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Rutkove SB. Advancing electrical impedance myography one small step at a time. Muscle Nerve 2024; 69:257-259. [PMID: 38126551 DOI: 10.1002/mus.28030] [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: 10/17/2023] [Revised: 11/08/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
See article on pages 288–294 in this issue.
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Affiliation(s)
- Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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2
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Offit MB, Khanli HM, Wu T, Lehky TJ. Electrical impedance myography in healthy volunteers. Muscle Nerve 2024; 69:288-294. [PMID: 37787098 PMCID: PMC10922034 DOI: 10.1002/mus.27978] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION/AIMS Electrical impedance myography (EIM) is a noninvasive technique being used in clinical studies to characterize muscle by phase, reactance, and resistance after application of a low-intensity current. The aim of this study was to obtain 50-kHz EIM data from healthy volunteers (HVs) for use in future clinical and research studies, perform reliability tests on EIM outcome measures, and compare findings with muscle ultrasound variables. METHODS Four arm and four leg muscles of HVs were evaluated using an EIM device with two sensors, P/N 20-0045 and P/N 014-009. Muscles were evaluated individually and eight-muscle average (8MU), four-muscle upper extremity average, and four-muscle lower extremity average. An intraclass correlation coefficient (ICC) was applied to assess interrater, intrarater, and intersensor reliability using a subset of HVs. Ultrasound studies on muscle thickness and elastography were also performed on a subset of HVs. RESULTS For the P/N 20-0045 sensor, the 8MU EIM mean and standard deviation (n = 41) was 14.54 ± 3.31 for phase, 7.04 ± 1.22 for reactance, and 28.91 ± 7.63 for resistance. Reliability for 8MU phase (n = 22) was good to excellent for both interrater (n = 22, ICC = 0.920, 95% CI 0.820 to 0.966) and intrarater (n = 22, ICC = 0.950, 95% CI 0.778 to 0.983). The P/N 014-009 sensor had similar reliability findings. Correlation analyses showed no association between EIM and muscle thickness. DISCUSSION EIM is a reproducible measure of muscle physiology. Obtaining EIM values from HVs allows us to gain a better understanding how EIM may be altered in diseased muscle.
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Affiliation(s)
- Michelle B. Offit
- Electromyography Section, National Institutes of Health of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Neurology Department, Georgetown University, Washington, DC, USA
| | - Hadi Mohammad Khanli
- Electromyography Section, National Institutes of Health of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
- Neurology Department, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Tianxia Wu
- Clinical Trials Unit, National Institutes of Health of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Tanya J. Lehky
- Electromyography Section, National Institutes of Health of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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McDonald C, Camino E, Escandon R, Finkel RS, Fischer R, Flanigan K, Furlong P, Juhasz R, Martin AS, Villa C, Sweeney HL. Draft Guidance for Industry Duchenne Muscular Dystrophy, Becker Muscular Dystrophy, and Related Dystrophinopathies - Developing Potential Treatments for the Entire Spectrum of Disease. J Neuromuscul Dis 2024; 11:499-523. [PMID: 38363616 DOI: 10.3233/jnd-230219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Background Duchenne muscular dystrophy (DMD) and related dystrophinopathies are neuromuscular conditions with great unmet medical needs that require the development of effective medical treatments. Objective To aid sponsors in clinical development of drugs and therapeutic biological products for treating DMD across the disease spectrum by integrating advancements, patient registries, natural history studies, and more into a comprehensive guidance. Methods This guidance emerged from collaboration between the FDA, the Duchenne community, and industry stakeholders. It entailed a structured approach, involving multiple committees and boards. From its inception in 2014, the guidance underwent revisions incorporating insights from gene therapy studies, cardiac function research, and innovative clinical trial designs. Results The guidance provides a deeper understanding of DMD and its variants, focusing on patient engagement, diagnostic criteria, natural history, biomarkers, and clinical trials. It underscores patient-focused drug development, the significance of dystrophin as a biomarker, and the pivotal role of magnetic resonance imaging in assessing disease progression. Additionally, the guidance addresses cardiomyopathy's prominence in DMD and the burgeoning field of gene therapy. Conclusions The updated guidance offers a comprehensive understanding of DMD, emphasizing patient-centric approaches, innovative trial designs, and the importance of biomarkers. The focus on cardiomyopathy and gene therapy signifies the evolving realm of DMD research. It acts as a crucial roadmap for sponsors, potentially leading to improved treatments for DMD.
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Affiliation(s)
| | - Eric Camino
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Rafael Escandon
- DGBI Consulting, LLC, Bainbridge Island, Washington, DC, USA
| | | | - Ryan Fischer
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Kevin Flanigan
- Center for Experimental Neurotherapeutics, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pat Furlong
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Rose Juhasz
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Ann S Martin
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Chet Villa
- Trinity Health Michigan, Grand Rapids, MI, USA
| | - H Lee Sweeney
- Cincinnati Children's Hospital Medical Center within the UC Department of Pediatrics, Cincinnati, OH, USA
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Gong Z, Lo WLA, Wang R, Li L. Electrical impedance myography combined with quantitative assessment techniques in paretic muscle of stroke survivors: Insights and challenges. Front Aging Neurosci 2023; 15:1130230. [PMID: 37020859 PMCID: PMC10069712 DOI: 10.3389/fnagi.2023.1130230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Aging is a non-modifiable risk factor for stroke and the global burden of stroke is continuing to increase due to the aging society. Muscle dysfunction, common sequela of stroke, has long been of research interests. Therefore, how to accurately assess muscle function is particularly important. Electrical impedance myography (EIM) has proven to be feasible to assess muscle impairment in patients with stroke in terms of micro structures, such as muscle membrane integrity, extracellular and intracellular fluids. However, EIM alone is not sufficient to assess muscle function comprehensively given the complex contributors to paretic muscle after an insult. This article discusses the potential to combine EIM and other common quantitative methods as ways to improve the assessment of muscle function in stroke survivors. Clinically, these combined assessments provide not only a distinct advantage for greater accuracy of muscle assessment through cross-validation, but also the physiological explanation on muscle dysfunction at the micro level. Different combinations of assessments are discussed with insights for different purposes. The assessments of morphological, mechanical and contractile properties combined with EIM are focused since changes in muscle structures, tone and strength directly reflect the muscle function of stroke survivors. With advances in computational technology, finite element model and machine learning model that incorporate multi-modal evaluation parameters to enable the establishment of predictive or diagnostic model will be the next step forward to assess muscle function for individual with stroke.
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Affiliation(s)
- Ze Gong
- Research & Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen, China
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ruoli Wang
- KTH MoveAbility Lab, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Le Li
- Research & Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen, China
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
- *Correspondence: Le Li,
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5
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Chrzanowski SM, Nagy JA, Pandeya S, Rutkove SB. Electrical Impedance Myography Correlates with Functional Measures of Disease Progression in D2-mdx Mice and Boys with Duchenne Muscular Dystrophy. J Neuromuscul Dis 2023; 10:81-90. [PMID: 36442205 DOI: 10.3233/jnd-210787] [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: 11/27/2022]
Abstract
BACKGROUND Sensitive, objective, and longitudinal outcome measures applicable to both pre-clinical and clinical interventions are needed to assess muscle health in Duchenne muscular dystrophy (DMD). Electrical impedance myography (EIM) has the potential to non-invasively measure disease progression in mice and boys with DMD. OBJECTIVE We sought to evaluate how electrical impedance values (i.e., phase, reactance, and resistance) correlate to established measures of disease in both D2-mdx and wild type (WT) mice and boys with and without DMD. METHODS Histological, functional, and EIM data collected from previous studies of WT and D2-mdx mice at 6, 13, 21 and 43 weeks of age were reanalyzed. In parallel, previously collected functional outcome measures and EIM values were reanalyzed from boys with and without DMD at four different age groups from 2 to 14 years old. RESULTS In mice, disease progression as detected by histological, functional, and EIM measures, was appreciable over this time period and grip strength best correlated to longitudinal phase and reactance impedance values. In boys, disease progression quantified through commonly utilized functional outcome measures was significant and longitudinal phase demonstrated the strongest correlation with functional outcome measures. CONCLUSION Similar changes in EIM values, specifically in longitudinal reactance and phase, were found to show significant correlations to functional measures in both mice and boys. Thus, EIM demonstrates applicability in both pre-clinical and clinical settings and can be used as a safe, non-invasive, and longitudinal proxy biomarker to assess muscle health in DMD.
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Affiliation(s)
- Stephen M Chrzanowski
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Janice A Nagy
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sarbesh Pandeya
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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6
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Pandeya SR, Nagy JA, Riveros D, Semple C, Taylor RS, Hu A, Sanchez B, Rutkove SB. Using machine learning algorithms to enhance the diagnostic performance of electrical impedance myography. Muscle Nerve 2022; 66:354-361. [PMID: 35727064 DOI: 10.1002/mus.27664] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/23/2022] [Accepted: 06/14/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION/AIMS We assessed the classification performance of machine learning (ML) using multifrequency electrical impedance myography (EIM) values to improve upon diagnostic outcomes as compared to those based on a single EIM value. METHODS EIM data was obtained from unilateral excised gastrocnemius in eighty diseased mice (26 D2-mdx, Duchenne muscular dystrophy model, 39 SOD1G93A ALS model, and 15 db/db, a model of obesity-induced muscle atrophy) and 33 wild-type (WT) animals. We assessed the classification performance of a ML random forest algorithm incorporating all the data (multifrequency resistance, reactance and phase values) comparing it to the 50 kHz phase value alone. RESULTS ML outperformed the 50 kHz analysis as based on receiver-operating characteristic curves and measurement of the area under the curve (AUC). For example, comparing all diseases together versus WT from the test set outputs, the AUC was 0.52 for 50 kHz phase, but was 0.94 for the ML model. Similarly, when comparing ALS versus WT, the AUCs were 0.79 for 50 kHz phase and 0.99 for ML. DISCUSSION Multifrequency EIM utilizing ML improves upon classification compared to that achieved with a single-frequency value. ML approaches should be considered in all future basic and clinical diagnostic applications of EIM.
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Affiliation(s)
- Sarbesh R Pandeya
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA
| | - Janice A Nagy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA
| | - Daniela Riveros
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA
| | - Carson Semple
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA
| | - Rebecca S Taylor
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA
| | | | - Benjamin Sanchez
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, Utah
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA
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Cebrián-Ponce Á, Irurtia A, Carrasco-Marginet M, Saco-Ledo G, Girabent-Farrés M, Castizo-Olier J. Electrical Impedance Myography in Health and Physical Exercise: A Systematic Review and Future Perspectives. Front Physiol 2021; 12:740877. [PMID: 34594243 PMCID: PMC8476966 DOI: 10.3389/fphys.2021.740877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/19/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Electrical impedance myography (EIM) is a non-invasive method that provides information about muscle health and changes that occur within it. EIM is based on the analysis of three impedance variables: resistance, reactance, and the phase angle. This systematic review of the literature provides a deeper insight into the scope and range of applications of EIM in health and physical exercise. The main goal of this work was to systematically review the studies on the applications of EIM in health and physical exercise in order to summarize the current knowledge on this method and outline future perspectives in this growing area, including a proposal for a research agenda. Furthermore, some basic assessment principles are provided. Methods: Systematic literature searches on PubMed, Scopus, SPORTDiscus and Web of Science up to September 2020 were conducted on any empirical investigations using localized bioimpedance devices to perform EIM within health and physical exercise contexts. The search included healthy individuals, elite soccer players with skeletal muscle injury, and subjects with primary sarcopenia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used to develop the systematic review protocol. The quality and risk of bias of the studies included were assessed with the AQUA tool. Results: Nineteen eligible original articles were included in this review, which were separated into three tables according to the nature of the study. The first table includes six studies on the bioelectrical characterization of muscle. The second table includes five studies analyzing muscle changes in injured elite soccer players. The third table includes studies on the short-, medium-, and long-term bioelectrical adaptations to physical exercise. Conclusions: EIM has been used for the evaluation of the muscle condition in the clinical field over the last few years, especially in different neuromuscular diseases. It can also play an important role in other contexts as an alternative to complex and expensive methods such as magnetic resonance imaging. However, further research is needed. The main step in establishing EIM as a valid tool in the scientific field is to standardize the protocol for performing impedance assessments.
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Affiliation(s)
- Álex Cebrián-Ponce
- Barcelona Sports Sciences Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC), Universitat de Barcelona (UB), Barcelona, Spain
| | - Alfredo Irurtia
- Barcelona Sports Sciences Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC), Universitat de Barcelona (UB), Barcelona, Spain
| | - Marta Carrasco-Marginet
- Barcelona Sports Sciences Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC), Universitat de Barcelona (UB), Barcelona, Spain
| | - Gonzalo Saco-Ledo
- Bioenergy and Motion Analysis Laboratory, National Research Center on Human Evolution (CENIEH), Burgos, Spain
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8
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Hobson-Webb LD, Zwelling PJ, Raja SS, Pifer AN, Kishnani PS. Quantitative muscle ultrasound and electrical impedance myography in late onset Pompe disease: A pilot study of reliability, longitudinal change and correlation with function. Mol Genet Metab Rep 2021; 28:100785. [PMID: 34401343 PMCID: PMC8348861 DOI: 10.1016/j.ymgmr.2021.100785] [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: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 01/23/2023] Open
Abstract
Background/objectives Late-onset Pompe disease (LOPD) is slowly progressive, making it difficult to assess clinical change and response to interventions. In this study, quantitative muscle ultrasonography (QMUS) and electrical impedance myography (EIM) were evaluated as potential biomarkers. Methods 25 patients with confirmed LOPD were recruited from the Duke Pompe Clinic and evaluated with standard clinical measures, QMUS, standard EIM (sEIM) and hand-held EIM (hEIM). Patients were evaluated at baseline, 12 months and 24 months. MUS, sEIM and hEIM were compared with the clinical data. Five patients were given hEIM devices to perform measurements at home. Results QMUS and hEIM had good reliability as measures of muscle structure and conduction properties. Home, patient-performed hEIM measurements did not differ significantly from those performed in the clinic setting. Thirteen patients completed all follow-up measures. Most measures did not change over the study period, however, vastus lateralis echointensity increased 27%, a sign of declining muscle health. Additionally, significant correlations between QMUS, hEIM and measures of muscle strength and function were present. Conclusions QMUS and hEIM may provide useful outcome measures for future studies in LOPD with hEIM providing an opportunity to collect data at home. Larger, multicenter studies are needed to explore these possibilities.
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Affiliation(s)
- Lisa D Hobson-Webb
- Department of Neurology/Neuromuscular Division, Duke University, Durham, NC, USA
| | - Paul J Zwelling
- Department of Neurology/Neuromuscular Division, Duke University, Durham, NC, USA
| | - Shruti S Raja
- Department of Neurology/Neuromuscular Division, Duke University, Durham, NC, USA
| | - Ashley N Pifer
- Department of Medicine/Infectious Disease, Duke University, Durham, NC, USA
| | - Priya S Kishnani
- Department of Pediatrics, Division of Medical Genetics, Duke University School of Medicine, Durham, NC, USA
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Cardoner MMDM, Kwon H, Pulido HVG, Nagy J, Rutkove S, Sanchez B. Modeling and Reproducibility of Twin Concentric Electrical Impedance Myography. IEEE Trans Biomed Eng 2021; 68:3068-3077. [PMID: 33661730 DOI: 10.1109/tbme.2021.3063724] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Electrical impedance myography (EIM) is a recent technology to assess muscle health. As of today, the clinical application of EIM has been applied only to evaluate muscle condition using non-invasive surface electrodes in contact with the skin; however, intermediate tissues at the recording site introduce confounding artifacts which reduce the technique's performance as a biomarker of neuromuscular disorders (NMD). Here, we develop and test in humans a new approach using two concentric needles for intramuscular EIM recordings. METHODS First, we study the recording characteristics of dual concentric needle EIM via analytical models and finite element models (FEMs). Next, the validity of the models is verified by performing experiments on saline and agar phantoms. Finally, 8 subjects with various neuromuscular diseases were studied measuring tibialis anterior, biceps, deltoid, adductor pollicis brevis, first dorsal interosseous and flexor carpi radialis muscles. RESULTS Analytical and FEM simulations are in good agreement with a maximum experimental discrepancy 8% and 9% using gauge needles 26 and 30, respectively. The inter-session reproducibility, as measured by the intraclass correlation coefficients for all muscles studied, was 0.926, which is comparable or exceeds the reproducibility of other well-established electrophysiological tests to assess muscle health. CONCLUSION The reproducibility of the technique support future clinical validation of needle EIM for assessment of disease status, either as part of standard patient care or as biomarker measure in clinical trials. SIGNIFICANCE Needle EIM has the potential of becoming a valuable diagnostic tool to evaluate NMD in adult population.
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Longo S, Coratella G, Rampichini S, Borrelli M, Scurati R, Limonta E, Cè E, Esposito F. Local fat content and muscle quality measured by a new electrical impedance myography device: correlations with ultrasound variables. Eur J Sport Sci 2020; 21:388-399. [PMID: 32237960 DOI: 10.1080/17461391.2020.1751306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractThe present study investigated the relationship between local fat percentage (SKfat) and muscle quality (MQ) estimated by a new hand-held electrical impedance myography (hEIM) device or derived from ultrasound and strength assessments. The right anterior thigh of 90 healthy participants (mean ± SD; age=22.9 ± 2.9 years; 45 men: BMI = 23.9 ± 2.4 kgm-2; 45 women: BMI = 21.1 ± 1.9 kgm-2) was scanned by hEIM and ultrasound. Correlations between SKfat, local subcutaneous fat (SUBfat), and echo intensity (EIus) were explored. Correlations between MQ, EIus, quadriceps femoris anatomical cross-sectional area (ACSAQF), knee extensors maximum voluntary isometric torque (T), T/ACSAQF, EIus/SUBfat, and ACSAQF/SUBfat were also assessed. SKfat correlated with SUBfat (r = 0.88; p < 0.001) and EIus (r = 0.64; p < 0.001). MQ correlated with EIus (r = -0.66; p < 0.001), ACSAQF (r = 0.37; p < 0.001), EIus/SUBfat (r = 0.37; p < 0.001), and ACSAQF/SUBfat (r = 0.81; p < 0.001). Multiple regression analysis showed that SUBfat, EIus, and sex explained 86% of SKfat variance, whereas ACSAQF/SUBfat, sex and EIus explained 75% of MQ variance. In conclusion, high hEIM local fat percentage relates to greater subcutaneous fat and intramuscular non-contractile tissue content. High hEIM muscle quality relates to greater muscle-size:subcutaneous-fat ratio and contractile tissue content. Sex influences the prediction of both parameters. This hEIM device seems to be useful to estimate local thigh composition.
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Affiliation(s)
- Stefano Longo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Coratella
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Susanna Rampichini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Marta Borrelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Raffaele Scurati
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Eloisa Limonta
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Emiliano Cè
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Fabio Esposito
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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11
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Rutkove SB. Electrical impedance myography: MRI-like data without the need for MRI. Muscle Nerve 2020; 61:554-556. [PMID: 32052459 DOI: 10.1002/mus.26832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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12
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Chrzanowski SM, Darras BT, Rutkove SB. The Value of Imaging and Composition-Based Biomarkers in Duchenne Muscular Dystrophy Clinical Trials. Neurotherapeutics 2020; 17:142-152. [PMID: 31879850 PMCID: PMC7007477 DOI: 10.1007/s13311-019-00825-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
As the drug development pipeline for Duchenne muscular dystrophy (DMD) rapidly advances, clinical trial outcomes need to be optimized. Effective assessment of disease burden, natural history progression, and response to therapy in clinical trials for Duchenne muscular dystrophy are critical factors for clinical trial success. By choosing optimal biomarkers to better assess therapeutic efficacy, study costs and sample size requirements can be reduced. Currently, functional measures continue to serve as the primary outcome for the majority of DMD clinical trials. Quantitative measures of muscle health, including magnetic resonance imaging and spectroscopy, electrical impedance myography, and ultrasound, sensitively identify diseased muscle, disease progression, and response to a therapeutic intervention. Furthermore, such non-invasive techniques have the potential to identify disease pathology prior to onset of clinical symptoms. Despite robust supportive evidence, non-invasive quantitative techniques are still not frequently utilized in clinical trials for Duchenne muscular dystrophy. Non-invasive quantitative techniques have demonstrated the ability to quantify disease progression and potential response to therapeutic intervention, and should be used as a supplement to current standard functional measures. Such methods have the potential to significantly accelerate the development and approval of therapies for DMD.
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Affiliation(s)
- Stephen M Chrzanowski
- Department of Medicine, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Basil T Darras
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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13
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Rutkove SB, Sanchez B. Electrical Impedance Methods in Neuromuscular Assessment: An Overview. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a034405. [PMID: 30291145 DOI: 10.1101/cshperspect.a034405] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Electrical impedance methods have been used as evaluation tools in biological and medical science for well over 100 years. However, only recently have these techniques been applied specifically to the evaluation of conditions affecting nerve and muscle. This specific application, termed electrical impedance myography (EIM), is finding wide application as it can provide a quantitative index of muscle condition that can assist with diagnosis, track disease progression, and assess the beneficial impact of therapy. Using noninvasive surface methods, EIM has been studied in a number of conditions ranging from amyotrophic lateral sclerosis to muscular dystrophy to disuse atrophy. Data support that the technique is sensitive to disease status and can offer the possibility of performing clinical trials with fewer subjects than would otherwise be possible. Recent advances in the field include improved approaches for using EIM as a "virtual biopsy" and the development of combined needle impedance-electromyography technology.
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Affiliation(s)
- Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215
| | - Benjamin Sanchez
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215
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14
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Martucci MG, McIlduff CE, Shin C, Gutierrez HV, Nam JY, Greenstein P, Phillips K, Uhlmann EJ, Wong ET, Rutkove SB. Quantitative ultrasound of muscle can detect corticosteroid effects. Clin Neurophysiol 2019; 130:1460-1464. [PMID: 31122815 DOI: 10.1016/j.clinph.2019.04.709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/20/2019] [Accepted: 04/07/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES In this study, we sought to determine whether quantitative ultrasound (QUS) could detect the impact of corticosteroids on muscle in the absence of frank weakness. METHODS QUS was performed on selected limb muscles of 20 brain tumor patients treated with dexamethasone and 30 healthy controls. Echointensity was quantified using gray scale level (GSL) analysis and compared between groups; correlation to corticosteroid exposure was also performed. RESULTS Average 4-muscle GSL (±standard deviation) was greater in patients compared to controls (35.5 ± 5.61 arbitrary units (AU) versus 30.4 ± 4.17 AU, p = 0.001), with the greatest differences in tibialis anterior. Average muscle GSL also correlated to length of corticosteroid therapy (rho = 0.52, p = 0.01). CONCLUSIONS These findings suggest that QUS may be able to quantify skeletal muscle alterations associated with chronic corticosteroid use. Further study of this approach is warranted. SIGNIFICANCE The findings of this study may provide a tool to evaluate corticosteroid myopathy.
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Affiliation(s)
- Maria G Martucci
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Courtney E McIlduff
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Carmen Shin
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Hilda V Gutierrez
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Joo Yeon Nam
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Patricia Greenstein
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Kester Phillips
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Erik J Uhlmann
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Eric T Wong
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
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Roy B, Darras BT, Zaidman CM, Wu JS, Kapur K, Rutkove SB. Exploring the relationship between electrical impedance myography and quantitative ultrasound parameters in Duchenne muscular dystrophy. Clin Neurophysiol 2019; 130:515-520. [PMID: 30772764 DOI: 10.1016/j.clinph.2019.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/10/2018] [Accepted: 01/13/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Quantitative ultrasound (QUS), including grayscale level analysis (GLA) and quantitative backscatter analysis (QBA), and electrical impedance myography (EIM) have been proposed as biomarkers in Duchenne muscular dystrophy (DMD). However, the relationship between these methods has not been assessed. METHODS QUS values (including GLA and QBA) and several EIM measures were recorded from six muscles in 36 DMD and 29 healthy boys between ages 5 and 13 years at baseline, 6-months, and 12-months. RESULTS In the DMD boys, a moderate correlation was noted between QUS and EIM parameters, with the strongest correlations being identified for averaged muscle values. Of the individual muscles, biceps brachii and deltoid showed the strongest correlations. For example, in biceps, the QBA/EIM correlation coefficient (Spearman rho) was ≥0.70 (p < 0.01). Importantly, changes in QUS values over 12 months also correlated moderately with changes in EIM parameters and EIM/QBA rho values mostly varied between -0.53 and -0.70 (p ≤ 0.02). No significant correlations were identified in the healthy boys. CONCLUSIONS A moderate correlation of QUS with EIM in DMD boys suggests that the two technologies provide related data but are sensitive to different pathological features of muscle. SIGNIFICANCE The use of both technologies jointly in assessing DMD progression and response to therapy should be considered.
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Affiliation(s)
- Bhaskar Roy
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | - Jim S Wu
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kush Kapur
- Boston Children's Hospital, Boston, MA, USA
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16
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Moore CJ, Caughey MC, Meyer DO, Emmett R, Jacobs C, Chopra M, Howard JF, Gallippi CM. In Vivo Viscoelastic Response (VisR) Ultrasound for Characterizing Mechanical Anisotropy in Lower-Limb Skeletal Muscles of Boys with and without Duchenne Muscular Dystrophy. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2519-2530. [PMID: 30174231 PMCID: PMC6215506 DOI: 10.1016/j.ultrasmedbio.2018.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/13/2018] [Accepted: 07/05/2018] [Indexed: 05/03/2023]
Abstract
Our group has previously found that in silico, mechanical anisotropy may be interrogated by exciting transversely isotropic materials with geometrically asymmetric acoustic radiation force excitations and then monitoring the associated induced displacements in the region of excitation. We now translate acoustic radiation force-based anisotropy assessment to human muscle in vivo and investigate its clinical relevance to monitoring muscle degeneration in Duchenne muscular dystrophy (DMD). Clinical anisotropy assessments were performed using Viscoelastic Response ultrasound, with a degree of anisotropy reflected by the ratios of Viscoelastic Response relative elasticity (RE) or relative viscosity (RV) measured with the asymmetric radiation force oriented parallel versus perpendicular to muscle fiber alignment. In vivo results from rectus femoris and gastrocnemius muscles of boys aged ∼7.9-10.4 y indicate that RE and RV anisotropy ratios in rectus femoris muscles of boys with DMD were significantly higher than those of healthy control boys (RE: DMD = 1.51 ± 0.87, control = 0.99 ± 0.69, p = 0.04, Wilcoxon rank sum test; RV: DMD = 1.04 ± 0.71, control = 0.74 ± 0.22, p = 0.02). In the gastrocnemius muscle, only the RV anisotropy ratio was significantly higher in dystrophic than control patients (DMD = 1.23 ± 0.35, control = 0.88 ± 0.31, p = 0.04). In the dystrophic rectus femoris muscle, the RE anisotropy ratio was inversely correlated (slope = -0.03/lbf, r = -0.43, p = 0.07, Pearson correlation) with quantitative muscle testing functional output measures but was not correlated with quantitative muscle testing in the dystrophic gastrocnemius. These results suggest that Viscoelastic Response RE and RV measures reflect differences in mechanical anisotropy associated with functional impairment with dystrophic degeneration that are relevant to monitoring DMD clinically.
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Affiliation(s)
- Christopher J Moore
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Melissa C Caughey
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Diane O Meyer
- Rehabilitation Services, University of North Carolina Hospital, Chapel Hill, North Carolina, USA
| | - Regina Emmett
- Rehabilitation Services, University of North Carolina Hospital, Chapel Hill, North Carolina, USA
| | - Catherine Jacobs
- Rehabilitation Services, University of North Carolina Hospital, Chapel Hill, North Carolina, USA
| | - Manisha Chopra
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James F Howard
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Caterina M Gallippi
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, North Carolina, USA; Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, North Carolina, USA.
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Calvo-Lobo C, Useros-Olmo AI, Almazán-Polo J, Martín-Sevilla M, Romero-Morales C, Sanz-Corbalán I, Rodríguez-Sanz D, López-López D. Quantitative Ultrasound Imaging Pixel Analysis of the Intrinsic Plantar Muscle Tissue between Hemiparesis and Contralateral Feet in Post-Stroke Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112519. [PMID: 30423860 PMCID: PMC6265729 DOI: 10.3390/ijerph15112519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 12/12/2022]
Abstract
Quantitative ultrasound imaging of the muscle tissue may be applied in the neurology field, due to B-mode grayscale pixels values could be used as potential biomarkers for disease progression and intervention effects in poststroke patients. Thus, the study aim was to compare and analyze the ultrasound imaging B-mode pixels differences between the intrinsic plantar muscles cross-sectional area (CSA) in hemiparetic and contralateral feet from poststroke patients by means of the Image J software. A case-control design and a convenience sampling method were used in order to recruit 22 feet from 11 poststroke patients. This total sample was divided into 11 hemiparetic feet and 11 contralateral feet. The Image J software was used in order to evaluate the interface distance, CSA as well as measure the pixels mean, standard deviation (SD) and count from all offline images in the flexor digitorum brevis, abductor hallucis (AbH), and flexor hallucis brevis muscles. Statistically significant differences (p = 0.003) were only shown for the pixels count in the AbH muscle. The rest of outcome measurements did not show any statistically significant difference (p > 0.05). Therefore, B-mode ultrasound imaging Image J software differences for the pixels count reduction were shown in the AbH muscle between hemiparetic and contralateral feet from poststroke patients. Further studies are necessary in order to apply our findings as potential biomarkers during the stroke disease course.
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Affiliation(s)
- Cesar Calvo-Lobo
- Nursing and Physical Therapy Department, Faculty of Health Sciences, Universidad de León, 24401 Ponferrada, Spain.
| | - Ana Isabel Useros-Olmo
- Departamento de Fisioterapia, Centro superior de estudios Universitarios La Salle, Motion in Brains Research Group, Universidad Autónoma de Madrid, 28023 Madrid, Spain.
- Unidad de Daño Cerebral, Hospital Beata Maria Ana, 28007 Madrid, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain.
| | | | - Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - Irene Sanz-Corbalán
- School of Nursing, Physiotherapy and Podiatry, University Complutense of Madrid, 28040 Madrid, Spain.
| | - David Rodríguez-Sanz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
- School of Nursing, Physiotherapy and Podiatry, University Complutense of Madrid, 28040 Madrid, Spain.
| | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain.
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Kapur K, Sanchez B, Pacheck A, Darras B, Rutkove SB, Selukar R. Functional Mixed-Effects Modeling of Longitudinal Duchenne Muscular Dystrophy Electrical Impedance Myography Data Using State-Space Approach. IEEE Trans Biomed Eng 2018; 66:1761-1768. [PMID: 30387720 DOI: 10.1109/tbme.2018.2879227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Electrical impedance myography (EIM) is a quantitative and objective tool to evaluate muscle status. EIM offers the possibility to replace conventional physical functioning scores or quality of life measures, which depend on patient cooperation and mood. METHODS Here, we propose a functional mixed-effects model using a state-space approach to describe the response trajectories of EIM data measured on 16 boys with Duchenne muscular dystrophy and 12 healthy controls, both groups measured over a period of two years. The modeling framework presented imposes a smoothing spline structure on EIM data collected at each visit and taking into account of within subject correlations of these curves along the longitudinal measurements. The modeling framework is recast in a state-space approach, thereby allowing for the employment of computationally efficient diffuse Kalman filtering and smoothing algorithms for the model estimation, as well as the estimates of the posterior variance-covariance matrix for the construction of the Bayesian [Formula: see text] confidence bands. RESULTS The proposed model allows us to simultaneously adjust for baseline variables, differentiate the longitudinal changes in the smooth functional response and estimate the subject and subject-time specific deviations from the population-averaged response curves. The code is made publicly available in the supplementary material. SIGNIFICANCE The modeling approach presented will potentially enhance EIM capability to serve as a biomarker for testing therapeutic efficacy in DMD and other clinical trials.
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19
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Rutkove SB, Kwon H, Guasch M, Wu JS, Sanchez B. Electrical impedance imaging of human muscle at the microscopic scale using a multi-electrode needle device: A simulation study. Clin Neurophysiol 2018; 129:1704-1708. [PMID: 29804914 DOI: 10.1016/j.clinph.2018.04.746] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/23/2018] [Accepted: 04/29/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To use a standard modeling approach to evaluate the feasibility of imaging healthy and diseased skeletal muscle at the microscopic scale with a novel electrical impedance imaging (EII) needle. METHODS We modeled an EII needle containing 16 impedance electrodes arranged circumferentially around the shaft of a non-conductive 19-gauge needle in 4 planes. We then combined the finite element method approach with a reconstruction algorithm to create imaging simulations of the electrical properties of the triceps brachii by localized intramuscular fat (as might be seen in any chronic neuromuscular disease) and by localized edema (as in inflammatory myositis or after direct muscle injury). RESULTS We were able to image a 1 cm radial region of interest with a resolution of 200 µm. Modeling localized deposition of fat and pockets of inflammatory cells, showing clear differences between the two modeled clinical states. CONCLUSIONS This modeling study shows needle EII's ability to image the internal composition of muscle. These results can serve as an initial guide in designing and manufacturing prototype EII needles for experimental testing in animals and eventually in humans. SIGNIFICANCE Needle EII could serve as a new minimally invasive technique for imaging human muscle at the microscopic scale, potentially serving as a new biomarker to assess disease response to therapy.
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Affiliation(s)
- Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-5491, USA
| | - Hyeuknam Kwon
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-5491, USA
| | - Maria Guasch
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-5491, USA
| | - Jim S Wu
- Department Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-5491, USA
| | - Benjamin Sanchez
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-5491, USA.
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20
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Kwon H, Malik WQ, Rutkove SB, Sanchez B. Separation of Subcutaneous Fat From Muscle in Surface Electrical Impedance Myography Measurements Using Model Component Analysis. IEEE Trans Biomed Eng 2018; 66:354-364. [PMID: 29993468 DOI: 10.1109/tbme.2018.2839977] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Electrical impedance myography (EIM) is a relatively new technique to assess neuromuscular disorders (NMD). Although the application of EIM using surface electrodes (sEIM) has been adopted by the neurology community in recent years to evaluate NMD status, sEIM's sensitivity as a biomarker of skeletal muscle condition is impacted by subcutaneous fat (SF) tissue. Here, we develop a method that is able to remove the contribution of SF from sEIM data. METHODS We evaluate independent component analysis (ICA) and principal component analysis (PCA) for this purpose. Then, we introduce the so-called model component analysis (MCA). All methods are validated with numerical simulations using impedivity data from SF and muscle tissues. The methods are then tested with measurements performed in diseased individuals ( n=3). RESULTS Simulations demonstrate that MCA is the most accurate method at separating the impedivity of SF and muscle tissues with the accuracy being 99.2%, followed by ICA with 51.4%, and finally PCA with 38.5%. Experimental results from sEIM data measured on the triceps brachii of patients are consistent with muscle grayscale level values obtained using ultrasound imaging. CONCLUSION MCA can be used to separate the impedivity of SF and muscle tissues from sEIM data, thus increasing the sensitivity to detect changes in the muscle. SIGNIFICANCE MCA can make the sEIM technique a better diagnostic tool and biomarker of disease progression and response to therapy by removing the confounding effect of SF tissue in NMD patients with excess subcutaneous fat tissue for any reason.
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21
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Zong Y, Shin HH, Wang YC, Li S, Zhou P, Li X. Assessing Hand Muscle Structural Modifications in Chronic Stroke. Front Neurol 2018; 9:296. [PMID: 29867714 PMCID: PMC5953342 DOI: 10.3389/fneur.2018.00296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/17/2018] [Indexed: 12/14/2022] Open
Abstract
The purpose of the study is to assess poststroke muscle structural alterations by examining muscular electrical conductivity and inherent electrophysiological properties. In particular, muscle impedance and compound muscle action potentials (CMAP) were measured from the hypothenar muscle bilaterally using the electrical impedance myography and the electrophysiological techniques, respectively. Significant changes of muscle impedance were observed in the paretic muscle compared with the contralateral side (resistance: paretic: 27.54 ± 0.97 Ω, contralateral: 25.46 ± 0.91 Ω, p < 0.05; phase angle: paretic: 8.81 ± 0.61°, contralateral: 10.79 ± 0.69°, p < 0.05). In addition, impedance changes correlated moderately with the CMAP amplitude in the paretic hand (phase angle: r = 0.66, p < 0.05; reactance: r = 0.58, p < 0.05). The study discloses significant muscle rearrangements as a result of fiber loss or atrophy, fat infiltration or impaired membrane integrity in chronic stroke.
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Affiliation(s)
- Ya Zong
- Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Guangdong Work Injury Rehabilitation Center, Guangzhou, China.,Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, TIRR Memorial Hermann Research Center, Houston, TX, United States
| | - Henry H Shin
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, TIRR Memorial Hermann Research Center, Houston, TX, United States
| | - Ying-Chih Wang
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, TIRR Memorial Hermann Research Center, Houston, TX, United States
| | - Ping Zhou
- Guangdong Work Injury Rehabilitation Center, Guangzhou, China.,Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, TIRR Memorial Hermann Research Center, Houston, TX, United States
| | - Xiaoyan Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, TIRR Memorial Hermann Research Center, Houston, TX, United States
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Arnold WD, Taylor RS, Li J, Nagy JA, Sanchez B, Rutkove SB. Electrical impedance myography detects age-related muscle change in mice. PLoS One 2017; 12:e0185614. [PMID: 29049394 PMCID: PMC5648130 DOI: 10.1371/journal.pone.0185614] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/16/2017] [Indexed: 12/14/2022] Open
Abstract
Loss of muscle mass and strength represents one of the most significant contributors to impaired function in older adults. Convenient and non-invasive biomarkers are needed that can readily identify and track age-related muscle change. Previous data has suggested electrical impedance myography (EIM) has the potential to serve in this capacity. In this study we investigated how changes in EIM compared with other standard measures of muscle structure and function in aged compared with young mice. A total of 19 male mice aged approximately 25 months and 19 male mice aged 3 months underwent surface multifrequency EIM of the right gastrocnemius muscle using standard methods. Fore and hind limb grip strength, sciatic compound muscle action potential amplitude, and in-situ force of the gastrocnemius were also measured; after sacrifice, gastrocnemius myofiber size was assessed using standard histology. Spearman correlation coefficients were calculated to investigate the association between EIM and muscle characteristics. EIM in aged animals demonstrated significantly lower 50 kHz impedance phase (p<0.001) and reactance (p<0.01) values as well as reduced multifrequency parameters. In contrast, absolute gastrocnemius muscle mass was no different between young and aged mice (p = 0.58) but was reduced in aged mice after normalization to body mass (p<0.001). Median myofiber size in the aged mice was not different from that of young mice (p = 0.72). Aged mice showed reduced muscle function on the basis of normalized fore limb (p<0.001) and normalized hind limb (p<0.001) grip strength, as well as normalized gastrocnemius twitch (p<0.001) and normalized maximal isometric force (p<0.001). Sciatic compound muscle action potential amplitude was reduced in aged mice (p<0.05). EIM parameters showed good correlation with reduced standard physiological and electrophysiological measures of muscle health. Our study suggests that EIM is sensitive to aged-related muscle change and may represent a convenient and valuable method of quantifying loss of muscle health.
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Affiliation(s)
- W. David Arnold
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Rebecca S. Taylor
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jia Li
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Janice A. Nagy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Benjamin Sanchez
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Seward B. Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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23
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Present Uses, Future Applications, and Technical Underpinnings of Electrical Impedance Myography. Curr Neurol Neurosci Rep 2017; 17:86. [DOI: 10.1007/s11910-017-0793-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Li X, Li L, Shin H, Li S, Zhou P. Electrical Impedance Myography for Evaluating Paretic Muscle Changes After Stroke. IEEE Trans Neural Syst Rehabil Eng 2017; 25:2113-2121. [PMID: 28574361 DOI: 10.1109/tnsre.2017.2707403] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Electrical impedance myography (EIM) was used to assess the paretic muscle intrinsic electrical properties post stroke. Twenty-seven subjects with chronic hemiparesis participated in this study. Muscle impedance was measured by applying high-frequency, low-intensity alternating current to biceps brachii muscles. Major EIM parameters, resistance ( ), reactance ( ), phase angle ( ), and electrical anisotropy ratios (AR) of the three parameters, were examined at 50 kHz. Statistical analysis demonstrated significant reduction of reactance, phase angle, AR of resistance, and AR of reactance in the paretic muscle compared with the contralateral side (Paretic X: , contralateral X: , and p < 0.001; Paretic : , contralateral : 14.5 ± 0.82°, and p < 0.001; Paretic AR of R: 0.969 ± 0.013, contralateral AR of R: 1.008 ± 0.011, and p < 0.02; and Paretic AR of X: 0.981 ± 0.066, contralateral AR of X: 1.114 ± 0.041, and p < 0.02). Correlation analysis, however, did not show any significant relationship between EIM parameters and clinical assessments. Findings of this paper indicated significant changes in the muscular intrinsic electrical properties after stroke, possibly related to structural modifications induced by loss of muscle fibers or fat infiltration as well as changes in the quality of cell membranes post stroke.
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Janssen MMHP, Harlaar J, Koopman B, de Groot IJM. Dynamic arm study: quantitative description of upper extremity function and activity of boys and men with duchenne muscular dystrophy. J Neuroeng Rehabil 2017; 14:45. [PMID: 28549441 PMCID: PMC5446682 DOI: 10.1186/s12984-017-0259-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/16/2017] [Indexed: 12/13/2022] Open
Abstract
Background Therapeutic management of upper extremity (UE) function of boys and men with Duchenne Muscular Dystrophy (DMD) requires sensitive and objective assessment. Therefore, we aimed to measure physiologic UE function of healthy subjects and DMD patients in different disease stages, and to evaluate the relation between these physiologic measures and functional UE scales. Methods Twenty-three DMD patients and twenty healthy controls (7–23 years) participated in this explorative case–control study. Maximal muscle torque, maximal and normalized surface electromyography (sEMG) amplitudes, muscle thickness, echogenicity and maximal passive and active joint angles were measured. At activity level, Brooke upper extremity rating scale and the Performance of Upper Limb (PUL) scale were used. Results Outcome measures related to proximal UE function could discriminate between disease stages. Increased normalized sEMG amplitudes were found in patients, even in early disease stages. Maximal active joint angles showed the strongest relation to Brooke scale (R2 = 0.88) and PUL scale (R2 = 0.85). Conclusions The decline of muscle functions precedes the decline in performance of UE activities, and therefore may play a role in early detection of UE limitations. Increased sEMG levels demonstrate that DMD patients use more of their muscle capacity compared to healthy subjects, to perform daily activities. This might result in increased fatigability. Active maximal joint angles are highly related to functional scales, so preserving the ability to use the full range of motion is important for the performance of daily activities. Close monitoring of active joint angles could therefore help in starting interventions that minimize functional UE decline in DMD patients timely.
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Affiliation(s)
- Mariska M H P Janssen
- Department of Rehabilitation, Radboud University Medical Center, Donders Centre for Neuroscience, Reinier Postlaan 4, 6525 GC, Nijmegen, The Netherlands.
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, VU University Medical Center, MOVE Research Institute, Amsterdam, The Netherlands
| | - Bart Koopman
- Department Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Imelda J M de Groot
- Department of Rehabilitation, Radboud University Medical Center, Donders Centre for Neuroscience, Reinier Postlaan 4, 6525 GC, Nijmegen, The Netherlands
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Rutkove SB, Kapur K, Zaidman CM, Wu JS, Pasternak A, Madabusi L, Yim S, Pacheck A, Szelag H, Harrington T, Darras BT. Electrical impedance myography for assessment of Duchenne muscular dystrophy. Ann Neurol 2017; 81:622-632. [PMID: 28076894 DOI: 10.1002/ana.24874] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 12/24/2016] [Accepted: 12/26/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Sensitive, objective, and easily applied methods for evaluating disease progression and response to therapy are needed for clinical trials in Duchenne muscular dystrophy (DMD). In this study, we evaluated whether electrical impedance myography (EIM) could serve this purpose. METHODS In this nonblinded study, 36 boys with DMD and 29 age-similar healthy boys underwent multifrequency EIM measurements for up to 2 years on 6 muscles unilaterally along with functional assessments. A linear mixed-effects model with random intercept and slope terms was used for the analysis of multifrequency EIM values and functional measures. Seven DMD boys were initiated on corticosteroids; these data were analyzed using a piecewise linear mixed-effects model. RESULTS In boys > 7.0 years old, a significant difference in the slope of EIM phase ratio trajectories in the upper extremity was observed by 6 months of -0.074/month, p = 0.023, 95% confidence interval (CI) = -0.013, -0.14; at 2 years, this difference was -0.048/month, p < 0.0001, 95% CI = -0.028, -0.068. In boys ≤ 7.0 years old, differences appeared at 6 months in gastrocnemius (EIM phase slope = -0.83 °/kHz/mo, p = 0.007, 95% CI = -0.26, -1.40). EIM outcomes showed significant differences earlier than functional tests. Initiation of corticosteroids significantly improved the slope of EIM phase ratio (0.057/mo, p = 0.00019, 95% CI = 0.028, 0.086) and EIM phase slope (0.14 °/kHz/mo, p = 0.013, 95% CI = 0.028, 0.25), consistent with corticosteroids' known clinical benefit. INTERPRETATION EIM detects deterioration in muscles of both younger and older boys by 6 months; it also identifies the therapeutic effect of corticosteroid initiation. Because EIM is rapid to apply, painless, and requires minimal operator training, the technique deserves to be further evaluated as a biomarker in DMD clinical therapeutic trials. Ann Neurol 2017;81:622-632.
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Affiliation(s)
- Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kush Kapur
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Craig M Zaidman
- Department of Neurology, Washington University in St Louis, St Louis, MO
| | - Jim S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Amy Pasternak
- Department of Physical Therapy Services and Occupational Therapy Services, Boston Children's Hospital, Boston, MA
| | - Lavanya Madabusi
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Sung Yim
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Adam Pacheck
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Heather Szelag
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Tim Harrington
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Basil T Darras
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Handheld Electrical Impedance Myography Probe for Assessing Carpal Tunnel Syndrome. Ann Biomed Eng 2017; 45:1572-1580. [DOI: 10.1007/s10439-017-1819-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/07/2017] [Indexed: 02/06/2023]
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Sanchez B, Iyer SR, Li J, Kapur K, Xu S, Rutkove SB, Lovering RM. Non-invasive assessment of muscle injury in healthy and dystrophic animals with electrical impedance myography. Muscle Nerve 2017; 56:E85-E94. [PMID: 28056487 DOI: 10.1002/mus.25559] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Dystrophic muscle is particularly susceptible to eccentric contraction-induced injury. We tested the hypothesis that electrical impedance myography (EIM) can detect injury induced by maximal-force lengthening contractions. METHODS We induced injury in the quadriceps of wild-type (WT) and dystrophic (mdx) mice with eccentric contractions using an established model. RESULTS mdx quadriceps had significantly greater losses in peak twitch and tetany compared with losses in WT quadriceps. Injured muscle showed a significant increase in EIM characteristic frequency in both WT (177 ± 7.7%) and mdx (167 ± 7.8%) quadriceps. EIM also revealed decreased extracellular resistance for both WT and mdx quadriceps after injury. DISCUSSION Our results show overall agreement between muscle function and EIM measurements of injured muscle, indicating that EIM is a viable tool to assess injury in dystrophic muscle. Muscle Nerve 56: E85-E94, 2017.
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Affiliation(s)
- Benjamin Sanchez
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Shama R Iyer
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Room 540, 100 Penn Street, Baltimore, Maryland, 21201, USA
| | - Jia Li
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kush Kapur
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Boston Children's Hospital, Boston, Massachusetts, USA
| | - Su Xu
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard M Lovering
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Room 540, 100 Penn Street, Baltimore, Maryland, 21201, USA
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Hakim CH, Mijailovic A, Lessa TB, Coates JR, Shin C, Rutkove SB, Duan D. Non-invasive evaluation of muscle disease in the canine model of Duchenne muscular dystrophy by electrical impedance myography. PLoS One 2017; 12:e0173557. [PMID: 28339469 PMCID: PMC5365102 DOI: 10.1371/journal.pone.0173557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/23/2017] [Indexed: 02/07/2023] Open
Abstract
Dystrophin-deficient dogs are by far the best available large animal models for Duchenne muscular dystrophy (DMD), the most common lethal childhood muscle degenerative disease. The use of the canine DMD model in basic disease mechanism research and translational studies will be greatly enhanced with the development of reliable outcome measures. Electrical impedance myography (EIM) is a non-invasive painless procedure that provides quantitative data relating to muscle composition and histology. EIM has been extensively used in neuromuscular disease research in both human patients and rodent models. Recent studies suggest that EIM may represent a highly reliable and convenient outcome measure in DMD patients and the mdx mouse model of DMD. To determine whether EIM can be used as a biomarker of disease severity in the canine model, we performed the assay in fourteen young (~6.6-m-old; 6 normal and 8 affected) and ten mature (~16.9-m-old; 4 normal and 6 affected) dogs of mixed background breeds. EIM was well tolerated with good inter-rater reliability. Affected dogs showed higher resistance, lower reactance and phase. The difference became more straightforward in mature dogs. Importantly, we observed a statistically significant correlation between the EIM data and muscle fibrosis. Our results suggest that EIM is a valuable objective measurement in the canine DMD model.
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Affiliation(s)
- Chady H. Hakim
- Department of Molecular Microbiology and Immunology, School of Medicine, The University of Missouri, Columbia, MO, United States of America
| | - Alex Mijailovic
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Thais B. Lessa
- Department of Molecular Microbiology and Immunology, School of Medicine, The University of Missouri, Columbia, MO, United States of America
| | - Joan R. Coates
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States of America
| | - Carmen Shin
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Seward B. Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Dongsheng Duan
- Department of Molecular Microbiology and Immunology, School of Medicine, The University of Missouri, Columbia, MO, United States of America
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States of America
- Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, United States of America
- Department of Bioengineering, University of Missouri, Columbia, MO, United States of America
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Rutkove SB, Pacheck A, Sanchez B. Sensitivity distribution simulations of surface electrode configurations for electrical impedance myography. Muscle Nerve 2017; 56:887-895. [PMID: 28056494 DOI: 10.1002/mus.25561] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/28/2016] [Accepted: 01/04/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Surface-based electrical impedance myography (EIM) is sensitive to muscle condition in neuromuscular disorders. However, the specific contribution of muscle to the obtained EIM values is unknown. METHODS We combined theory and the finite element method to calculate the electrical current distribution in a 3-dimensional model using different electrode array designs and subcutaneous fat thicknesses (SFTs). Through a sensitivity analysis, we decoupled the contribution of muscle from other surrounding tissues in the measured surface impedance values. RESULTS The contribution of muscle to surface EIM values varied greatly depending on the electrode array size and the SFT. For example, the contribution of muscle with 6-mm SFT was 8% for a small array compared with 32% for a large array. CONCLUSIONS The approach presented can be employed to inform the design of robust EIM electrode configurations that maximize the contribution of muscle across the disease and injury spectrum. Muscle Nerve 56: 887-895, 2017.
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Affiliation(s)
- Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, DA-0730A, 330 Brookline Avenue, Boston, Masachusetts, 02215-5491, USA
| | - Adam Pacheck
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, DA-0730A, 330 Brookline Avenue, Boston, Masachusetts, 02215-5491, USA
| | - Benjamin Sanchez
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, DA-0730A, 330 Brookline Avenue, Boston, Masachusetts, 02215-5491, USA
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Sanchez B, Rutkove SB. Electrical Impedance Myography and Its Applications in Neuromuscular Disorders. Neurotherapeutics 2017; 14:107-118. [PMID: 27812921 PMCID: PMC5233633 DOI: 10.1007/s13311-016-0491-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Electrical impedance myography (EIM) refers to the specific application of electrical bioimpedance techniques for the assessment of neuromuscular disorders. In EIM, a weak, high-frequency electrical current is applied to a muscle or muscle group of interest and the resulting voltages measured. Among its advantages, the technique can be used noninvasively across a variety of disorders and requires limited subject cooperation and evaluator training to obtain accurate and repeatable data. Studies in both animals and human subjects support its potential utility as a primary diagnostic tool, as well as a biomarker for clinical trial or individual patient use. This review begins by providing an overview of the current state and technological advances in electrical impedance myography and its specific application to the study of muscle. We then provide a summary of the clinical and preclinical applications of EIM for neuromuscular conditions, and conclude with an evaluation of ongoing research efforts and future developments.
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Affiliation(s)
- Benjamin Sanchez
- Department of Neurology, Division of Neuromuscular Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Seward B Rutkove
- Department of Neurology, Division of Neuromuscular Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.
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Arnold WD, Duque S, Iyer CC, Zaworski P, McGovern VL, Taylor SJ, von Herrmann KM, Kobayashi DT, Chen KS, Kolb SJ, Paushkin SV, Burghes AHM. Normalization of Patient-Identified Plasma Biomarkers in SMNΔ7 Mice following Postnatal SMN Restoration. PLoS One 2016; 11:e0167077. [PMID: 27907033 PMCID: PMC5132001 DOI: 10.1371/journal.pone.0167077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/08/2016] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Spinal muscular atrophy (SMA) is an autosomal recessive motor neuron disorder. SMA is caused by homozygous loss of the SMN1 gene and retention of the SMN2 gene resulting in reduced levels of full length SMN protein that are insufficient for motor neuron function. Various treatments that restore levels of SMN are currently in clinical trials and biomarkers are needed to determine the response to treatment. Here, we sought to investigate in SMA mice a set of plasma analytes, previously identified in patients with SMA to correlate with motor function. The goal was to determine whether levels of plasma markers were altered in the SMNΔ7 mouse model of SMA and whether postnatal SMN restoration resulted in normalization of the biomarkers. METHODS SMNΔ7 and control mice were treated with antisense oligonucleotides (ASO) targeting ISS-N1 to increase SMN protein from SMN2 or scramble ASO (sham treatment) via intracerebroventricular injection on postnatal day 1 (P1). Brain, spinal cord, quadriceps muscle, and liver were analyzed for SMN protein levels at P12 and P90. Ten plasma biomarkers (a subset of biomarkers in the SMA-MAP panel available for analysis in mice) were analyzed in plasma obtained at P12, P30, and P90. RESULTS Of the eight plasma biomarkers assessed, 5 were significantly changed in sham treated SMNΔ7 mice compared to control mice and were normalized in SMNΔ7 mice treated with ASO. CONCLUSION This study defines a subset of the SMA-MAP plasma biomarker panel that is abnormal in the most commonly used mouse model of SMA. Furthermore, some of these markers are responsive to postnatal SMN restoration. These findings support continued clinical development of these potential prognostic and pharmacodynamic biomarkers.
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MESH Headings
- Animals
- Animals, Newborn
- Biomarkers/metabolism
- Brain/metabolism
- Brain/pathology
- Clinical Trials as Topic
- Disease Models, Animal
- Gene Expression Regulation
- Genetic Complementation Test
- Humans
- Injections, Intraventricular
- Liver/metabolism
- Liver/pathology
- Mice
- Mice, Transgenic
- Motor Neurons/metabolism
- Motor Neurons/pathology
- Muscle, Skeletal/metabolism
- Muscle, Skeletal/pathology
- Muscular Atrophy, Spinal/genetics
- Muscular Atrophy, Spinal/metabolism
- Muscular Atrophy, Spinal/pathology
- Oligonucleotides, Antisense/genetics
- Oligonucleotides, Antisense/metabolism
- Spinal Cord/metabolism
- Spinal Cord/pathology
- Survival of Motor Neuron 1 Protein/genetics
- Survival of Motor Neuron 1 Protein/metabolism
- Survival of Motor Neuron 2 Protein/genetics
- Survival of Motor Neuron 2 Protein/metabolism
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Affiliation(s)
- W. David Arnold
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus Ohio, United States of America
- Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus Ohio, United States of America
| | - Sandra Duque
- VIB Center for the Biology of Disease – KU Leuven Department of Human Genetics, Leuven Belgium, United States of America
| | - Chitra C. Iyer
- Department of Biological Chemistry and Pharmacology, The Ohio State University Wexner Medical Center, Columbus Ohio, United States of America
| | | | - Vicki L. McGovern
- Department of Biological Chemistry and Pharmacology, The Ohio State University Wexner Medical Center, Columbus Ohio, United States of America
| | | | | | | | - Karen S. Chen
- SMA Foundation, New York, New York, United States of America
| | - Stephen J. Kolb
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus Ohio, United States of America
- Department of Biological Chemistry and Pharmacology, The Ohio State University Wexner Medical Center, Columbus Ohio, United States of America
| | | | - Arthur H. M. Burghes
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus Ohio, United States of America
- Department of Biological Chemistry and Pharmacology, The Ohio State University Wexner Medical Center, Columbus Ohio, United States of America
- * E-mail:
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Loehr JA, Stinnett GR, Hernández-Rivera M, Roten WT, Wilson LJ, Pautler RG, Rodney GG. Eliminating Nox2 reactive oxygen species production protects dystrophic skeletal muscle from pathological calcium influx assessed in vivo by manganese-enhanced magnetic resonance imaging. J Physiol 2016; 594:6395-6405. [PMID: 27555555 PMCID: PMC5088246 DOI: 10.1113/jp272907] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/12/2016] [Indexed: 01/18/2023] Open
Abstract
KEY POINTS Inhibiting Nox2 reactive oxygen species (ROS) production reduced in vivo calcium influx in dystrophic muscle. The lack of Nox2 ROS production protected against decreased in vivo muscle function in dystrophic mice. Manganese-enhanced magnetic resonance imaging (MEMRI) was able to detect alterations in basal calcium levels in skeletal muscle and differentiate disease status. Administration of Mn2+ did not affect muscle function or the health of the animal, and Mn2+ was cleared from skeletal muscle rapidly. We conclude that MEMRI may be a viable, non-invasive technique to monitor molecular alterations in disease progression and evaluate the effectiveness of potential therapies for Duchenne muscular dystrophy. ABSTRACT Duchenne muscular dystrophy (DMD) is an X-linked progressive degenerative disease resulting from a mutation in the gene that encodes dystrophin, leading to decreased muscle mechanical stability and force production. Increased Nox2 reactive oxygen species (ROS) production and sarcolemmal Ca2+ influx are early indicators of disease pathology, and eliminating Nox2 ROS production reduces aberrant Ca2+ influx in young mdx mice, a model of DMD. Various imaging modalities have been used to study dystrophic muscle in vivo; however, they are based upon alterations in muscle morphology or inflammation. Manganese has been used for indirect monitoring of calcium influx across the sarcolemma and may allow detection of molecular alterations in disease progression in vivo using manganese-enhanced magnetic resonance imaging (MEMRI). Therefore, we hypothesized that eliminating Nox2 ROS production would decrease calcium influx in adult mdx mice and that MEMRI would be able to monitor and differentiate disease status in dystrophic muscle. Both in vitro and in vivo data demonstrate that eliminating Nox2 ROS protected against aberrant Ca2+ influx and improved muscle function in dystrophic muscle. MEMRI was able to differentiate between different pathological states in vivo, with no long-term effects on animal health or muscle function. We conclude that MEMRI is a viable, non-invasive technique to differentiate disease status and might provide a means to monitor and evaluate the effectiveness of potential therapies in dystrophic muscle.
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Affiliation(s)
- James A Loehr
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Gary R Stinnett
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | | | - Wesley T Roten
- SMART Program, Baylor College of Medicine, Houston, TX, USA
- Department of Biology, University of North Carolina, Chapel Hill, NC, USA
| | - Lon J Wilson
- Department of Chemistry, Rice University, Houston, TX, USA
| | - Robia G Pautler
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - George G Rodney
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA.
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Rutkove SB, Wu JS, Zaidman C, Kapur K, Yim S, Pasternak A, Madabusi L, Szelag H, Harrington T, Li J, Pacheck A, Darras BT. Loss of electrical anisotropy is an unrecognized feature of dystrophic muscle that may serve as a convenient index of disease status. Clin Neurophysiol 2016; 127:3546-3551. [PMID: 27825055 DOI: 10.1016/j.clinph.2016.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/28/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We sought to understand the alteration in the anisotropic, or direction dependent, character of muscle as measured by electrical impedance myography (EIM) in subjects with Duchenne muscular dystrophy (DMD) and its potential to serve as a biomarker of disease status. METHODS Thirty-six boys with DMD and 27 healthy controls were measured with EIM, with electrical current applied both parallel and perpendicular to the major muscle fiber direction. In addition, muscle extracted from 10 mdx and 10 wild-type mice were measured analogously. RESULTS Normalized reactance anisotropy, a direction-dependent measure of membrane charge storage capability, was significantly lower in the four muscles of DMD subjects as compared to controls (p<0.01). Normalized reactance anisotropy also decreased with increasing age in DMD subjects (r=-0.36, p=0.031), but not in healthy boys. Analogous changes were observed in mdx mouse gastrocnemius as compared to wild type (p=0.019). CONCLUSION These results support that loss of electrical anisotropy is a previously unrecognized feature of dystrophic muscle. SIGNIFICANCE Anisotropic alterations may offer novel indices to assist in neuromuscular disease diagnosis and to serve as easy-to-obtain biomarkers in clinical therapeutic trials.
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Affiliation(s)
- Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.
| | - Jim S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Craig Zaidman
- Department of Neurology, Washington University in St. Louis, 660 S Euclid Ave, St. Louis, MO 63110, USA
| | - Kush Kapur
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Sung Yim
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Amy Pasternak
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Lavanya Madabusi
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Heather Szelag
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Tim Harrington
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Jia Li
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Adam Pacheck
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Basil T Darras
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Sanchez B, Pacheck A, Rutkove SB. Guidelines to electrode positioning for human and animal electrical impedance myography research. Sci Rep 2016; 6:32615. [PMID: 27585740 PMCID: PMC5009322 DOI: 10.1038/srep32615] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/10/2016] [Indexed: 12/14/2022] Open
Abstract
The positioning of electrodes in electrical impedance myography (EIM) is critical for accurately assessing disease progression and effectiveness of treatment. In human and animal trials for neuromuscular disorders, inconsistent electrode positioning adds errors to the muscle impedance. Despite its importance, how the reproducibility of resistance and reactance, the two parameters that define EIM, are affected by changes in electrode positioning remains unknown. In this paper, we present a novel approach founded on biophysical principles to study the reproducibility of resistance and reactance to electrode misplacements. The analytical framework presented allows the user to quantify a priori the effect on the muscle resistance and reactance using only one parameter: the uncertainty placing the electrodes. We also provide quantitative data on the precision needed to position the electrodes and the minimum muscle length needed to achieve a pre-specified EIM reproducibility. The results reported here are confirmed with finite element model simulations and measurements on five healthy subjects. Ultimately, our data can serve as normative values to enhance the reliability of EIM as a biomarker and facilitate comparability of future human and animal studies.
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Affiliation(s)
- Benjamin Sanchez
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-5491, USA
| | - Adam Pacheck
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-5491, USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215-5491, USA
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Koppaka S, Shklyar I, Rutkove SB, Darras BT, Anthony BW, Zaidman CM, Wu JS. Quantitative Ultrasound Assessment of Duchenne Muscular Dystrophy Using Edge Detection Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1889-1897. [PMID: 27417736 PMCID: PMC5512886 DOI: 10.7863/ultra.15.04065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 12/13/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the ability of quantitative ultrasound (US) using edge detection analysis to assess patients with Duchenne muscular dystrophy (DMD). METHODS After Institutional Review Board approval, US examinations with fixed technical parameters were performed unilaterally in 6 muscles (biceps, deltoid, wrist flexors, quadriceps, medial gastrocnemius, and tibialis anterior) in 19 boys with DMD and 21 age-matched control participants. The muscles of interest were outlined by a tracing tool, and the upper third of the muscle was used for analysis. Edge detection values for each muscle were quantified by the Canny edge detection algorithm and then normalized to the number of edge pixels in the muscle region. The edge detection values were extracted at multiple sensitivity thresholds (0.01-0.99) to determine the optimal threshold for distinguishing DMD from normal. Area under the receiver operating curve values were generated for each muscle and averaged across the 6 muscles. RESULTS The average age in the DMD group was 8.8 years (range, 3.0-14.3 years), and the average age in the control group was 8.7 years (range, 3.4-13.5 years). For edge detection, a Canny threshold of 0.05 provided the best discrimination between DMD and normal (area under the curve, 0.96; 95% confidence interval, 0.84-1.00). According to a Mann-Whitney test, edge detection values were significantly different between DMD and controls (P < .0001). CONCLUSIONS Quantitative US imaging using edge detection can distinguish patients with DMD from healthy controls at low Canny thresholds, at which discrimination of small structures is best. Edge detection by itself or in combination with other tests can potentially serve as a useful biomarker of disease progression and effectiveness of therapy in muscle disorders.
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Affiliation(s)
- Sisir Koppaka
- Laboratory for Manufacturing and Productivity, Massachusetts Institute of Technology, Cambridge, Massachusetts USA, Medical Electronic Device Realization Center, Massachusetts Institute of Technology, Cambridge, Massachusetts USA
| | - Irina Shklyar
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts USA
| | - Basil T Darras
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts USA
| | - Brian W Anthony
- Laboratory for Manufacturing and Productivity, Massachusetts Institute of Technology, Cambridge, Massachusetts USA, Medical Electronic Device Realization Center, Massachusetts Institute of Technology, Cambridge, Massachusetts USA
| | - Craig M Zaidman
- Departments of Neurology and Pediatrics, Washington University, St Louis Missouri USA
| | - Jim S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts USA
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Bazzocchi A, Filonzi G, Ponti F, Albisinni U, Guglielmi G, Battista G. Ultrasound: Which role in body composition? Eur J Radiol 2016; 85:1469-80. [PMID: 27235340 DOI: 10.1016/j.ejrad.2016.04.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 03/01/2016] [Accepted: 04/13/2016] [Indexed: 01/21/2023]
Abstract
Ultrasound is a non-invasive, fast, relatively inexpensive and available tool for estimating adiposity in clinical practice, and in several research settings. It does not expose patients to ionizing radiation risks, making the method ideal for the evaluation, and for follow-up studies. Several parameters and indexes based on adipose tissue thickness have been introduced and tested, and these have been correlated with clinical and laboratoristic parameters. Moreover, ultrasound can also be directed to the estimation of adipose tissue and intracellular fat indirectly, at cellular-molecular level: an opportunity for many radiologists who already and sometimes unconsciously perform "body composition" assessment when looking at the liver, at muscle as well as at other organs. However, standardized procedure and parameters are needing to improve accuracy and reproducibility. The purposes of this review are: 1) to provide a complete overview of the most used and shared measurements of adiposity; 2) to analyze technical conditions, accuracy, and clinical meaning of ultrasound in the study of body composition; 3) to provide some elements for the use of ultrasound in the evaluation of intra-cellular lipids accumulation, in two hot spots: liver and skeletal muscle.
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Affiliation(s)
- Alberto Bazzocchi
- Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy.
| | - Giacomo Filonzi
- Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy; Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna. Sant'Orsola-Malpighi Hospital, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Ugo Albisinni
- Diagnostic and Interventional Radiology, The "Rizzoli" Orthopaedic Institute, Via G. C. Pupilli 1, 40136 Bologna, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, 71100 Foggia, Italy; Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Foggia, Italy
| | - Giuseppe Battista
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna. Sant'Orsola-Malpighi Hospital, Via G. Massarenti 9, 40138 Bologna, Italy
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Arnold W, McGovern VL, Sanchez B, Li J, Corlett KM, Kolb SJ, Rutkove SB, Burghes AH. The neuromuscular impact of symptomatic SMN restoration in a mouse model of spinal muscular atrophy. Neurobiol Dis 2015; 87:116-23. [PMID: 26733414 DOI: 10.1016/j.nbd.2015.12.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/20/2015] [Accepted: 12/25/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Significant advances in the development of SMN-restoring therapeutics have occurred since 2010 when very effective biological treatments were reported in mouse models of spinal muscular atrophy. As these treatments are applied in human clinical trials, there is pressing need to define quantitative assessments of disease progression, treatment stratification, and therapeutic efficacy. The electrophysiological measures Compound Muscle Action Potential and Motor Unit Number Estimation are reliable measures of nerve function. In both the SMN∆7 mouse and a pig model of spinal muscular atrophy, early SMN restoration results in preservation of electrophysiological measures. Currently, clinical trials are underway in patients at post-symptomatic stages of disease progression. In this study, we present results from both early and delayed SMN restoration using clinically-relevant measures including electrical impedance myography, compound muscle action potential, and motor unit number estimation to quantify the efficacy and time-sensitivity of SMN-restoring therapy. METHODS SMA∆7 mice were treated via intracerebroventricular injection with antisense oligonucleotides targeting ISS-N1 to increase SMN protein from the SMN2 gene on postnatal day 2, 4, or 6 and compared with sham-treated spinal muscular atrophy and control mice. Compound muscle action potential and motor unit number estimation of the triceps surae muscles were performed at day 12, 21, and 30 by a single evaluator blinded to genotype and treatment. Similarly, electrical impedance myography was measured on the biceps femoris muscle at 12days for comparison. RESULTS Electrophysiological measures and electrical impedance myography detected significant differences at 12days between control and late-treated (4 or 6days) and sham-treated spinal muscular atrophy mice, but not in mice treated at 2days (p<0.01). EIM findings paralleled and correlated with compound muscle action potential and motor unit number estimation (r=0.61 and r=0.50, respectively, p<0.01). Longitudinal measures at 21 and 30days show that symptomatic therapy results in reduced motor unit number estimation associated with delayed normalization of compound muscle action potential. CONCLUSIONS The incomplete effect of symptomatic treatment is accurately identified by both electrophysiological measures and electrical impedance myography. There is strong correlation between these measures and with weight and righting reflex. This study predicts that measures of compound muscle action potential, motor unit number estimation, and electrical impedance myography are promising biomarkers of treatment stratification and effect for future spinal muscular atrophy trials. The ease of application and simplicity of electrical impedance myography compared with standard electrophysiological measures may be particularly valuable in future pediatric clinical trials.
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Affiliation(s)
- W Arnold
- Department of Neurology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, Columbus, OH 43210, United States; Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, 480 Medical Center Drive, Columbus, OH 43210, United States; Department of Neuroscience, The Ohio State University Wexner Medical Center, 480 Medical Center Drive, Columbus, OH 43210, United States
| | - Vicki L McGovern
- Department of Biological Chemistry and Pharmacology, The Ohio State University Wexner Medical Center, 363 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210, United States
| | - Benjamin Sanchez
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Jia Li
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Kaitlyn M Corlett
- Department of Biological Chemistry and Pharmacology, The Ohio State University Wexner Medical Center, 363 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210, United States
| | - Stephen J Kolb
- Department of Neurology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, Columbus, OH 43210, United States; Department of Neuroscience, The Ohio State University Wexner Medical Center, 480 Medical Center Drive, Columbus, OH 43210, United States; Department of Biological Chemistry and Pharmacology, The Ohio State University Wexner Medical Center, 363 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210, United States
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Arthur H Burghes
- Department of Neurology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, Columbus, OH 43210, United States; Department of Biological Chemistry and Pharmacology, The Ohio State University Wexner Medical Center, 363 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210, United States
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Bioimpedance Analysis as a Method to Evaluate the Proportion of Fatty and Muscle Tissues in Progressive Myopathy in Pompe Disease. JIMD Rep 2015; 26:45-51. [PMID: 26253708 DOI: 10.1007/8904_2015_473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 12/04/2022] Open
Abstract
During progressive myopathy, the space of atrophic muscle tissue is gradually filled by fatty tissue. The proportion of these two tissue types relative to body mass provides an indication of the extent of muscle tissue destruction, i.e., the progression and severity of the disease.In this study we use Pompe disease as an example to report the new possibility of using bioimpedance analysis (BIA) to assess the relative proportion of fatty and muscle tissue in diseases associated with muscle atrophy, thus enabling the assessment of disease progression and the effectiveness of treatment. Results from BIA analysis were compared with magnetic resonance images.The results of muscle magnetic resonance images and BIA analysis were similar, which suggests that BIA may provide valuable diagnostic guidance for the assessment of the progression of the disorder.
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Zaidman CM, Wang LL, Connolly AM, Florence J, Wong BL, Parsons JA, Apkon S, Goyal N, Williams E, Escolar D, Rutkove SB, Bohorquez JL. Electrical impedance myography in duchenne muscular dystrophy and healthy controls: A multicenter study of reliability and validity. Muscle Nerve 2015; 52:592-7. [DOI: 10.1002/mus.24611] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 02/02/2015] [Accepted: 02/10/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Craig M. Zaidman
- Department of Neurology; Washington University School of Medicine; 660 South Euclid Avenue, Box 8111 St. Louis Missouri 63110 USA
- Department of Pediatrics; Washington University School of Medicine; St. Louis Missouri USA
| | | | - Anne M. Connolly
- Department of Neurology; Washington University School of Medicine; 660 South Euclid Avenue, Box 8111 St. Louis Missouri 63110 USA
- Department of Pediatrics; Washington University School of Medicine; St. Louis Missouri USA
| | - Julaine Florence
- Department of Neurology; Washington University School of Medicine; 660 South Euclid Avenue, Box 8111 St. Louis Missouri 63110 USA
| | - Brenda L. Wong
- Department of Pediatrics; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio USA
| | - Julie A. Parsons
- Department of Pediatrics and Neurology; University of Colorado; Denver Colorado USA
| | - Susan Apkon
- Department of Rehabilitation Medicine; University of Washington; Seattle Washington USA
| | - Namita Goyal
- Department of Neurology; Massachusetts General Hospital; Boston Massachusetts USA
| | | | - Diana Escolar
- DART Therapeutics, Inc; Stockbridge Massachusetts USA
| | - Seward B. Rutkove
- Department of Neurology; Beth Israel Deaconess Medical Center; Boston Massachusetts USA
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Magnetic Resonance Assessment of Hypertrophic and Pseudo-Hypertrophic Changes in Lower Leg Muscles of Boys with Duchenne Muscular Dystrophy and Their Relationship to Functional Measurements. PLoS One 2015; 10:e0128915. [PMID: 26103164 PMCID: PMC4477876 DOI: 10.1371/journal.pone.0128915] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 05/01/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction The primary objectives of this study were to evaluate contractile and non-contractile content of lower leg muscles of boys with Duchenne muscular dystrophy (DMD) and determine the relationships between non-contractile content and functional abilities. Methods Lower leg muscles of thirty-two boys with DMD and sixteen age matched unaffected controls were imaged. Non-contractile content, contractile cross sectional area and non-contractile cross sectional area of lower leg muscles (tibialis anterior, extensor digitorum longus, peroneal, medial gastrocnemius and soleus) were assessed by magnetic resonance imaging (MRI). Muscle strength, timed functional tests and the Brooke lower extremity score were also assessed. Results Non-contractile content of lower leg muscles (peroneal, medial gastrocnemius, and soleus) was significantly greater than control group (p<0.05). Non-contractile content of lower leg muscles correlated with Brooke score (rs = 0.64-0.84) and 30 feet walk (rs = 0.66-0.80). Dorsiflexor (DF) and plantarflexor (PF) specific torque was significantly different between the groups. Discussion Overall, non-contractile content of the lower leg muscles was greater in DMD than controls. Furthermore, there was an age dependent increase in contractile content in the medial gastrocnemius of boys with DMD. The findings of this study suggest that T1 weighted MR images can be used to monitor disease progression and provide a quantitative estimate of contractile and non-contractile content of tissue in children with DMD.
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Wu JS, Li J, Greenman RL, Bennett D, Geisbush T, Rutkove SB. Assessment of aged mdx mice by electrical impedance myography and magnetic resonance imaging. Muscle Nerve 2015; 52:598-604. [PMID: 25597760 DOI: 10.1002/mus.24573] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2015] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Similar to magnetic resonance imaging (MRI), electrical impedance myography (EIM) is dependent on the presence and location of water in muscle to assess neuromuscular diseases. We compared the 2 technologies in mdx mice to better understand their relationship. METHODS EIM and MRI, using T2 relaxation and diffusion-weighted imaging (DWI), were performed on the gastrocnemius of 10 mdx and 10 wild-type mice. Muscle function and tissue composition measurements were compared with the EIM and MRI data. RESULTS EIM reactance and T2 relaxation mapping can discriminate healthy from diseased mice (P < .001 for both), but DWI could not. Both T2 relaxation and EIM reactance also correlated closely with muscle function/composition and with each other. CONCLUSION Given the low cost of EIM and the simplicity of application, it may be a valuable alternative to muscle MRI in Duchenne muscular dystrophy, where simple cumulative indices of muscle health are being sought.
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Affiliation(s)
- Jim S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, 02215, USA
| | - Jia Li
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert L Greenman
- Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA
| | - David Bennett
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, 02215, USA
| | - Tom Geisbush
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Shklyar I, Pasternak A, Kapur K, Darras BT, Rutkove SB. Composite biomarkers for assessing Duchenne muscular dystrophy: an initial assessment. Pediatr Neurol 2015; 52:202-5. [PMID: 25447928 PMCID: PMC4336219 DOI: 10.1016/j.pediatrneurol.2014.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/08/2014] [Accepted: 09/20/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Compared with individual parameters, composite biomarkers may provide a more effective means for monitoring disease progression and the effects of therapy in clinical trials than single measures. In this study, we built composite biomarkers for use in Duchenne muscular dystrophy by combining values from two objective measures of disease severity: electrical impedance myography and quantitative ultrasound and evaluating how well they correlated to standard functional measures. METHODS Using data from an ongoing study of electrical impedance myography and quantitative ultrasound in 31 Duchenne muscular dystrophy and 26 healthy boys aged 2-14 years, we combined data sets by first creating z scores based on the normal subject data and then using simple mathematical operations (addition and multiplication) to create composite measures. These composite scores were then correlated to age and standard measures of function including the 6-minute walk test, the North Star Ambulatory Assessment, and handheld dynamometry. RESULTS Combining data sets resulted in stronger correlations with all four outcomes than for either electrical impedance myography or quantitative ultrasound alone in six of eight instances. These improvements reached statistical significance (P < 0.05) in several cases. For example, the correlation coefficient for the composite measure with the North Star Ambulatory Assessment was 0.79 but was only 0.66 and 0.67 (respectively) for gray scale level and electrical impedance myography separately. CONCLUSIONS Arithmetically derived composite scores can provide stronger correlations to functional measures than isolated biomarkers. Longitudinal study of such composite markers in Duchenne muscular dystrophy clinical trials is warranted.
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Affiliation(s)
- Irina Shklyar
- Departments of Neurology, Beth Israel Deaconess Medical Center,
Boston, MA
| | - Amy Pasternak
- Boston Children’s Hospital, Harvard Medical School, Boston,
MA
| | - Kush Kapur
- Boston Children’s Hospital, Harvard Medical School, Boston,
MA
| | - Basil T. Darras
- Boston Children’s Hospital, Harvard Medical School, Boston,
MA
| | - Seward B. Rutkove
- Departments of Neurology, Beth Israel Deaconess Medical Center,
Boston, MA
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Geisbush TR, Visyak N, Madabusi L, Rutkove SB, Darras BT. Inter-session reliability of electrical impedance myography in children in a clinical trial setting. Clin Neurophysiol 2014; 126:1790-6. [PMID: 25533276 DOI: 10.1016/j.clinph.2014.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 11/12/2014] [Accepted: 11/21/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE High reliability is a prerequisite for any test to be useful as a biomarker in a clinical trial. Here we assessed the reproducibility of electrical impedance myography (EIM) in children by comparing data obtained by different evaluators on separate days. METHODS Healthy boys and boys with Duchenne muscular dystrophy (DMD) aged 2-14 years underwent EIM of multiple muscles performed by two evaluators on two visits separated by 3-7 days. Single and multifrequency data were analyzed. Reliability was assessed via calculation of the percent relative standard deviation (% RSD), Bland-Altman analysis, and the intraclass correlation coefficient (ICC). RESULTS For both individual muscle data and data averaged across muscles, intra-evaluator measurements showed high repeatability for both 50 kHz phase and 50/200 kHz phase ratio values, with ICCs generally above 0.90 and % RSD below 10%. Inter-evaluator results showed very similar ICC and % RSD values as those obtained by the same evaluator. CONCLUSIONS Both the 50 kHz phase and 50/200 kHz phase ratio are reliable measures both across time and evaluators and in both health and disease. SIGNIFICANCE These results support the concept that EIM can serve as a reliable measure in clinical therapeutic trials in a pediatric population.
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Affiliation(s)
- Tom R Geisbush
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nicole Visyak
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lavanya Madabusi
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Basil T Darras
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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