1
|
El Khalfi R, Maupoint E, Chiavassa-Gandois H, Goumarre C, Filliole A, Lapègue F, Fabry V, Acket B, Laforet A, Sans N, Cintas P, Faruch-Bilfeld M. Assessment of whole-body muscle MRI for the early diagnosis of Amyotrophic Lateral Sclerosis. Eur J Radiol 2024; 176:111481. [PMID: 38703513 DOI: 10.1016/j.ejrad.2024.111481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/01/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES To evaluate muscle signal abnormalities on whole-body muscle MRI with T2 and diffusion-weighted imaging in early ALS stages. METHODS 101 muscles were analyzed in newly diagnosed ALS patients and healthy controls on a whole-body MRI protocol including four-point T2-Dixon imaging and diffusion-weighted imaging (b0 and b800). Sensitivity and inter-observer agreement were assessed. RESULTS 15 patients (mean age, 64 +/- 12 [SD], 9 men) who met the Awaji-Shima criteria for definite, probable or possible ALS and 9 healthy controls were assessed (mean age, 53 +/- 13 [SD], 2 men). 61 % of the muscles assessed in ALS patients (62/101) showed signal hyperintensities on T2-weighted imaging, mainly in the upper and lower extremities (legs, hands and feet). ALS patients had a significantly higher number of involved muscles compared to healthy controls (p = 0,006). Diffusion-weighted imaging allowed for the detection of additional involvement in 22 muscles, thus improving the sensitivity of whole-body MRI from 60 % (using T2-weighted imaging only) up to 80 % (with the combination of T2-weighted and diffusion-weighted imaging). CONCLUSIONS ALS patients exhibited significant muscle signal abnormalities on T2-weighted and diffusion-weighted imaging in early disease stages. Whole-body MRI could be used for pre-EMG mapping of muscle involvement in order to choose suitable targets, thus improving early diagnosis.
Collapse
Affiliation(s)
- Rokia El Khalfi
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France.
| | - Estelle Maupoint
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Hélène Chiavassa-Gandois
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Céline Goumarre
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Antoine Filliole
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Franck Lapègue
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Vincent Fabry
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Blandine Acket
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Anne Laforet
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Nicolas Sans
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Pascal Cintas
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Marie Faruch-Bilfeld
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France.
| |
Collapse
|
2
|
Shin-Yi Lin C, Howells J, Rutkove S, Nandedkar S, Neuwirth C, Noto YI, Shahrizaila N, Whittaker RG, Bostock H, Burke D, Tankisi H. Neurophysiological and imaging biomarkers of lower motor neuron dysfunction in motor neuron diseases/amyotrophic lateral sclerosis: IFCN handbook chapter. Clin Neurophysiol 2024; 162:91-120. [PMID: 38603949 DOI: 10.1016/j.clinph.2024.03.015] [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: 10/03/2023] [Revised: 02/07/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024]
Abstract
This chapter discusses comprehensive neurophysiological biomarkers utilised in motor neuron disease (MND) and, in particular, its commonest form, amyotrophic lateral sclerosis (ALS). These encompass the conventional techniques including nerve conduction studies (NCS), needle and high-density surface electromyography (EMG) and H-reflex studies as well as novel techniques. In the last two decades, new methods of assessing the loss of motor units in a muscle have been developed, that are more convenient than earlier methods of motor unit number estimation (MUNE),and may use either electrical stimulation (e.g. MScanFit MUNE) or voluntary activation (MUNIX). Electrical impedance myography (EIM) is another novel approach for the evaluation that relies upon the application and measurement of high-frequency, low-intensity electrical current. Nerve excitability techniques (NET) also provide insights into the function of an axon and reflect the changes in resting membrane potential, ion channel dysfunction and the structural integrity of the axon and myelin sheath. Furthermore, imaging ultrasound techniques as well as magnetic resonance imaging are capable of detecting the constituents of morphological changes in the nerve and muscle. The chapter provides a critical description of the ability of each technique to provide neurophysiological insight into the complex pathophysiology of MND/ALS. However, it is important to recognise the strengths and limitations of each approach in order to clarify utility. These neurophysiological biomarkers have demonstrated reliability, specificity and provide additional information to validate and assess lower motor neuron dysfunction. Their use has expanded the knowledge about MND/ALS and enhanced our understanding of the relationship between motor units, axons, reflexes and other neural circuits in relation to clinical features of patients with MND/ALS at different stages of the disease. Taken together, the ultimate goal is to aid early diagnosis, distinguish potential disease mimics, monitor and stage disease progression, quantify response to treatment and develop potential therapeutic interventions.
Collapse
Affiliation(s)
- Cindy Shin-Yi Lin
- Faculty of Medicine and Health, Central Clinical School, Brain and Mind Centre, University of Sydney, Sydney 2006, Australia.
| | - James Howells
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Seward Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sanjeev Nandedkar
- Natus Medical Inc, Middleton, Wisconsin, USA and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Roger G Whittaker
- Newcastle University Translational and Clinical Research Institute (NUTCRI), Newcastle University., Newcastle Upon Tyne, United Kingdom
| | - Hugh Bostock
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, WC1N 3BG, London, United Kingdom
| | - David Burke
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| |
Collapse
|
3
|
Risi B, Cotti Piccinelli S, Gazzina S, Labella B, Caria F, Damioli S, Poli L, Padovani A, Filosto M. Prognostic Usefulness of Motor Unit Number Index (MUNIX) in Patients Newly Diagnosed with Amyotrophic Lateral Sclerosis. J Clin Med 2023; 12:5036. [PMID: 37568439 PMCID: PMC10420094 DOI: 10.3390/jcm12155036] [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: 06/18/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
The MUNIX technique allows us to estimate the number and size of surviving motor units (MUs). Previous studies on ALS found correlations between MUNIX and several clinical measures, but its potential role as a predictor of disease progression rate (DPR) has not been thoroughly evaluated to date. We aimed to investigate MUNIX's ability to predict DPR at a six-month follow up. METHODS 24 ALS patients with short disease duration (<24 months from symptoms' onset) were enrolled and divided according to their baseline DPR into two groups (normal [DPR-N] and fast [DPR-F] progressors). MUNIX values were obtained from five muscles (TA, APB, ADM, FDI, Trapezius) and averaged for each subject. RESULTS MUNIX was found to predict DPR at follow up in a multivariable linear regression model; namely, patients with lower MUNIX values were at risk of showing greater DPR scores at follow up. The result was replicated in a simple logistic regression analysis, with the dichotomic category "MUNIX-Low" as the independent variable and the outcome "DPR-F" as the dependent variable. CONCLUSIONS our results pave the way for the use of the MUNIX method as a prognostic tool in early ALS, enabling patients' stratification according to their rates of future decline.
Collapse
Affiliation(s)
- Barbara Risi
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25123 Brescia, Italy;
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
| | - Stefano Cotti Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
| | - Stefano Gazzina
- Unit of Neurophysiology, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Beatrice Labella
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Filomena Caria
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
| | - Simona Damioli
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
| | - Loris Poli
- Unit of Neurology, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25123 Brescia, Italy;
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy; (B.R.); (S.C.P.); (B.L.); (A.P.)
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Gussago, Italy; (F.C.); (S.D.)
| |
Collapse
|
4
|
Vegezzi E, Cortese A, Bergsland N, Mussinelli R, Paoletti M, Solazzo F, Currò R, Ascagni L, Callegari I, Quartesan I, Lozza A, Deligianni X, Santini F, Marchioni E, Cosentino G, Alfonsi E, Tassorelli C, Bastianello S, Merlini G, Palladini G, Obici L, Pichiecchio A. Muscle quantitative MRI as a novel biomarker in hereditary transthyretin amyloidosis with polyneuropathy: a cross-sectional study. J Neurol 2023; 270:328-339. [PMID: 36064814 DOI: 10.1007/s00415-022-11336-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The development of reproducible and sensitive outcome measures has been challenging in hereditary transthyretin (ATTRv) amyloidosis. Recently, quantification of intramuscular fat by magnetic resonance imaging (MRI) has proven as a sensitive marker in patients with other genetic neuropathies. The aim of this study was to investigate the role of muscle quantitative MRI (qMRI) as an outcome measure in ATTRv. METHODS Calf- and thigh-centered multi-echo T2-weighted spin-echo and gradient-echo sequences were obtained in patients with ATTRv amyloidosis with polyneuropathy (n = 24) and healthy controls (n = 12). Water T2 (wT2) and fat fraction (FF) were calculated. Neurological assessment was performed in all ATTRv subjects. Quantitative MRI parameters were correlated with clinical and neurophysiological measures of disease severity. RESULTS Quantitative imaging revealed significantly higher FF in lower limb muscles in patients with ATTRv amyloidosis compared to controls. In addition, wT2 was significantly higher in ATTRv patients. There was prominent involvement of the posterior compartment of the thighs. Noticeably, FF and wT2 did not exhibit a length-dependent pattern in ATTRv patients. MRI biomarkers correlated with previously validated clinical outcome measures, Polyneuropathy Disability scoring system, Neuropathy Impairment Score (NIS) and NIS-lower limb, and neurophysiological parameters of axonal damage regardless of age, sex, treatment and TTR mutation. CONCLUSIONS Muscle qMRI revealed significant difference between ATTRv and healthy controls. MRI biomarkers showed high correlation with clinical and neurophysiological measures of disease severity making qMRI as a promising tool to be further investigated in longitudinal studies to assess its role at monitoring onset, progression, and therapy efficacy for future clinical trials on this treatable condition.
Collapse
Affiliation(s)
- Elisa Vegezzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Andrea Cortese
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. .,Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK.
| | - Niels Bergsland
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Roberta Mussinelli
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Matteo Paoletti
- Neuroradiology Department, Advanced Imaging and Radiomics Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Francesca Solazzo
- Specialization School in Occupational Medicine, University of Pavia, Pavia, Italy
| | - Riccardo Currò
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Lucia Ascagni
- Neuroscience Department, Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Ilaria Callegari
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031, Basel, Switzerland
| | - Ilaria Quartesan
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Alessandro Lozza
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Xeni Deligianni
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, Basel Muscle MRI Group, University of Basel, Allschwil, Switzerland
| | - Francesco Santini
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, Basel Muscle MRI Group, University of Basel, Allschwil, Switzerland
| | - Enrico Marchioni
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Enrico Alfonsi
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefano Bastianello
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Neuroradiology Department, Advanced Imaging and Radiomics Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Giovanni Palladini
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Laura Obici
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Neuroradiology Department, Advanced Imaging and Radiomics Center, IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
5
|
Tosolini AP, Sleigh JN, Surana S, Rhymes ER, Cahalan SD, Schiavo G. BDNF-dependent modulation of axonal transport is selectively impaired in ALS. Acta Neuropathol Commun 2022; 10:121. [PMID: 35996201 PMCID: PMC9396851 DOI: 10.1186/s40478-022-01418-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 02/08/2023] Open
Abstract
Axonal transport ensures long-range delivery of essential cargoes between proximal and distal compartments, and is needed for neuronal development, function, and survival. Deficits in axonal transport have been detected at pre-symptomatic stages in the SOD1G93A and TDP-43M337V mouse models of amyotrophic lateral sclerosis (ALS), suggesting that impairments in this critical process are fundamental for disease pathogenesis. Strikingly, in ALS, fast motor neurons (FMNs) degenerate first whereas slow motor neurons (SMNs) are more resistant, and this is a currently unexplained phenomenon. The main aim of this investigation was to determine the effects of brain-derived neurotrophic factor (BDNF) on in vivo axonal transport in different α-motor neuron (MN) subtypes in wild-type (WT) and SOD1G93A mice. We report that despite displaying similar basal transport speeds, stimulation of wild-type MNs with BDNF enhances in vivo trafficking of signalling endosomes specifically in FMNs. This BDNF-mediated enhancement of transport was also observed in primary ventral horn neuronal cultures. However, FMNs display selective impairment of axonal transport in vivo in symptomatic SOD1G93A mice, and are refractory to BDNF stimulation, a phenotype that was also observed in primary embryonic SOD1G93A neurons. Furthermore, symptomatic SOD1G93A mice display upregulation of the classical non-pro-survival truncated TrkB and p75NTR receptors in muscles, sciatic nerves, and Schwann cells. Altogether, these data indicate that cell- and non-cell autonomous BDNF signalling is impaired in SOD1G93A MNs, thus identifying a new key deficit in ALS.
Collapse
Affiliation(s)
- Andrew P Tosolini
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK.
- UCL Queen Square Motor Neuron Disease Centre, University College London, London, WC1N 3BG, UK.
| | - James N Sleigh
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
- UCL Queen Square Motor Neuron Disease Centre, University College London, London, WC1N 3BG, UK
- UK Dementia Research Institute, University College London, London, WC1E 6BT, UK
| | - Sunaina Surana
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
- UCL Queen Square Motor Neuron Disease Centre, University College London, London, WC1N 3BG, UK
- UK Dementia Research Institute, University College London, London, WC1E 6BT, UK
| | - Elena R Rhymes
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
- UCL Queen Square Motor Neuron Disease Centre, University College London, London, WC1N 3BG, UK
| | - Stephen D Cahalan
- Comparative Neuromuscular Disease Laboratory, Department of Clinical Sciences and Services, Royal Veterinary College, University of London, London, NW1 0TU, UK
| | - Giampietro Schiavo
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK.
- UCL Queen Square Motor Neuron Disease Centre, University College London, London, WC1N 3BG, UK.
- UK Dementia Research Institute, University College London, London, WC1E 6BT, UK.
| |
Collapse
|
6
|
Liu X, Xing F, Yang C, Kuo CCJ, Babu S, El Fakhri G, Jenkins T, Woo J. VoxelHop: Successive Subspace Learning for ALS Disease Classification Using Structural MRI. IEEE J Biomed Health Inform 2022; 26:1128-1139. [PMID: 34339378 PMCID: PMC8807766 DOI: 10.1109/jbhi.2021.3097735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Deep learning has great potential for accurate detection and classification of diseases with medical imaging data, but the performance is often limited by the number of training datasets and memory requirements. In addition, many deep learning models are considered a "black-box," thereby often limiting their adoption in clinical applications. To address this, we present a successive subspace learning model, termed VoxelHop, for accurate classification of Amyotrophic Lateral Sclerosis (ALS) using T2-weighted structural MRI data. Compared with popular convolutional neural network (CNN) architectures, VoxelHop has modular and transparent structures with fewer parameters without any backpropagation, so it is well-suited to small dataset size and 3D imaging data. Our VoxelHop has four key components, including (1) sequential expansion of near-to-far neighborhood for multi-channel 3D data; (2) subspace approximation for unsupervised dimension reduction; (3) label-assisted regression for supervised dimension reduction; and (4) concatenation of features and classification between controls and patients. Our experimental results demonstrate that our framework using a total of 20 controls and 26 patients achieves an accuracy of 93.48 % and an AUC score of 0.9394 in differentiating patients from controls, even with a relatively small number of datasets, showing its robustness and effectiveness. Our thorough evaluations also show its validity and superiority to the state-of-the-art 3D CNN classification approaches. Our framework can easily be generalized to other classification tasks using different imaging modalities.
Collapse
Affiliation(s)
- Xiaofeng Liu
- Gordon Center for Medical Imaging, Dept. of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Fangxu Xing
- Gordon Center for Medical Imaging, Dept. of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - C.-C. Jay Kuo
- Dept. of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA
| | - Suma Babu
- Sean M Healey & AMG Center for ALS, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Dept. of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas Jenkins
- Sheffield Institute for Translational Neuroscience, University of Sheffield, 385a Glossop Road, Sheffield S10 2HQ, UK
| | - Jonghye Woo
- Gordon Center for Medical Imaging, Dept. of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
7
|
Paoletti M, Diamanti L, Muzic SI, Ballante E, Solazzo F, Foppoli L, Deligianni X, Santini F, Figini S, Bergsland N, Pichiecchio A. Longitudinal Quantitative MRI Evaluation of Muscle Involvement in Amyotrophic Lateral Sclerosis. Front Neurol 2021; 12:749736. [PMID: 34899571 PMCID: PMC8651545 DOI: 10.3389/fneur.2021.749736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/11/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Biomarkers of disease progression and outcome measures are still lacking for patients with amyotrophic lateral sclerosis (ALS). Muscle MRI can be a promising candidate to track longitudinal changes and to predict response to the therapy in clinical trials. Objective: Our aim is to apply quantitative muscle MRI in the evaluation of disease progression, focusing on thigh and leg muscles of patients with ALS, and to explore the correlation between radiological and clinical scores. Methods: We enrolled newly diagnosed patients with ALS, longitudinally scored using the ALS Functional Rating Scale-Revised (ALSFRS-R), who underwent a 3T muscle MRI protocol including a 6-point Dixon gradient-echo sequence and multi-echo turbo spin echo (TSE) T2-weighted sequence for quantification of fat fraction (FF), cross-sectional area (CSA), and water T2 (wT2). A total of 12 muscles of the thigh and six muscles of the leg were assessed by the manual drawing of 18 regions of interest (ROIs), for each side. A group of 11 age-matched healthy controls (HCs) was enrolled for comparison. Results: 15 patients (M/F 8/7; mean age 62.2 years old, range 29-79) diagnosed with possible (n = 2), probable (n = 12), or definite (n = 1) ALS were enrolled. Eleven patients presented spinal onset, whereas four of them had initial bulbar involvement. All patients performed MRI at T0, nine of them at T1, and seven of them at T2. At baseline, wT2 was significantly elevated in ALS subjects compared to HCs for several muscles of the thigh and mainly for leg muscles. By contrast, FF was elevated in few muscles, and mainly at the level of the thigh. The applied mixed effects model showed that FF increased significantly in the leg muscles over time (mainly in the triceps surae) and that wT2 decreased significantly in line with worsening in the leg subscore of ALSFRS-R, mainly at the leg level and in the anterior and medial compartment of the thigh. Conclusions: Quantitative MRI represents a non-invasive tool that is able to outline the trajectory of pathogenic modifications at the muscle level in ALS. In particular, wT2 was found to be increased early in the clinical history of ALS and also tended to decrease over time, also showing a positive correlation with leg subscore of ALSFRS-R.
Collapse
Affiliation(s)
- Matteo Paoletti
- Neuroradiology Department, Advanced Imaging and Radiomics Center, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Luca Diamanti
- Neuro-Oncology Unit, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Shaun I Muzic
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Department of Radiology, Fondazione Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Policlinico San Matteo, Medical School University of Pavia, Pavia, Italy
| | - Elena Ballante
- Department of Mathematics, University of Pavia, Pavia, Italy.,BioData Science Center, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Francesca Solazzo
- Neuroradiology Department, Advanced Imaging and Radiomics Center, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Lia Foppoli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Xeni Deligianni
- Radiology/Division of Radiological Physics, University Hospital of Basel, Basel, Switzerland.,Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Francesco Santini
- Radiology/Division of Radiological Physics, University Hospital of Basel, Basel, Switzerland.,Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Silvia Figini
- Department of Political and Social Sciences, University of Pavia, Pavia, Italy
| | - Niels Bergsland
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States.,IRCCS Fondazione Don Carlo Gnocchi Organizzazione non lucrativa di utilità sociale (ONLUS), Milan, Italy
| | - Anna Pichiecchio
- Neuroradiology Department, Advanced Imaging and Radiomics Center, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
8
|
Chan Y, Alix JJP, Neuwirth C, Barkhaus PE, Castro J, Jenkins TM, McDermott CJ, Shaw PJ, de Carvalho M, Nandedkar S, Stålberg E, Weber M. Reinnervation as measured by the motor unit size index is associated with preservation of muscle strength in amyotrophic lateral sclerosis, but not all muscles reinnervate. Muscle Nerve 2021; 65:203-210. [PMID: 34687220 DOI: 10.1002/mus.27444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION/AIMS The motor unit size index (MUSIX) may provide insight into reinnervation patterns in diseases such as amyotrophic lateral sclerosis (ALS). However, it is not known whether MUSIX detects clinically relevant changes in reinnervation, or if all muscles manifest changes in MUSIX in response to reinnervation after motor unit loss. METHODS Fifty-seven patients with ALS were assessed at 3-month intervals for 12 months in four centers. Muscles examined were abductor pollicis brevis, abductor digiti minimi, biceps brachii, and tibialis anterior. Results were split into two groups: muscles with increases in MUSIX and those without increases. Longitudinal changes in MUSIX, motor unit number index (MUNIX), compound muscle action potential amplitude, and Medical Research Council strength score were investigated. RESULTS One hundred thirty-three muscles were examined. Fifty-nine percent of the muscles exhibited an increase in MUSIX during the study. Muscles with MUSIX increases lost more motor units (58% decline in MUNIX at 12 months, P < .001) than muscles that did not increase MUSIX (34.6% decline in MUNIX at 12 months, P < .001). However, longitudinal changes in muscle strength were similar. When motor unit loss was similar, the absence of a MUSIX increase was associated with a significantly greater loss of muscle strength (P = .002). DISCUSSION MUSIX increases are associated with greater motor unit loss but relative preservation of muscle strength. Thus, MUSIX appears to be measuring a clinically relevant response that can provide a quantitative outcome measure of reinnervation in clinical trials. Furthermore, MUSIX suggests that reinnervation may play a major role in determining the progression of weakness.
Collapse
Affiliation(s)
- Young Chan
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - James J P Alix
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| | | | - José Castro
- Department of Neurosciences, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Thomas M Jenkins
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | | | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Mamede de Carvalho
- Department of Neurosciences, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | | | - Erik Stålberg
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
| | - Markus Weber
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| |
Collapse
|
9
|
Roesl C, Evans ER, Dissanayake KN, Boczonadi V, Jones RA, Jordan GR, Ledahawsky L, Allen GCC, Scott M, Thomson A, Wishart TM, Hughes DI, Mead RJ, Shone CC, Slater CR, Gillingwater TH, Skehel PA, Ribchester RR. Confocal Endomicroscopy of Neuromuscular Junctions Stained with Physiologically Inert Protein Fragments of Tetanus Toxin. Biomolecules 2021; 11:1499. [PMID: 34680132 PMCID: PMC8534034 DOI: 10.3390/biom11101499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 01/09/2023] Open
Abstract
Live imaging of neuromuscular junctions (NMJs) in situ has been constrained by the suitability of ligands for inert vital staining of motor nerve terminals. Here, we constructed several truncated derivatives of the tetanus toxin C-fragment (TetC) fused with Emerald Fluorescent Protein (emGFP). Four constructs, namely full length emGFP-TetC (emGFP-865:TetC) or truncations comprising amino acids 1066-1315 (emGFP-1066:TetC), 1093-1315 (emGFP-1093:TetC) and 1109-1315 (emGFP-1109:TetC), produced selective, high-contrast staining of motor nerve terminals in rodent or human muscle explants. Isometric tension and intracellular recordings of endplate potentials from mouse muscles indicated that neither full-length nor truncated emGFP-TetC constructs significantly impaired NMJ function or transmission. Motor nerve terminals stained with emGFP-TetC constructs were readily visualised in situ or in isolated preparations using fibre-optic confocal endomicroscopy (CEM). emGFP-TetC derivatives and CEM also visualised regenerated NMJs. Dual-waveband CEM imaging of preparations co-stained with fluorescent emGFP-TetC constructs and Alexa647-α-bungarotoxin resolved innervated from denervated NMJs in axotomized WldS mouse muscle and degenerating NMJs in transgenic SOD1G93A mouse muscle. Our findings highlight the region of the TetC fragment required for selective binding and visualisation of motor nerve terminals and show that fluorescent derivatives of TetC are suitable for in situ morphological and physiological characterisation of healthy, injured and diseased NMJs.
Collapse
Affiliation(s)
- Cornelia Roesl
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Elizabeth R. Evans
- Public Health England, National Infection Service, Porton Down, Salisbury SP4 0JG, UK; (E.R.E.); (C.C.S.)
| | - Kosala N. Dissanayake
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Veronika Boczonadi
- Applied Neuromuscular Junction Facility, Bio-Imaging Unit, Biosciences Institute, University of Newcastle-upon-Tyne, Framlington Place, Newcastle-upon-Tyne NE2 4HH, UK; (V.B.); (C.R.S.)
| | - Ross A. Jones
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Graeme R. Jordan
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Leire Ledahawsky
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Guy C. C. Allen
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Molly Scott
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Alanna Thomson
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Thomas M. Wishart
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, College of Medicine and Veterinary Medicine, University of Edinburgh, Easter Bush, Edinburgh EH25 9RG, UK;
| | - David I. Hughes
- Spinal Cord Research Group, Institute of Neuroscience and Psychology, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Richard J. Mead
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Glossop Road, Sheffield S10 2HQ, UK;
| | - Clifford C. Shone
- Public Health England, National Infection Service, Porton Down, Salisbury SP4 0JG, UK; (E.R.E.); (C.C.S.)
| | - Clarke R. Slater
- Applied Neuromuscular Junction Facility, Bio-Imaging Unit, Biosciences Institute, University of Newcastle-upon-Tyne, Framlington Place, Newcastle-upon-Tyne NE2 4HH, UK; (V.B.); (C.R.S.)
| | - Thomas H. Gillingwater
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Paul A. Skehel
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| | - Richard R. Ribchester
- Centre for Discovery Brain Sciences and the Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, George Square, Edinburgh EH8 9XD, UK; (C.R.); (K.N.D.); (R.A.J.); (G.R.J.); (L.L.); (G.C.C.A.); (M.S.); (A.T.); (T.H.G.)
| |
Collapse
|
10
|
Kriss A, Jenkins T. Muscle MRI in motor neuron diseases: a systematic review. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:161-175. [PMID: 34151652 DOI: 10.1080/21678421.2021.1936062] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: To summarize applications of muscle magnetic resonance imaging (MRI) in cross-sectional assessment and longitudinal monitoring of motor neuron diseases and evaluate associations with clinical assessment techniques.Methods: PubMed and Scopus were searched for research published up to May 2021 relating to muscle MRI in motor neuron diseases, according to predefined inclusion and exclusion criteria. Studies were systematically appraised for bias and data were extracted for discussion.Results: Twenty-eight papers met inclusion criteria. The studies assessed muscle T1- and T2-weighted signal, diffusion, muscle volume, and fat infiltration, employing quantitative, qualitative, and semi-quantitative approaches. Various regions of interest were considered; changes in thigh and calf muscles were most frequently reported. Preliminary evidence of concordance between clinical and radiological findings and utility as an objective longitudinal biomarker is emerging.Conclusion: Muscle MRI appears a promising objective, versatile, and practical biomarker to assess motor neuron diseases.
Collapse
Affiliation(s)
| | - Thomas Jenkins
- Sheffield Institute for Translational Neuroscience, University of Sheffield, UK
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW This review draws together the most recent findings in ALS biomarker research from biochemical, imaging and neurophysiology techniques. RECENT FINDINGS The potential of circulating RNA is highlighted, including new retrieval techniques. With ongoing genetic clinical trials, the need for pharmacodynamic biomarkers is essential. There is a strong case for neurofilament proteins being validated in ALS; their biomarker profile is discussed. Oxidative stress and neuroinflammation studies offer insight into disease mechanisms and offer good biomarker potential. Recent metabolic studies include investigation of lipid profiles, creatinine and ferritin. The potential of chitinase proteins as pharmacodynamic and prognostic biomarkers is highlighted. The role of tau and amyloidβ is debated, as evidenced by the articles presented here. Proteomic approaches provide unbiased discoveries of novel biomarkers, together with confirmation of previous findings. The use of imaging techniques is outlined to demonstrate selective atrophy, volume loss, muscle and tract involvement. In-vivo imaging is discussed with reference to histone deacetylase, oxidative stress, neuroinflammation and metabolic changes. New applications of electrophysiology demonstrate objective muscle biomarkers and brain network perturbations. SUMMARY The biomarker research field continues to provide insight into the disease. Multicentre collaborations are needed to validate these promising recent findings.
Collapse
|
12
|
Bashford J, Mills K, Shaw C. The evolving role of surface electromyography in amyotrophic lateral sclerosis: A systematic review. Clin Neurophysiol 2020; 131:942-950. [PMID: 32044239 PMCID: PMC7083223 DOI: 10.1016/j.clinph.2019.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/23/2019] [Accepted: 12/14/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is an adult-onset neurodegenerative disease that leads to inexorable motor decline and a median survival of three years from symptom onset. Surface EMG represents a major technological advance that has been harnessed in the development of novel neurophysiological biomarkers. We have systematically reviewed the current application of surface EMG techniques in ALS. METHODS We searched PubMed to identify 42 studies focusing on surface EMG and its associated analytical methods in the diagnosis, prognosis and monitoring of ALS patients. RESULTS A wide variety of analytical techniques were identified, involving motor unit decomposition from high-density grids, motor unit number estimation and measurements of neuronal hyperexcitability or neuromuscular architecture. Some studies have proposed specific diagnostic and prognostic criteria however clinical calibration in large ALS cohorts is currently lacking. The most validated method to monitor disease is the motor unit number index (MUNIX), which has been implemented as an outcome measure in two ALS clinical trials. CONCLUSION Surface EMG offers significant practical and analytical flexibility compared to invasive techniques. To capitalise on this fully, emphasis must be placed upon the multi-disciplinary collaboration of clinicians, bioengineers, mathematicians and biostatisticians. SIGNIFICANCE Surface EMG techniques can enrich effective biomarker development in ALS.
Collapse
Affiliation(s)
- J. Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | | | | |
Collapse
|