and Clinical Parameters in 150 Patients with Hereditary Polyneuropathies. Neurotherapeutics 2021; 18:2425-2435. [PMID: 34708324 PMCID: PMC8804010 DOI: 10.1007/s13311-021-01141-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/26/2022] Open
Abstract
Hereditary neuropathies are of variable genotype and phenotype. With upcoming therapies, there is urgent need for early disease recognition and outcome measures. High-resolution nerve and muscle ultrasound is a dynamic, non-invasive, well-established tool in the field of inflammatory and traumatic neuropathies. In this study, we defined nerve and muscle ultrasound parameters as recognition and progression markers in 150 patients with genetically confirmed hereditary neuropathies, including Charcot-Marie-Tooth (CMT) disease (CMT1A, n = 55; other CMT1/4, n = 28; axonal CMT, n = 15; CMTX, n = 15), hereditary neuropathy with liability to pressure palsies (HNPP, n = 16), hereditary transthyretin-amyloidosis (ATTRv, n = 14), and Fabry's disease (n = 7). The CMT1A, followed by the CMT1/4 group, had the most homogeneous enlargement of the nerve cross-sectional areas (CSA) in the ultrasound pattern sum (UPSS) and homogeneity score. Entrapment scores were highest in HNPP, ATTRv amyloidosis, and Fabry's disease patients. In demyelinating neuropathies, the CSA correlated inversely with nerve conduction studies. The muscle echo intensity was significantly highest in the clinically most affected muscles, which was independent from the underlying disease cause and correlated with muscle strength and disease duration. Further correlations were seen with combined clinical (CMTES-2) and electrophysiological (CMTNS-2) scores of disease severity. We conclude that nerve ultrasound is a helpful tool to distinguish different types of hereditary neuropathies by pattern recognition, whereas muscle ultrasound is an objective parameter for disease severity. The implementation of neuromuscular ultrasound might enrich diagnostic procedures both in clinical routines and research.
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Affiliation(s)
- Natalie Winter
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Debora Vittore
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Burkhard Gess
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Jülich Aachen Research Alliance (JARA), FZ Jülich and RWTH University, Jülich, Germany
| | - Alexander Grimm
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.
| | - Maike F Dohrn
- Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Human Genetics and John P. Hussman Institute for Human Genomics, Dr. John T. Macdonald Foundation, University of Miami, Miller School of Medicine, Miami, FL, USA
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14
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Škarabot J, Balshaw TG, Maeo S, Massey GJ, Lanza MB, Maden-Wilkinson TM, Folland JP. Neural adaptations to long-term resistance training: evidence for the confounding effect of muscle size on the interpretation of surface electromyography. J Appl Physiol (1985) 2021; 131:702-715. [PMID: 34166110 DOI: 10.1152/japplphysiol.00094.2021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study compared elbow flexor (EF; experiment 1) and knee extensor (KE; experiment 2) maximal compound action potential (Mmax) amplitude between long-term resistance trained (LTRT; n = 15 and n = 14, 6 ± 3 and 4 ± 1 yr of training) and untrained (UT; n = 14 and n = 49) men, and examined the effect of normalizing electromyography (EMG) during maximal voluntary torque (MVT) production to Mmax amplitude on differences between LTRT and UT. EMG was recorded from multiple sites and muscles of EF and KE, Mmax was evoked with percutaneous nerve stimulation, and muscle size was assessed with ultrasonography (thickness, EF) and magnetic resonance imaging (cross-sectional area, KE). Muscle-electrode distance (MED) was measured to account for the effect of adipose tissue on EMG and Mmax. LTRT displayed greater MVT (+66%-71%, P < 0.001), muscle size (+54%-56%, P < 0.001), and Mmax amplitudes (+29%-60%, P ≤ 0.010) even when corrected for MED (P ≤ 0.045). Mmax was associated with the size of both muscle groups (r ≥ 0.466, P ≤ 0.011). Compared with UT, LTRT had higher absolute voluntary EMG amplitude for the KE (P < 0.001), but not the EF (P = 0.195), and these differences/similarities were maintained after correction for MED; however, Mmax normalization resulted in no differences between LTRT and UT for any muscle and/or muscle group (P ≥ 0.652). The positive association between Mmax and muscle size, and no differences when accounting for peripheral electrophysiological properties (EMG/Mmax), indicates the greater absolute voluntary EMG amplitude of LTRT might be confounded by muscle morphology, rather than providing a discrete measure of central neural activity. This study therefore suggests limited agonist neural adaptation after LTRT.NEW & NOTEWORTHY In a large sample of long-term resistance-trained individuals, we showed greater maximal M-wave amplitude of the elbow flexors and knee extensors compared with untrained individuals, which appears to be at least partially mediated by differences in muscle size. The lack of group differences in voluntary EMG amplitude when normalized to maximal M-wave suggests that differences in muscle morphology might impair interpretation of voluntary EMG as an index of central neural activity.
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Affiliation(s)
- Jakob Škarabot
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, United Kingdom
| | - Thomas G Balshaw
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, United Kingdom.,Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Loughborough University, Leicestershire, United Kingdom
| | - Sumiaki Maeo
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, United Kingdom.,Faculty of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Garry J Massey
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, United Kingdom.,School of Sport and Health Sciences, University of Exeter, Exeter, United Kingdom
| | - Marcel B Lanza
- Department of Physical Therapy and Rehabilitation, University of Maryland, Baltimore, Maryland
| | - Thomas M Maden-Wilkinson
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, United Kingdom.,Academy of Sport and Physical Activity, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom
| | - Jonathan P Folland
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, United Kingdom.,Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Loughborough University, Leicestershire, United Kingdom
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15
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Abraham A, Fainmesser Y, Lovblom LE, Bril V, Drory VE. Superiority of sonographic evaluation of contracted versus relaxed muscle thickness in motor neuron diseases. Clin Neurophysiol 2020; 131:1480-1486. [DOI: 10.1016/j.clinph.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/15/2020] [Accepted: 04/01/2020] [Indexed: 12/13/2022]
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16
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AlMohimeed I, Ono Y. Ultrasound Measurement of Skeletal Muscle Contractile Parameters Using Flexible and Wearable Single-Element Ultrasonic Sensor. SENSORS 2020; 20:s20133616. [PMID: 32605006 PMCID: PMC7374409 DOI: 10.3390/s20133616] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 12/25/2022]
Abstract
Skeletal muscle is considered as a near-constant volume system, and the contractions of the muscle are related to the changes in tissue thickness. Assessment of the skeletal muscle contractile parameters such as maximum contraction thickness (Th), contraction time (Tc), contraction velocity (Vc), sustain time (Ts), and half-relaxation (Tr) provides valuable information for various medical applications. This paper presents a single-element wearable ultrasonic sensor (WUS) and a method to measure the skeletal muscle contractile parameters in A-mode ultrasonic data acquisition. The developed WUS was made of double-layer polyvinylidene fluoride (PVDF) piezoelectric polymer films with a simple and low-cost fabrication process. A flexible, lightweight, thin, and small size WUS would provide a secure attachment to the skin surface without affecting the muscle contraction dynamics of interest. The developed WUS was employed to monitor the contractions of gastrocnemius (GC) muscle of a human subject. The GC muscle contractions were evoked by the electrical muscle stimulation (EMS) at varying EMS frequencies from 2 Hz up to 30 Hz. The tissue thickness changes due to the muscle contractions were measured by utilizing a time-of-flight method in the ultrasonic through-transmission mode. The developed WUS demonstrated the capability to monitor the tissue thickness changes during the unfused and fused tetanic contractions. The tetanic progression level was quantitatively assessed using the parameter of the fusion index (FI) obtained. In addition, the contractile parameters (Th, Tc, Vc, Ts, and Tr) were successfully extracted from the measured tissue thickness changes. In addition, the unfused and fused tetanus frequencies were estimated from the obtained FI-EMS frequency curve. The WUS and ultrasonic method proposed in this study could be a valuable tool for inexpensive, non-invasive, and continuous monitoring of the skeletal muscle contractile properties.
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Affiliation(s)
- Ibrahim AlMohimeed
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON K1S 5B6, Canada;
- Department of Medical Equipment Technology, Majmaah University, Majmaah 11952, Saudi Arabia
| | - Yuu Ono
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON K1S 5B6, Canada;
- Correspondence:
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17
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Abraham A, Fainmesser Y, Drory VE, Bril V. Split-hand phenomenon in motor neuron diseases: Sonographic assesment of muscle thickness. Clin Neurophysiol 2020; 131:1721-1725. [PMID: 32504931 DOI: 10.1016/j.clinph.2020.04.163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/21/2020] [Accepted: 04/07/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To explore the diagnostic accuracy of the split-hand index (SHI) for amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy (SMA) using sonographic assessment of muscle thickness. METHODS We performed a prospective sonographic assessment of hand muscle thickness in 59 controls, 87 patients with ALS, and 33 patients with SMA. We determined the diagnostic accuracy of SHI for differentiating patients with ALS and SMA from controls. RESULTS Patients with ALS and SMA had significantly lower muscle thickness and SHI values compared with controls. SHI showed excellent diagnostic accuracy for differentiating ALS from controls, and good diagnostic accuracy for differentiating SMA from controls. CONCLUSIONS SHI determined by sonographic measurement of hand muscle thickness seems to be a promising tool for the diagnosis of ALS and may be added easily when performing neuromuscular ultrasound. SIGNIFICANCE SHI determined by sonographic measurement of hand muscle thickness can differentiate between healthy subjects and patients with ALS and SMA.
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Affiliation(s)
- Alon Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yaara Fainmesser
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Vivian E Drory
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada; Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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18
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Abraham A, Drory VE, Fainmesser Y, Lovblom LE, Bril V. Quantitative sonographic evaluation of muscle thickness and fasciculation prevalence in healthy subjects. Muscle Nerve 2019; 61:234-238. [PMID: 31725905 DOI: 10.1002/mus.26758] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the current study, we aimed to determine normative values for muscle thickness and fasciculation prevalence in healthy subjects. METHODS We performed a prospective study from October to December 2018 in 65 healthy subjects. All subjects underwent quantitative sonographic evaluation of muscle thickness and fasciculation prevalence in the following 8 muscles: Biceps brachii, abductor pollicis brevis, first dorsal interosseous, abductor digiti minimi, quadriceps, tibialis anterior, extensor digitorum brevis, and abductor hallucis brevis. RESULTS Subject ages ranged from 21 to 82 years, with 63% women. Normative values for muscle thickness were determined using the fifth percentile. Multivariate regression analysis showed that sex, age, body mass index, and hand dominance affected muscle thickness. Fasciculations were observed frequently only in distal muscles. CONCLUSIONS Normal values for muscle thickness were determined, and may enhance neuromuscular ultrasound sensitivity and serve as a basis for future studies. Larger series are needed to confirm these values.
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Affiliation(s)
- Alon Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Vivian E Drory
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaara Fainmesser
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Leif E Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, Sinai Health System, and Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada.,Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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