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López-Navarro C, Serrano-Valero M, Fages-Caravaca EM, Martínez-Payá JJ, Del Baño-Aledo ME, Ríos-Díaz J. Dynamic analysis of muscles and the internal structure of the peripheral nerve as biomarkers of amyotrophic lateral sclerosis: A pilot study with ultrasound imaging. Neurologia 2024; 39:457-466. [PMID: 37116686 DOI: 10.1016/j.nrleng.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/25/2021] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION The aim of this study was to determine the behaviour of ultrasound biomarkers of fascicle density and muscle strength in patients with amyotrophic lateral sclerosis (ALS). METHODS We conducted an observational, cross-sectional pilot study of 14 patients with ALS (28.6% women) and 14 controls. Bilateral cross-sectional ultrasound scans were performed in the abductor pollicis brevis (APB) and tibialis anterior (TA) muscles, with recording of muscle thickness (MT) at rest and in contraction, and the difference in thickness. In the median, sciatic, and common peroneal nerves, we analysed the cross-sectional area (CSA), number of fascicles (NF) and fascicle density (FD). Analyses were nested by laterality. RESULTS Intra- and interrater agreement regarding NF was very good, with a minimum detectable error of < 0.7%. In patients with ALS, MT was lower in the APB both at rest (P = .003; g-Hedges = 1.03) and in contraction (P = .017; g-Hedges = 0.78) and in TA at rest (P = .002; g-Hedges = 0.15) and in contraction (P = .001; g-Hedges = 0.46), with lower thickening capacity. In the nerves, patients displayed lower CSA, with lower NF and higher FD. Significant correlations were found between MT of the ABP and Medical Research Council (MRC) scores for muscle strength (r = 0.34; r2 = 12%; P = .011) and with revised ALS Functional Rating Scale scores (r = 0.44; r2 = 19%; P < .001). The difference in TA thickening correlated with MRC scores (r = 0.30; r2 = 15%; P = .003) and with revised ALS Functional Rating Scale scores (r = 0.26; r2 = 7%; P = .049). NF in the sciatic nerve showed a significant correlation with MRC scores (r = 0.35; r2 = 12%; P = .008). CONCLUSION MT measurements derived from dynamic testing together with NF and FD may be useful biomarkers for monitoring patients with ALS and establishing a prognosis.
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Affiliation(s)
- C López-Navarro
- Departamento de Fisioterapia, Facultad de Medicina, Campus de Espinardo 30100, Universidad de Murcia, Murcia, Spain
| | - M Serrano-Valero
- Departamento de Fisioterapia, Facultad de Medicina, Campus de Espinardo 30100, Universidad de Murcia, Murcia, Spain
| | - E M Fages-Caravaca
- Departamento de Neurología, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - J J Martínez-Payá
- Departamento de Fisioterapia, Facultad de Medicina, Campus de Espinardo 30100, Universidad de Murcia, Murcia, Spain.
| | - M E Del Baño-Aledo
- Departamento de Fisioterapia, Facultad de Medicina, Campus de Espinardo 30100, Universidad de Murcia, Murcia, Spain
| | - J Ríos-Díaz
- Centro de Ciencias de la Salud San Rafael, Fundación San Juan de Dios, Universidad de Nebrija, Madrid, Spain
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Nasr-Eldin YK, Cartwright MS, Hamed A, Ali LH, Abdel-Nasser AM. Neuromuscular Ultrasound in Polyneuropathies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1181-1198. [PMID: 38504399 DOI: 10.1002/jum.16447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/21/2024]
Abstract
Neuromuscular ultrasound is a painless, radiation-free, high-resolution imaging technique for assessing the peripheral nervous system. It can accurately depict changes in the nerves and muscles of individuals with neuromuscular conditions, and it is therefore a robust diagnostic tool for the assessment of individuals with polyneuropathies. This review will outline the typical ultrasonographic changes found in a wide variety of polyneuropathies. In general, demyelinating conditions result in greater nerve enlargement than axonal conditions, and acquired conditions result in more patchy nerve enlargement compared to diffuse nerve enlargement in hereditary conditions. This review is data-driven, but more nuanced anecdotal findings are also described. The overall goal of this paper is to provide clinicians with an accessible review of the ultrasonographic approaches and findings in a wide variety of polyneuropathies.
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Affiliation(s)
| | - Michael S Cartwright
- Neurology Department, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ahmed Hamed
- Rheumatology and Rehabilitation Department, Minia University, Minia, Egypt
| | - Lamia Hamdy Ali
- Clinical Pathology Department, Minia University, Minia, Egypt
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Shin-Yi Lin C, Howells J, Rutkove S, Nandedkar S, Neuwirth C, Noto YI, Shahrizaila N, Whittaker RG, Bostock H, Burke D, Tankisi H. Neurophysiological and imaging biomarkers of lower motor neuron dysfunction in motor neuron diseases/amyotrophic lateral sclerosis: IFCN handbook chapter. Clin Neurophysiol 2024; 162:91-120. [PMID: 38603949 DOI: 10.1016/j.clinph.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/07/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024]
Abstract
This chapter discusses comprehensive neurophysiological biomarkers utilised in motor neuron disease (MND) and, in particular, its commonest form, amyotrophic lateral sclerosis (ALS). These encompass the conventional techniques including nerve conduction studies (NCS), needle and high-density surface electromyography (EMG) and H-reflex studies as well as novel techniques. In the last two decades, new methods of assessing the loss of motor units in a muscle have been developed, that are more convenient than earlier methods of motor unit number estimation (MUNE),and may use either electrical stimulation (e.g. MScanFit MUNE) or voluntary activation (MUNIX). Electrical impedance myography (EIM) is another novel approach for the evaluation that relies upon the application and measurement of high-frequency, low-intensity electrical current. Nerve excitability techniques (NET) also provide insights into the function of an axon and reflect the changes in resting membrane potential, ion channel dysfunction and the structural integrity of the axon and myelin sheath. Furthermore, imaging ultrasound techniques as well as magnetic resonance imaging are capable of detecting the constituents of morphological changes in the nerve and muscle. The chapter provides a critical description of the ability of each technique to provide neurophysiological insight into the complex pathophysiology of MND/ALS. However, it is important to recognise the strengths and limitations of each approach in order to clarify utility. These neurophysiological biomarkers have demonstrated reliability, specificity and provide additional information to validate and assess lower motor neuron dysfunction. Their use has expanded the knowledge about MND/ALS and enhanced our understanding of the relationship between motor units, axons, reflexes and other neural circuits in relation to clinical features of patients with MND/ALS at different stages of the disease. Taken together, the ultimate goal is to aid early diagnosis, distinguish potential disease mimics, monitor and stage disease progression, quantify response to treatment and develop potential therapeutic interventions.
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Affiliation(s)
- Cindy Shin-Yi Lin
- Faculty of Medicine and Health, Central Clinical School, Brain and Mind Centre, University of Sydney, Sydney 2006, Australia.
| | - James Howells
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Seward Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sanjeev Nandedkar
- Natus Medical Inc, Middleton, Wisconsin, USA and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Roger G Whittaker
- Newcastle University Translational and Clinical Research Institute (NUTCRI), Newcastle University., Newcastle Upon Tyne, United Kingdom
| | - Hugh Bostock
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, WC1N 3BG, London, United Kingdom
| | - David Burke
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Fuentes-Abolafio IJ, Ricci M, Bernal-López MR, Gómez-Huelgas R, Cuesta-Vargas AI, Pérez-Belmonte LM. Relationship between quadriceps femoris echotexture biomarkers and muscle strength and physical function in older adults with heart failure with preserved ejection fraction. Exp Gerontol 2024; 190:112412. [PMID: 38570057 DOI: 10.1016/j.exger.2024.112412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Muscle wasting is pronounced in patients with heart failure with preserved ejection fraction (HFpEF). The quadriceps femoris echotexture biomarkers assessed by ultrasound (US) have not been studied in these patients. OBJECTIVE To describe echotexture biomarkers assessed by the US and to assess their relationship with sex, age, body mass index (BMI), self-reported outcomes, muscle strength and physical function in older adults with HFpEF. METHODS A cross-sectional study was conducted. Patients 70 years and older with HFpEF were included. The sex, age, BMI, and self-reported outcomes were collected. The US assessed muscle and subcutaneous fat tissue contrast, correlation, energy, homogeneity, and entropy at rest and maximal voluntary isometrical contraction (MVIC). The six-minute walk test (6MWT), the short physical performance battery (SPPB), the timed up and go test (TUG), the usual pace gait speed test (UGS), and the fast pace gait speed test (FGS) were used to assess physical function. The five-repetitions sit-to-stand test (5-STS) was performed to assess muscle strength. Bivariant Pearson correlations and subsequent multivariate linear regression analyses were conducted. RESULTS Seventy-two older adults with HFpEF [81.06 years, 29.13 BMI, and 55.60% females] were recruited. In women, relaxed and MVIC muscle energy and entropy explained 35.40% of the TUG variance; relaxed muscle entropy and MVIC muscle energy shared 24.00% of the UGS variance; relaxed and MVIC muscle entropy, MVIC muscle contrast and MVIC muscle energy explained 32.60% of the FGS variance, adjusted all the models by age and BMI. CONCLUSIONS Echotexture biomarkers are related to women's muscle strength and physical function, especially muscle energy, contrast, and entropy. Echotexture biomarkers assessed by the US could facilitate the management of older adults with HFpEF, monitor its progression and assess the effectiveness of treatments on the musculoskeletal structure. TRIAL REGISTRATION NCT03909919. April 10, 2019. Retrospectively registered.
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Affiliation(s)
- Iván José Fuentes-Abolafio
- Grupo de Investigación Clinimetría CTS-631, Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand)), IBIMA Plataforma‑Bionand, Málaga, Spain
| | - Michele Ricci
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - María Rosa Bernal-López
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand)), IBIMA Plataforma‑Bionand, Málaga, Spain; Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain; CIBER Fisio-patología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Ricardo Gómez-Huelgas
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand)), IBIMA Plataforma‑Bionand, Málaga, Spain; Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain; CIBER Fisio-patología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Ignacio Cuesta-Vargas
- Grupo de Investigación Clinimetría CTS-631, Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand)), IBIMA Plataforma‑Bionand, Málaga, Spain; School of Clinical Sciences, Faculty of Health at the Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Luis Miguel Pérez-Belmonte
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand)), IBIMA Plataforma‑Bionand, Málaga, Spain; Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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Hu N, Li Y, Liu J, Cui L, Liu M. Split Phenomenon of Fasciculation between Antagonistic Muscles in Amyotrophic Lateral Sclerosis: An Ultrasound Study. Can J Neurol Sci 2024; 51:187-195. [PMID: 37183728 DOI: 10.1017/cjn.2023.62] [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: 05/16/2023]
Abstract
OBJECTIVE Paresis of muscle groups in patients with amyotrophic lateral sclerosis (ALS) tends to present split phenomena. We explored the split phenomenon of fasciculation in multiple antagonistic muscle groups in ALS patients. METHODS One hundred and forty ALS patients and 66 non-ALS patients were included from a single ALS center. Muscle ultrasonography (MUS) was performed to detect fasciculation in elbow flexor-extensor, wrist flexor-extensor, knee flexor-extensor, and ankle flexor-extensor. Split phenomena of fasciculation between different antagonistic muscle groups were summarized, and the possible influence factors were analyzed through stratified analysis. RESULTS The frequency of split phenomenon of fasciculation intensity was significantly higher than those of muscle strength (26.1% vs. 7.1% for elbow flexor-extensor, 38.3% vs. 5.7% for wrist flexor-extensor, 37.9% vs. 3.0% for knee extensor-flexor, and 33.6% vs. 14.4% for ankle flexor-extensor) (P < 0.01). For muscles with 0-1 level of muscle strength (the Medical Research Council, MRC, score), significance difference in mean fasciculation intensity was observed only in ankle flexor-extensor. For muscles with 2-5 level of muscle strength, significant dissociation of fasciculation grade was common, especially among patients with slow rapid progression rate and both upper and lower motor neuron (UMN and LMN) involvement. As for non-ALS patients, no significant difference was observed in fasciculation intensity between antagonistic muscles. CONCLUSION Split phenomenon of fasciculation between antagonistic muscles was common and relatively specific in ALS patients. Muscle strength, progression rate, and UMN involvement were influence factors of the split phenomenon of fasciculation intensity.
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Affiliation(s)
- Nan Hu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Yi Li
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Jingwen Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
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Fionda L, Vanoli F, Di Pasquale A, Leonardi L, Morino S, Merlonghi G, Lauletta A, Alfieri G, Costanzo R, Tufano L, Rossini E, Bucci E, Grossi A, Tupler R, Salvetti M, Garibaldi M, Antonini G. Comparison of quantitative muscle ultrasound and whole-body muscle MRI in facioscapulohumeral muscular dystrophy type 1 patients. Neurol Sci 2023; 44:4057-4064. [PMID: 37311950 PMCID: PMC10570177 DOI: 10.1007/s10072-023-06842-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/06/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Muscle ultrasound is a fast, non-invasive and cost-effective examination that can identify structural muscular changes by assessing muscle thickness and echointensity (EI) with a quantitative analysis (QMUS). To assess applicability and repeatability of QMUS, we evaluated patients with genetically confirmed facioscapulohumeral muscular dystrophy type 1 (FSHD1), comparing their muscle ultrasound characteristics with healthy controls and with those detected by MRI. We also evaluated relationships between QMUS and demographic and clinical characteristics. MATERIALS AND METHODS Thirteen patients were included in the study. Clinical assessment included MRC sum score, FSHD score and The Comprehensive Clinical Evaluation Form (CCEF). QMUS was performed with a linear transducer scanning bilaterally pectoralis major, deltoid, rectus femoris, tibialis anterior and semimembranosus muscles in patients and healthy subjects. For each muscle, we acquired three images, which were analysed calculating muscle EI by computer-assisted grey-scale analysis. QMUS analysis was compared with semiquantitative 1.5 T muscle MRI scale. RESULTS All muscles in FSHD patients showed a significant increased echogenicity compared to the homologous muscles in healthy subjects. Older subjects and patients with higher FSHD score presented increased muscle EI. Tibialis anterior MRC showed a significant inverse correlation with EI. Higher median EI was found in muscles with more severe MRI fat replacement. CONCLUSIONS QMUS allows quantitative evaluation of muscle echogenicity, displaying a tight correlation with muscular alterations, clinical and MRI data. Although a confirmation on larger sample is needed, our research suggests a possible future application of QMUS in diagnosis and management of muscular disorders.
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Affiliation(s)
- Laura Fionda
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
| | - Fiammetta Vanoli
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
- Neurology IV-Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | | | - Luca Leonardi
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Stefania Morino
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Gioia Merlonghi
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Antonio Lauletta
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Girolamo Alfieri
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
- Neurology IV-Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133, Milan, Italy
| | - Rocco Costanzo
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Laura Tufano
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Elena Rossini
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Elisabetta Bucci
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Andrea Grossi
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Rossella Tupler
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Salvetti
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Matteo Garibaldi
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
| | - Giovanni Antonini
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, SAPIENZA University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy
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Alnajjar SA, Fathihelabad D, Abraham A, Daniyal L, Lovblom LE, Bril V. Systematic Comparison of Muscle Ultrasound Thickness in Polyneuropathies and Other Neuromuscular Diseases. Neurol Ther 2023; 12:1623-1630. [PMID: 37338783 PMCID: PMC10444740 DOI: 10.1007/s40120-023-00485-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/18/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND We have aimed to assess whether muscle thickness ultrasound (US) shows differences between patients with chronic inflammatory demyelinating polyneuropathy (CIDP), chronic axonal polyneuropathy (CAP), and other neuromuscular (NM) diseases compared to controls and to each other. METHODS We performed a cross-sectional study from September 2021 to June 2022. All subjects underwent quantitative sonographic evaluation of muscle thickness in eight relaxed muscles and four contracted muscles. Differences were assessed using multivariable linear regression, correcting for age and body mass index (BMI). RESULTS The study cohort consisted of 65 healthy controls, and 95 patients: 31 with CIDP, 34 with CAP, and 30 with other NM diseases. Both relaxed and contracted muscle thickness in all patient groups were lower than in the healthy controls, after controlling for age and body mass index (BMI). Regression confirmed that the differences persisted between patient groups and healthy controls. Differences between patient groups were not apparent. CONCLUSION The current study shows that muscle ultrasound thickness is not specific in NM disorders, but shows a global reduction in thickness compared with healthy controls after corrections for age and BMI.
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Affiliation(s)
- Sara A Alnajjar
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, Toronto, Canada
- University of Toronto, Toronto, Canada
- King Abdulaziz Hospital, Ministry of National Guard Health Affair, Al Ahsa, Saudi Arabia
| | - Davood Fathihelabad
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Alon Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lubna Daniyal
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | - Vera Bril
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, Toronto, Canada.
- University of Toronto, Toronto, Canada.
- 5EC-309, Toronto General Hospital, 200 Elizabeth St., Toronto, ON, Canada.
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Zhou L, Liu S, Zheng W. Automatic Analysis of Transverse Musculoskeletal Ultrasound Images Based on the Multi-Task Learning Model. ENTROPY (BASEL, SWITZERLAND) 2023; 25:e25040662. [PMID: 37190450 PMCID: PMC10138032 DOI: 10.3390/e25040662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
Musculoskeletal ultrasound imaging is an important basis for the early screening and accurate treatment of muscle disorders. It allows the observation of muscle status to screen for underlying neuromuscular diseases including myasthenia gravis, myotonic dystrophy, and ankylosing muscular dystrophy. Due to the complexity of skeletal muscle ultrasound image noise, it is a tedious and time-consuming process to analyze. Therefore, we proposed a multi-task learning-based approach to automatically segment and initially diagnose transverse musculoskeletal ultrasound images. The method implements muscle cross-sectional area (CSA) segmentation and abnormal muscle classification by constructing a multi-task model based on multi-scale fusion and attention mechanisms (MMA-Net). The model exploits the correlation between tasks by sharing a part of the shallow network and adding connections to exchange information in the deep network. The multi-scale feature fusion module and attention mechanism were added to MMA-Net to increase the receptive field and enhance the feature extraction ability. Experiments were conducted using a total of 1827 medial gastrocnemius ultrasound images from multiple subjects. Ten percent of the samples were randomly selected for testing, 10% as the validation set, and the remaining 80% as the training set. The results show that the proposed network structure and the added modules are effective. Compared with advanced single-task models and existing analysis methods, our method has a better performance at classification and segmentation. The mean Dice coefficients and IoU of muscle cross-sectional area segmentation were 96.74% and 94.10%, respectively. The accuracy and recall of abnormal muscle classification were 95.60% and 94.96%. The proposed method achieves convenient and accurate analysis of transverse musculoskeletal ultrasound images, which can assist physicians in the diagnosis and treatment of muscle diseases from multiple perspectives.
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Affiliation(s)
- Linxueying Zhou
- College of Computer Science and Engineering, Shandong University of Science and Technology, Qingdao 266590, China
| | - Shangkun Liu
- College of Computer Science and Engineering, Shandong University of Science and Technology, Qingdao 266590, China
| | - Weimin Zheng
- College of Computer Science and Engineering, Shandong University of Science and Technology, Qingdao 266590, China
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Quantitative muscle ultrasound assessment using automatic thresholding methods in amyotrophic lateral sclerosis. Clin Neurophysiol 2022; 142:236-243. [DOI: 10.1016/j.clinph.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022]
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López-Navarro C, Serrano-Valero M, Fages-Caravaca E, Martínez-Payá J, del Baño-Aledo M, Ríos-Díaz J. Análisis dinámico muscular y de la estructura interna del nervio periférico como biomarcadores para la esclerosis lateral amiotrófica: estudio piloto mediante ecografía. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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11
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Quantitative Ultrasound Changes in Echotexture and Functional Parameters after a Multicomponent Training Program in Pre-Frailty Individuals: A Pilot Randomized Clinical Trial. Healthcare (Basel) 2021; 9:healthcare9101279. [PMID: 34682959 PMCID: PMC8535283 DOI: 10.3390/healthcare9101279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/13/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Currently, ultrasound imaging (USI) is considered a feasible tool in the evaluation of structural and textural muscle differences due to aging. The main aim of this study was to evaluate sonographic changes in muscular structure and function after a 12-week multicomponent training program in pre-frailty individuals. Design: A prospective, randomized, clinical trial was carried out. Participants: Thirty-two pre-frailty subjects were recruited and randomly divided into a multicomponent training program group (n = 16; Multicomponent group) and a conventional care group (n = 14; Control group) with a 12-week follow up. Main outcome measures: Rectus femoris thickness, cross-sectional area (CSA), echointensity, echovariation and vastus lateralis pennation angle tests were carried out to assess the structure and echotexture, and the force-velocity (F-V) profile for muscle power and muscle strength was employed to assess the functional parameters. Results: Statistically significant differences (p < 0.05) were shown for the left rectus femoris echointensity and in the functional parameter of muscle power after a 12-week program for the multicomponent training group compared to the conventional care group. Conclusions: Pre-frailty elderly subjects showed a decrease in rectus femoris echointensity (RF-EI) and an increase in the functional parameter of muscle power after a 12-week multicomponent training program compared to the control group.
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12
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Hu N, Wang J, Liu M. Split hand in amyotrophic lateral sclerosis: A systematic review and meta-analysis. J Clin Neurosci 2021; 90:293-301. [PMID: 34275566 DOI: 10.1016/j.jocn.2021.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/05/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the frequency of split hand (SI) and its diagnostic performance in amyotrophic lateral sclerosis (ALS). METHODS PubMed, EMBASE, OVID and other databases were searched systematically up to March 2021 for relevant reports about the split hand syndrome. Two reviewers screened and selected the titles and abstracts of the studies independently during the database searches and performed full-text reviews and extracted available data. In our study, AACMAP was calculated by AACMAP = APBCMAP/ADMCMAP and split-hand index (SI) was calculated by SICMAP = (APBCMAP × FDICMAP)/ADMCMAP. The mean differences (MD) in APB/ADMCMAP and SICMAP between patients with ALS and control group were calculated (APB the abductor pollicis brevis muscle; ADM the abductor digiti minimi muscle; CMAP compound muscle action potentials). Meta-analysis was performed to determine summary sensitivity, specificity, and area under the curve (AUC) with 95% confidence intervals (CI) for SICMAP. RESULTS Pooled results of five studies including 339 patients showed that 50% (95%CI: 35%-65%) of patients with ALS presented split hand. APB/ADMCMAP in patients with ALS was significantly lower than healthy population (MD: -0.38, 95%CI: -0.48, -0.28). SICMAP in patients with ALS was significantly lower than healthy controls (MD: -5.87, 95%CI: -6.28, -5.46) and neuromuscular controls (MD: -5.60, 95%CI: -5.78, -5.42). Receiver operating characteristic curve analysis showed that the AUC was 0.860 [95%CI: 0.808, 0.911] for SICMAP. The sensitivity and specificity for SICMAP were 78% and 81% (cut-off value: 5.2-11.8), respectively. CONCLUSION Half of ALS patients might show split hand sign. SICMAP could be a potential biomarker in the diagnosis of ALS.
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Affiliation(s)
- Nan Hu
- Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Jingyi Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China.
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13
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Kaczmarczyk I, Rawji V, Rothwell JC, Hodson-Tole E, Sharma N. Comparison between surface electrodes and ultrasound monitoring to measure TMS evoked muscle contraction. Muscle Nerve 2021; 63:724-729. [PMID: 33533504 DOI: 10.1002/mus.27192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Transcranial magnetic stimulation (TMS) is widely used to explore cortical physiology in health and disease. Surface electromyography (sEMG) is appropriate for superficial muscles, but cannot be applied easily to less accessible muscles. Muscle ultrasound (mUS) may provide an elegant solution to this problem, but fundamental questions remain. We explore the relationship between TMS evoked muscle potentials and TMS evoked muscle contractions measured with mUS. METHODS In 10 participants, we performed a TMS recruitment curve, simultaneously measuring motor evoked potentials (MEPs) and mUS in biceps (BI), first dorsal interosseous (FDI), tibialis anterior (TA), and the tongue (TO). RESULTS Resting motor threshold (RMT) measurements and recruitment curves were found to be consistent across sEMG and mUS. DISCUSSION This work supports the use of TMS-US to study less accessible muscles. The implications are broad but could include the study of a new range of muscles in disorders such as amyotrophic lateral sclerosis.
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Affiliation(s)
- Isabella Kaczmarczyk
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Vishal Rawji
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - John C Rothwell
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Emma Hodson-Tole
- Musculoskeletal Sciences and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Nikhil Sharma
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK
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14
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Rajabkhah S, Moradi K, Okhovat AA, Van Alfen N, Fathi D, Aghaghazvini L, Ashraf-Ganjouei A, Attarian S, Nafissi S, Fatehi F. Application of muscle ultrasound for the evaluation of patients with amyotrophic lateral sclerosis: An observational cross-sectional study. Muscle Nerve 2020; 62:516-521. [PMID: 32710682 DOI: 10.1002/mus.27036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION We evaluated the association between muscle ultrasound, number of motor units, and clinical parameters, and assessed their utility for distinguishing amyotrophic lateral scleorisis (ALS) patients from healthy individuals. METHODS Three muscle pairs (abductor pollicis brevis, abductor digiti minimi, and tibialis anterior) of 18 ALS patients and 18 controls underwent muscle ultrasound (echointensity and thickness) and assessment of motor unit number index (MUNIX). The clinical and functional status of participants were also assessed. RESULTS Mean age of the patients was 53.8 ± 12.1 years, and score on the ALS Functional Rating Scale-Revised was 38.9 ± 4.1. Echointensity of all tested muscles of ALS participants was significantly higher than that of controls, but there was no significant difference in muscle thickness. Muscle echointensity correlated significantly with clinical and electrophysiological parameters. CONCLUSION Echointensity of muscles was highly associated with clinical scales and MUNIX, confirming its relevance as an ancillary diagnostic test in ALS patients.
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Affiliation(s)
- Sahebeh Rajabkhah
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Jalal al Ahmad, Tehran, 1411713135, Iran
| | - Kamyar Moradi
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Jalal al Ahmad, Tehran, 1411713135, Iran
| | - Ali A Okhovat
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Jalal al Ahmad, Tehran, 1411713135, Iran.,Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nens Van Alfen
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Davood Fathi
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Jalal al Ahmad, Tehran, 1411713135, Iran.,Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Aghaghazvini
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ashraf-Ganjouei
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Jalal al Ahmad, Tehran, 1411713135, Iran
| | - Shahram Attarian
- Neuromuscular Disease and ALS Reference Center, Timone University Hospital Aix-Marseille University, Marseille, France
| | - Shahriar Nafissi
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Jalal al Ahmad, Tehran, 1411713135, Iran.,Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Jalal al Ahmad, Tehran, 1411713135, Iran.,Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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15
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McIlduff CE, Martucci MG, Shin C, Qi K, Pacheck AK, Gutierrez H, Mortreux M, Rutkove SB. Quantitative ultrasound of the tongue: Echo intensity is a potential biomarker of bulbar dysfunction in amyotrophic lateral sclerosis. Clin Neurophysiol 2020; 131:2423-2428. [PMID: 32828046 DOI: 10.1016/j.clinph.2020.06.027] [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] [Received: 04/01/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To learn if quantitative ultrasound (QUS) distinguishes the tongues of healthy participants and amyotrophic lateral sclerosis (ALS) patients by echo intensity (EI) and to evaluate if EI correlates with measures of bulbar function. METHODS Ultrasound was performed along the midline of the anterior tongue surface in 16 ALS patients and 16 age-matched controls using a linear hockey stick 16-7 MHz transducer. A region of interest was manually drawn and then EI was determined for the upper 1/3 of the muscle. For patients, the ALS functional rating scale - revised (ALSFRS-R) was used to calculate bulbar sub-scores and the Iowa Oral Performance Instrument (IOPI) was used to measure tongue strength. RESULTS EI was significantly higher in ALS patients than in healthy participants (49.8 versus 37.8 arbitrary units, p < 0.01). In the patient group, EI was negatively correlated with ALSFRS-R bulbar sub-score (RS = -0.65, p < 0.01). An inverse correlation between EI and tongue strength did not reach significance (RS = -0.34, p = 0.28). CONCLUSIONS This study suggests that EI can differentiate healthy from diseased tongue muscle, and correlates with a standard functional measure in ALS patients. SIGNIFICANCE Tongue EI may represent a novel biomarker for bulbar dysfunction in ALS.
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Affiliation(s)
- C E McIlduff
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA.
| | - M G Martucci
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA
| | - C Shin
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA
| | - K Qi
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA
| | - A K Pacheck
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA
| | - H Gutierrez
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA
| | - M Mortreux
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA
| | - S B Rutkove
- Beth Israel Deaconess Medical Center, Department of Neurology, 330 Brookline Avenue, TCC-810, Boston, MA 02215, USA
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16
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Abraham A, Fainmesser Y, Drory VE, Bril V. Split-hand phenomenon in motor neuron diseases: Sonographic assesment of muscle thickness. Clin Neurophysiol 2020; 131:1721-1725. [PMID: 32504931 DOI: 10.1016/j.clinph.2020.04.163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/21/2020] [Accepted: 04/07/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To explore the diagnostic accuracy of the split-hand index (SHI) for amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy (SMA) using sonographic assessment of muscle thickness. METHODS We performed a prospective sonographic assessment of hand muscle thickness in 59 controls, 87 patients with ALS, and 33 patients with SMA. We determined the diagnostic accuracy of SHI for differentiating patients with ALS and SMA from controls. RESULTS Patients with ALS and SMA had significantly lower muscle thickness and SHI values compared with controls. SHI showed excellent diagnostic accuracy for differentiating ALS from controls, and good diagnostic accuracy for differentiating SMA from controls. CONCLUSIONS SHI determined by sonographic measurement of hand muscle thickness seems to be a promising tool for the diagnosis of ALS and may be added easily when performing neuromuscular ultrasound. SIGNIFICANCE SHI determined by sonographic measurement of hand muscle thickness can differentiate between healthy subjects and patients with ALS and SMA.
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Affiliation(s)
- Alon Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yaara Fainmesser
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Vivian E Drory
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada; Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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17
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Duarte ML, Iared W, Oliveira ASB, Dos Santos LR, Peccin MS. Ultrasound versus electromyography for the detection of fasciculation in amyotrophic lateral sclerosis: systematic review and meta-analysis. Radiol Bras 2020; 53:116-121. [PMID: 32336828 PMCID: PMC7170585 DOI: 10.1590/0100-3984.2019.0055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The objective of this study was to determine the diagnostic accuracy of ultrasound and electromyography for the detection of fasciculation in patients with amyotrophic lateral sclerosis and to compare detection rates between the two methods. By searching the Cochrane Library, MEDLINE, Excerpta Medica, and Latin-American and Caribbean Health Sciences Literature databases, we identified studies evaluating the diagnostic accuracy and fasciculation detection rates of ultrasound and electromyography. The Quality Assessment of Diagnostic Accuracy Studies, version 2, and RTI item bank tools were used for the evaluation of methodological quality. Ultrasound, for 10 s or 30 s, had a higher detection rate than did electromyography in all muscles evaluated. The overall detection rate (in patients) did not differ significantly between ultrasound for 10 s and ultrasound for 30 s. The accuracy of ultrasound for 10 s was 70% in muscles and 85% in patients. The accuracy of ultrasound for 30 s was 82% in patients. Ultrasound provided detection rates superior to those achieved with electromyography, independent of the examination time and muscles evaluated.
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Affiliation(s)
- Márcio Luís Duarte
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Wagner Iared
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | | | - Maria Stella Peccin
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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18
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Ozsoy-Unubol T, Bahar-Ozdemir Y, Yagci I. Diagnosis and grading of carpal tunnel syndrome with quantitative ultrasound: Is it possible? J Clin Neurosci 2020; 75:25-29. [PMID: 32234336 DOI: 10.1016/j.jocn.2020.03.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/21/2020] [Indexed: 12/22/2022]
Abstract
The recent diagnostic tools for carpal tunnel syndrome (CTS) include nerve conduction studies (NCS) and ultrasound (US). Quantitative US (QUS) can be used for demonstrating muscle changes according to denervation. The aim of this study was to evaluate if QUS can diagnose and grade the severity of CTS. In this single blinded cross-sectional study, female patients diagnosed with CTS and age-matched healthy female subjects were included in the study. Median and ulnar nerve conduction studies (NCS) were performed for CTS diagnosis. Median and ulnar nerve cross-sectional area (CSA) was measured, and the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) muscles were longitudinally and transversally visualised. Axial images were analysed for echo intensity (EI) via computer-assisted, grayscale analysis. Intra-rater and inter-rater reliability analysis was performed. The Boston questionnaire was used for the evaluation of symptom severity and functional status. Forty-two patients (42 hands) and 32 controls were included. In the CTS group, 17 patients had mild, 13 patients had moderate, and 12 patients had severe CTS. CSA of the median nerve and APB echo intensity was significantly higher in patients with CTS. However, according to the CTS grade, no significant difference was detected for APB EI. The intraclass correlation coefficient (ICC) was calculated as 0.928 for intra-rater reliability and 0.768 for inter-rater reliability. QUS evaluation is helpful for the diagnosis of CTS, but not for grading. Further studies are needed with a larger population including both genders.
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Affiliation(s)
- Tugba Ozsoy-Unubol
- Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, Fevzi Çakmak, Muhsin Yazıcıoğlu Cd No: 10, 34899 Pendik/İstanbul, Turkey.
| | - Yeliz Bahar-Ozdemir
- Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, Fevzi Çakmak, Muhsin Yazıcıoğlu Cd No: 10, 34899 Pendik/İstanbul, Turkey
| | - Ilker Yagci
- Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, Fevzi Çakmak, Muhsin Yazıcıoğlu Cd No: 10, 34899 Pendik/İstanbul, Turkey
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19
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Intrarater and Interrater Reliability of Heckmatt Scoring System in Amyotrophic Lateral Sclerosis. J Clin Neurophysiol 2020; 38:293-298. [DOI: 10.1097/wnp.0000000000000690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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20
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Abraham A, Drory VE, Fainmesser Y, Lovblom LE, Bril V. Quantitative sonographic evaluation of muscle thickness and fasciculation prevalence in healthy subjects. Muscle Nerve 2019; 61:234-238. [PMID: 31725905 DOI: 10.1002/mus.26758] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the current study, we aimed to determine normative values for muscle thickness and fasciculation prevalence in healthy subjects. METHODS We performed a prospective study from October to December 2018 in 65 healthy subjects. All subjects underwent quantitative sonographic evaluation of muscle thickness and fasciculation prevalence in the following 8 muscles: Biceps brachii, abductor pollicis brevis, first dorsal interosseous, abductor digiti minimi, quadriceps, tibialis anterior, extensor digitorum brevis, and abductor hallucis brevis. RESULTS Subject ages ranged from 21 to 82 years, with 63% women. Normative values for muscle thickness were determined using the fifth percentile. Multivariate regression analysis showed that sex, age, body mass index, and hand dominance affected muscle thickness. Fasciculations were observed frequently only in distal muscles. CONCLUSIONS Normal values for muscle thickness were determined, and may enhance neuromuscular ultrasound sensitivity and serve as a basis for future studies. Larger series are needed to confirm these values.
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Affiliation(s)
- Alon Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Vivian E Drory
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaara Fainmesser
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Leif E Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, Sinai Health System, and Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada.,Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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21
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Todo H, Nishida K, Ando R, Yamasaki H, Futamura N, Funakawa I. Count of Fasciculation in Ultrasound Can Predict the Prognosis of Amyotrophic Lateral Sclerosis. Ann Indian Acad Neurol 2019; 22:482-484. [PMID: 31736575 PMCID: PMC6839311 DOI: 10.4103/aian.aian_429_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/10/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Although muscle ultrasound (MUS) is known to facilitate the diagnosis and evaluation of the severity of amyotrophic lateral sclerosis (ALS), the number of fasciculation has been scarcely examined as a predictive marker of the prognosis in ALS. Objective: The objective of this study was to examine the predictive value of fasciculation number for the prognosis of ALS. Materials and Methods: We examined fasciculation count (FasC), defined as the number of fasciculation per unit of time and area in MUS, of 11 patients with clinically probable or definite ALS. Thereafter, they were observed for maximally 2 years, unless they reached the endpoint of decease or receiving tracheostomy. Results: Six patients, who thereafter reached the endpoint within 2 years, had significantly higher FasC (223 [49.3] vs. 34 [13], P = 0.0043) and shorter disease duration (7 [2.3] vs. 33 [17], P = 0.0022) at MUS than the remaining five patients without reaching the endpoint. Discussion and Conclusion: Our study suggested that high FasC in MUS can predict rapid progression in ALS. Due to the limitations such as small sample size, suboptimal length of the observational period, and confounding factor of disease duration, further investigations are required.
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Affiliation(s)
- Hiroyuki Todo
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
| | - Katsuya Nishida
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
| | - Ryuki Ando
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
| | - Hiroshi Yamasaki
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
| | - Naonobu Futamura
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
| | - Itaru Funakawa
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
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22
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Abraham A, Drory VE, Fainmesser Y, Algom AA, Lovblom LE, Bril V. Muscle thickness measured by ultrasound is reduced in neuromuscular disorders and correlates with clinical and electrophysiological findings. Muscle Nerve 2019; 60:687-692. [PMID: 31478199 DOI: 10.1002/mus.26693] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Nerve imaging has a limited role in axonal and muscle fiber loss. In this study, we sought to explore the utility of standardized muscle ultrasound (US) assessment in these clinical scenarios. METHODS We performed a prospective study from March to August 2018 of patients attending the neuromuscular clinic. All patients underwent clinical evaluation and standardized muscle thickness measurement by US in seven muscles. RESULTS The study cohort consisted of 114 participants, including patients with polyneuropathy, motor neuron disease, and myopathy. The smallest distal muscle thickness was found in patients with polyneuropathy, while the smallest proximal muscle thickness was found in patients with myopathy. Muscle thickness was strongly correlated with muscle strength (r 2 = 0.62), electrophysiological findings (r 2 : 0.44-0.55), and disability score (r 2 = 0.53). DISCUSSION Standardized muscle thickness measured by US shows diagnostic usefulness in a spectrum of neuromuscular disorders and correlates with clinical and electrophysiological findings.
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Affiliation(s)
- Alon Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vivian E Drory
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaara Fainmesser
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Avi A Algom
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Leif E Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, Sinai Health System, and Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada.,Department for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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23
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Abstract
Advances in high-resolution ultrasound have provided clinicians with unique opportunities to study diseases of the peripheral nervous system. Ultrasound complements the clinical and electrophysiology exam by showing the degree of abnormalities in myopathies, as well as spontaneous muscle activities in motor neuron diseases and other disorders. In experienced hands, ultrasound is more sensitive than MRI in detecting peripheral nerve pathologies. It can also guide needle placement for electromyography exam, therapeutic injections, and muscle biopsy. Ultrasound enhances the ability to detect carpal tunnel syndrome and other focal nerve entrapment, as well as pathological nerve enlargements in genetic and acquired neuropathies. Furthermore, ultrasound can potentially be used as a biomarker for muscular dystrophy and spinal muscular atrophy. The combination of electromyography and ultrasound can increase the diagnostic certainty of amyotrophic lateral sclerosis, aid in the localization of brachial plexus or peripheral nerve trauma and allow for surveillance of nerve tumor progression in neurofibromatosis. Potential limitations of ultrasound include an inability to image deeper structures, with lower sensitivities in detecting neuromuscular diseases in young children and those with mitochondrial myopathies, due to subtle changes or early phase of the disease. As well, its utility in detecting critical illness neuromyopathy remains unclear. This review will focus on the clinical applications of neuromuscular ultrasound. The diagnostic values of ultrasound for screening of myopathies, neuropathies, and motor neuron diseases will be presented.
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Barnes SL, Simon NG. Clinical and research applications of neuromuscular ultrasound in amyotrophic lateral sclerosis. Degener Neurol Neuromuscul Dis 2019; 9:89-102. [PMID: 31406480 PMCID: PMC6642653 DOI: 10.2147/dnnd.s215318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/14/2019] [Indexed: 12/20/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disorder characterized by dysfunction at multiple levels of the neuraxis. It remains a clinical diagnosis without a definitive diagnostic investigation. Electrodiagnostic testing provides supportive information and, along with imaging and biochemical markers, can help exclude mimicking conditions. Neuromuscular ultrasound has a valuable role in the diagnosis and monitoring of ALS and provides complementary information to clinical assessment and electrodiagnostic testing as well as insights into the underlying pathophysiology of this disease. This review highlights the evidence for ultrasound in the evaluation of bulbar, limb and respiratory musculature and peripheral nerves in ALS. Further research in this evolving area is required.
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Affiliation(s)
- Stephanie L Barnes
- Department of Neurology, Concord Repatriation General Hospital, Concord, NSW, Australia.,St Vincent's Clinical School, School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia
| | - Neil G Simon
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Berenpas F, Weerdesteyn V, Geurts AC, van Alfen N. Long-term use of implanted peroneal functional electrical stimulation for stroke-affected gait: the effects on muscle and motor nerve. J Neuroeng Rehabil 2019; 16:86. [PMID: 31292003 PMCID: PMC6621964 DOI: 10.1186/s12984-019-0556-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/21/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Peripheral changes to muscle and motor nerves occur following stroke, which may further impair functional capacity. We investigated whether a year-long use of an implanted peroneal FES system reverses stroke-related changes in muscles and motor nerves in people with foot drop in the chronic phase after supratentorial stroke. METHODS Thirteen persons with a chronic stroke (mean age 56.1 years, median Fugl-Meyer Assessment leg score 71%) were included and received an implanted peroneal FES system (ActiGait®). Quantitative muscle ultrasound (QMUS) images were obtained bilaterally from three leg muscles (i.e. tibialis anterior, rectus femoris, gastrocnemius). Echogenicity (muscle ultrasound gray value) and muscle thickness were assessed over a one-year follow-up and compared to age-, sex-, height- and weight-corrected reference values. Compound motor action potentials (CMAPs) and motor evoked potentials (MEPs) were obtained from the tibialis anterior muscle. Generalized estimated equation modeling was used to assess changes in QMUS, CMAPs and MEPs outcomes over the follow-up period. RESULTS Echogenicity of the tibialis anterior decreased significantly during the follow-up on the paretic side. Z-scores changed from 0.88 at baseline to - 0.15 after 52 weeks. This was accompanied by a significant increase in muscle thickness on the paretic side, where z-scores changed from - 0.32 at baseline to 0.48 after 52 weeks. Echogenicity of the rectus femoris normalized on both the paretic and non-paretic side (z-scores changed from - 1.09 and - 1.51 to 0.14 and - 0.49, respectively). Amplitudes of CMAP and MEP (normalized to CMAP) were reduced during follow-up, particularly on the paretic side (ΔCMAP = 20% and ΔMEP = 14%). CONCLUSIONS We show that the structural changes to muscles following stroke are reversible with FES and that these changes might not be limited to electrically stimulated muscles. No evidence for improvement of the motor nerves was found.
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Affiliation(s)
- Frank Berenpas
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Alexander C Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
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Diaphragm ultrasonography in amyotrophic lateral sclerosis: a diagnostic tool to assess ventilatory dysfunction and disease severity. Neurol Sci 2019; 40:2065-2071. [DOI: 10.1007/s10072-019-03938-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/13/2019] [Indexed: 12/13/2022]
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Hobson-Webb LD, Simmons Z. ULTRASOUND IN THE DIAGNOSIS AND MONITORING OF AMYOTROPHIC LATERAL SCLEROSIS: A REVIEW. Muscle Nerve 2019; 60:114-123. [PMID: 30989697 DOI: 10.1002/mus.26487] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 12/28/2022]
Abstract
Neuromuscular ultrasound is complementary to electrodiagnostic (EDx) testing and is useful in enhancing the diagnosis of mononeuropathies, peripheral nerve trauma, and demyelinating polyneuropathies. There is increasing interest in using ultrasound both to aid in the diagnosis of amyotrophic lateral sclerosis (ALS) and to monitor its progression. In this article we review the relevant literature on ultrasound in ALS. Ultrasound is more sensitive than EDx in identifying fasciculations in patients with ALS. It can detect decreased muscle thickness, increased muscle echointensity and echovariance, and reduced peripheral nerve size in these patients. Ultrasound is also a helpful tool in assessment of diaphragm function. Although additional studies are required to define the exact role of ultrasound in the evaluation and monitoring of ALS, it can improve the diagnostic yield in patients when ALS is suspected, but insufficiently supported, by clinical and EDx examinations. Muscle Nerve 60: 114-123, 2019.
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Affiliation(s)
- Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University Medical Center, DUMC 3403, Durham, North Carolina 27710, USA
| | - Zachary Simmons
- Department of Neurology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
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Quantitative neuromuscular ultrasound analysis as biomarkers in amyotrophic lateral sclerosis. Eur Radiol 2019; 29:4266-4275. [PMID: 30666448 DOI: 10.1007/s00330-018-5943-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/09/2018] [Accepted: 11/30/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess the differences in morphological and texture parameters of median nerve (MN) and abductor pollicis brevis (APB) between amyotrophic lateral sclerosis (ALS) patients and controls. METHODS The cross-sectional area (CSA) of the MN and the muscle thickness (MTh) of APB were measured bilaterally in 59 recently diagnosed ALS patients and 20 matched healthy controls. Echointensity (EI), echovariation (EV) and grey-level co-occurrence matrix (GLCM) texture features of both structures were also analysed. Correlations between these parameters and clinical variables (muscle strength and disability) were analysed. RESULTS The CSA of MN was significantly lower in ALS patients (MD = - 1.83 mm2 [95% CI = 2.89; - 0.77 mm2]; p = 0.01). ALS patients showed significantly lower MTh (- 2.23 mm [3.16; - 1.30 mm]; p < 0.001) and EV (- 7.40 [11.5; - 3.33]; p = 0.004) and higher EI (21.2 [11.9; 30.6]; p < 0.001) in the APB muscle. No relevant differences were detected in GLCM features for this muscle. The model including all parameters (CSA for MN and MTh, EI and EV for APB) showed an AUC of 82% (sensitivity 87%; specificity 42%). Muscle strength and disability correlated with APB muscle ultrasound parameters but not with those of the MN. CONCLUSIONS APB muscle ultrasound biomarkers (especially MTh and EI) showed better discrimination capacity and correlation with clinical variables than MN biomarkers. However, the combination of both biomarkers increased their ability to detect LMN impairment, suggesting that both biomarkers could be used in a complementary manner for the diagnosis and progression monitoring in ALS. KEY POINTS • Abductor pollicis brevis muscle and median nerve impairment is detectable by ultrasound in amyotrophic lateral sclerosis patients, even in those without clinical impairment. • Muscle ultrasound biomarkers show better discrimination capacity than nerve biomarkers in amyotrophic lateral sclerosis. • Quantitative neuromuscular ultrasound biomarkers could be useful in a general amyotrophic lateral sclerosis population early on the disease.
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Pathak S, Caress JB, Wosiski-Kuhn M, Milligan C, Williams D, Cartwright MS. A pilot study of neuromuscular ultrasound as a biomarker for amyotrophic lateral sclerosis. Muscle Nerve 2018; 59:181-186. [PMID: 30338851 DOI: 10.1002/mus.26360] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This study explores the reliability and responsiveness of neuromuscular ultrasound in amyotrophic lateral sclerosis (ALS). METHODS Investigations were conducted with 10 healthy controls, 10 patients with ALS (single point in time), and 10 different patients with ALS (followed over 6 months; 4 completed follow-up). Ultrasound was used to measure the thickness of the geniohyoid, bilateral biceps/brachialis, bilateral tibialis anterior, and bilateral hemidiaphragms (at inspiration and expiration). Interrater and intrarater reliability and change in muscle thickness over 6 months were measured. RESULTS Interrater correlation coefficients ranged between 0.80 and 0.99 in healthy controls and between 0.78 and 0.97 in patients with ALS. Intrarater correlation coefficients ranged between 0.83 and 0.98 in healthy controls. The mean percentage decline in muscle thickness over 6 months was 20.25%. DISCUSSION Muscle ultrasound appears to be a reliable technique for measuring important muscles in patients with ALS. Larger studies with age-matched controls should be conducted to assess further the responsiveness of this biomarker in ALS. Muscle Nerve 59:181-186, 2019.
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Affiliation(s)
- Sapna Pathak
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - James B Caress
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Marlena Wosiski-Kuhn
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carol Milligan
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Delaney Williams
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Walker FO, Cartwright MS, Alter KE, Visser LH, Hobson-Webb LD, Padua L, Strakowski JA, Preston DC, Boon AJ, Axer H, van Alfen N, Tawfik EA, Wilder-Smith E, Yoon JS, Kim BJ, Breiner A, Bland JDP, Grimm A, Zaidman CM. Indications for neuromuscular ultrasound: Expert opinion and review of the literature. Clin Neurophysiol 2018; 129:2658-2679. [PMID: 30309740 DOI: 10.1016/j.clinph.2018.09.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/10/2018] [Accepted: 09/02/2018] [Indexed: 12/11/2022]
Abstract
Over the last two decades, dozens of applications have emerged for ultrasonography in neuromuscular disorders. We wanted to measure its impact on practice in laboratories where the technique is in frequent use. After identifying experts in neuromuscular ultrasound and electrodiagnosis, we assessed their use of ultrasonography for different indications and their expectations for its future evolution. We then identified the earliest papers to provide convincing evidence of the utility of ultrasound for particular indications and analyzed the relationship of their date of publication with expert usage. We found that experts use ultrasonography often for inflammatory, hereditary, traumatic, compressive and neoplastic neuropathies, and somewhat less often for neuronopathies and myopathies. Usage significantly correlated with the timing of key publications in the field. We review these findings and the extensive evidence supporting the value of neuromuscular ultrasound. Advancement of the field of clinical neurophysiology depends on widespread translation of these findings.
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Affiliation(s)
- Francis O Walker
- Department of Neurology at Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA.
| | - Michael S Cartwright
- Department of Neurology at Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA.
| | - Katharine E Alter
- Department of Rehabilitation Medicine, National INeurolnstitutes of Health, Bethesda, MD 20892, USA.
| | - Leo H Visser
- Departments of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University School of Medicine, Durham, NC, USA.
| | - Luca Padua
- Don Carlo Gnocchi ONLUS Foundation, Piazzale Rodolfo Morandi, 6, 20121 Milan, Italy; Department of Geriatrics, Neurosciences and Orthopaedics, Universita Cattolica del Sacro Cuore, Rome, Italy.
| | - Jeffery A Strakowski
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA; Department of Physical Medicine and Rehabilitation, OhioHealth Riverside Methodist Hospital, Columbus, OH, USA; OhioHealth McConnell Spine, Sport and Joint Center, Columbus, OH, USA.
| | - David C Preston
- Neurological Institute, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena 07747, Germany.
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Eman A Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Einar Wilder-Smith
- Department of Neurology, Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Neurology, Kantonsspital Lucerne, Switzerland; Department of Neurology, Inselspital Berne, Switzerland.
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Republic of Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Ari Breiner
- Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Canada.
| | - Jeremy D P Bland
- Deparment of Clinical Neurophysiology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK.
| | - Alexander Grimm
- Department of Neurology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Craig M Zaidman
- Division of Neuromuscular Medicine, Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Box 8111, St. Louis, MO 63110, USA.
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Seok HY, Park J, Kim YH, Oh KW, Kim SH, Kim BJ. Split hand muscle echo intensity index as a reliable imaging marker for differential diagnosis of amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2018; 89:943-948. [PMID: 29666207 DOI: 10.1136/jnnp-2017-317917] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/22/2018] [Accepted: 03/05/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the usefulness of muscle ultrasound in evaluating dissociated small hand muscle atrophy, termed 'split hand', and its feasibility in the diagnosis of amyotrophic lateral sclerosis (ALS). METHODS Forty-four patients with ALS, 18 normal subjects and 9 patients with other neuromuscular disorders were included in this study. The hand muscles were divided into three regions, the median-innervated lateral hand muscle group (ML), the ulnar-innervated lateral hand muscle (UL) and the ulnar-innervated medial hand muscle (UM), and the muscle echo intensity (EI) and compound muscle action potential (CMAP) were measured. We calculated the split hand index (SHI) using muscle EI (SHImEI) and CMAP (SHICMAP) for comparison among groups. The SHI was derived by dividing muscle EI (or CMAP) measured at the ML and UL by that measured at the UM. RESULTS The SHImEI was significantly higher in patients with ALS (51.7±28.3) than in normal controls (29.7±9.9) and disease controls with other neuromuscular disorders (36.5±7.3; P<0.001), particularly in upper limb-onset ALS (66.5±34.0; P<0.001). Receiver operating characteristic curve analysis indicated that the SHImEI had significantly better diagnostic accuracy than the SHICMAP. CONCLUSIONS The SHImEI was more sensitive in evaluating dissociated small hand muscle atrophy compared with the SHICMAP and may be a reliable diagnostic marker for differentiating ALS from other neuromuscular disorders and healthy controls.
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Affiliation(s)
- Hung Youl Seok
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea.,Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jinseok Park
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Yoo Hwan Kim
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea.,Department of Neurology, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
| | - Ki-Wook Oh
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seung Hyun Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea.,Brain Convergence Research Center, Korea University, Seoul, Republic of Korea
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Lori S, Lolli F, Molesti E, Bastianelli M, Gabbanini S, Saia V, Trapani S, Marinoni M. Muscle-ultrasound evaluation in healthy pediatric subjects: Age-related normative data. Muscle Nerve 2018; 58:245-250. [PMID: 29679375 DOI: 10.1002/mus.26151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The muscle ultrasound examination (MUS) is a noninvasive and inexpensive technique for evaluating neuromyopathies. Standardized MUS normative data are incomplete in pediatric subjects. METHODS We performed a MUS study with 120 healthy children (59 males; mean age, 10.44 years; age range, 2-16 years). We measured the width and the echogenicity bilaterally in the following muscles: biceps brachii and brachialis, brachioradialis, forearm-flexors, rectus femoris and vastus intermedius, tibialis anterior, extensor hallucis longus, lateral and medial gastrocnemius. RESULTS The muscle thickness increased with age for all muscles. Confidence limits were set for each age group muscle width. Echogenicity increased with age only in some muscles. DISCUSSIONS Our MUS study provides new data on physiological muscle structural changes in healthy children to address the limited available references in this age group. Muscle Nerve 58: 245-250, 2018.
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Affiliation(s)
- Silvia Lori
- University Hospital Careggi, Dipartimento Neuromuscolo Scheletrico e degli organi di senso, Firenze, Italy
| | - Francesco Lolli
- University Hospital Careggi, Dipartimento Neuromuscolo Scheletrico e degli organi di senso, Firenze, Italy.,University of Florence, Dipartimento di Scienze Biomediche Sperimentali e Cliniche Mario Serio, viale Pieraccini 6 Firenze, 50134, Italy
| | - Elisabetta Molesti
- University Hospital Careggi, Dipartimento Neuromuscolo Scheletrico e degli organi di senso, Firenze, Italy
| | - Maria Bastianelli
- University Hospital Careggi, Dipartimento Neuromuscolo Scheletrico e degli organi di senso, Firenze, Italy
| | - Simonetta Gabbanini
- University Hospital Careggi, Dipartimento Neuromuscolo Scheletrico e degli organi di senso, Firenze, Italy
| | - Valentina Saia
- University Hospital Careggi, Dipartimento Neuromuscolo Scheletrico e degli organi di senso, Firenze, Italy
| | - Sara Trapani
- University Hospital Careggi, Dipartimento Neuromuscolo Scheletrico e degli organi di senso, Firenze, Italy
| | - Marinella Marinoni
- University Hospital Careggi, Dipartimento Neuromuscolo Scheletrico e degli organi di senso, Firenze, Italy.,University of Florence, Dipartimento di Scienze Biomediche Sperimentali e Cliniche Mario Serio, viale Pieraccini 6 Firenze, 50134, Italy
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Gonçalves LMN, Palinkas M, Hallak JEC, Marques Júnior W, Vasconcelos PBD, Frota NPR, Regalo IH, Siéssere S, Regalo SCH. Alterations in the stomatognathic system due to amyotrophic lateral sclerosis. J Appl Oral Sci 2018; 26:e20170408. [PMID: 29898176 PMCID: PMC5963914 DOI: 10.1590/1678-7757-2017-0408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/05/2018] [Indexed: 08/30/2023] Open
Abstract
Objectives: To compare the molar bite force, electromyographic activity, chewing efficiency and thickness of the masseter and temporalis muscles in individuals with amyotrophic lateral sclerosis (ALS) and healthy individuals. Material and Methods: Thirty individuals enrolled in the study were divided into the study group (with ALS, n=15) and control group (healthy individuals, n=15). Data regarding molar bite force (right and left), electromyographic activity (mandibular rest, right and left laterality, protrusion, and maximum voluntary contraction), chewing efficiency (habitual and non-habitual), and masticatory muscle thickness (rest and maximum voluntary contraction) were tabulated and subjected to statistical analysis (Student’s t-test, p≤0.05). Results: Comparisons between the groups demonstrated a statistically significant increase in the electromyographic activity of the right masseter (p=0.03) and left masseter (p=0.03) muscles during mandibular rest; left masseter (p=0.00), right temporalis (p=0.00), and left temporalis (p=0.03) muscles during protrusion; and right masseter (p=0.00), left masseter (p=0.00), and left temporalis (p=0.00) muscles during left laterality, in individuals with ALS as compared with healthy individuals. A statistically significant decrease was observed in the habitual chewing efficiency of the right masseter (p=0.00) and right temporalis (p=0.04) muscles in individuals with ALS. No statistically significant difference between the groups was found the masticatory muscle thickness and maximal molar bite force. Conclusions: ALS may lead to modifications in the activities of the stomatognathic system, including muscular hyperactivity and reduction in chewing efficiency; however, no change has been observed in the masticatory muscle thickness and molar bite force.
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Affiliation(s)
- Lígia Maria Napolitano Gonçalves
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Morfologia, Fisiologia e Patologia Básica, Ribeirão Preto, São Paulo, Brasil
| | - Marcelo Palinkas
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Morfologia, Fisiologia e Patologia Básica, Ribeirão Preto, São Paulo, Brasil.,Faculdade Anhanguera de Ribeirão Preto, São Paulo, Brasil
| | - Jaime Eduardo Cecilio Hallak
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neuropsiquiatria e Psicologia Médica, Ribeirão Preto, São Paulo, Brasil
| | - Wilson Marques Júnior
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neuropsiquiatria e Psicologia Médica, Ribeirão Preto, São Paulo, Brasil
| | - Paulo Batista de Vasconcelos
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Morfologia, Fisiologia e Patologia Básica, Ribeirão Preto, São Paulo, Brasil
| | - Nicolly Parente Ribeiro Frota
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Morfologia, Fisiologia e Patologia Básica, Ribeirão Preto, São Paulo, Brasil
| | - Isabela Hallak Regalo
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Morfologia, Fisiologia e Patologia Básica, Ribeirão Preto, São Paulo, Brasil
| | - Selma Siéssere
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Morfologia, Fisiologia e Patologia Básica, Ribeirão Preto, São Paulo, Brasil
| | - Simone Cecilio Hallak Regalo
- Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Morfologia, Fisiologia e Patologia Básica, Ribeirão Preto, São Paulo, Brasil
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Martínez-Payá JJ, Ríos-Díaz J, Medina-Mirapeix F, Vázquez-Costa JF, Del Baño-Aledo ME. Monitoring Progression of Amyotrophic Lateral Sclerosis Using Ultrasound Morpho-Textural Muscle Biomarkers: A Pilot Study. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:102-109. [PMID: 29100791 DOI: 10.1016/j.ultrasmedbio.2017.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/09/2017] [Accepted: 09/15/2017] [Indexed: 06/07/2023]
Abstract
The need is increasing for progression biomarkers that allow the loss of motor neurons in amyotrophic lateral sclerosis (ALS) to be monitored in clinical trials. In this prospective longitudinal study, muscle thickness, echointensity, echovariation and gray level co-occurrence matrix textural features are examined as possible progression ultrasound biomarkers in ALS patients during a 5-mo follow-up period. We subjected 13 patients to 3 measurements for 20 wk. They showed a significant loss of muscle, an evident tendency to loss of thickness and increased echointensity and echovariation. In regard to textural parameters, muscle heterogeneity tended to increase as a result of the neoformation of non-contractile tissue through denervation. Considering some limitations of the study, the quantitative muscle ultrasound biomarkers evaluated showed a promising ability to monitor patients affected by ALS.
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Affiliation(s)
- Jacinto J Martínez-Payá
- ECOFISTEM Research Group, Health Sciences Department, Facultad de Ciencias de la Salud, Universidad Católica de Murcia, Guadalupe (Murcia), Spain.
| | - José Ríos-Díaz
- Centro Universitario de Ciencias de la Salud San Rafael-Nebrija, Paseo de la Habana, Madrid, Spain; Fundación San Juan de Dios, Madrid, Spain
| | | | - Juan F Vázquez-Costa
- Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Neuromuscular and Ataxias Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
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Martínez-Payá JJ, Ríos-Díaz J, Del Baño-Aledo ME, Tembl-Ferrairó JI, Vazquez-Costa JF, Medina-Mirapeix F. Quantitative Muscle Ultrasonography Using Textural Analysis in Amyotrophic Lateral Sclerosis. ULTRASONIC IMAGING 2017; 39:357-368. [PMID: 28553752 DOI: 10.1177/0161734617711370] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to analyze differences in gray-level co-occurrence matrix (GLCM) parameters, as assessed by muscle ultrasound (MUS), between amyotrophic lateral sclerosis (ALS) patients and healthy controls, and to compare the diagnostic accuracy of these GLCM parameters with first-order MUS parameters (echointensity [EI], echovariation [EV], and muscle thickness [MTh]) in different muscle groups. Twenty-six patients with ALS and 26 healthy subjects underwent bilateral and transverse ultrasound of the biceps/brachialis, forearm flexor, quadriceps femoris, and tibialis anterior muscle groups. MTh was measured with electronic calipers, and EI, EV, and GLCM were obtained using Image J (v.1.48) software. Sensitivity, specificity, likelihood ratios, and area under the curve (AUC) were performed by logistic regression models and receiver operating characteristic curves. GLCM parameters showed reduced granularity in the muscles of ALS patients compared with the controls. Regarding the discrimination capacity, the best single diagnostic parameter in forearm flexors and quadriceps was GLCM and in biceps brachialis and tibialis anterior was EV. The respective combination of these two parameters with MTh resulted in the best AUC (over 90% in all muscle groups and close to the maximum combination model). The use of new textural parameters (EV and GLCM) combined with usual quantitative MUS variables is a promising biomarker in ALS.
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Affiliation(s)
| | - José Ríos-Díaz
- 2 Centro de Ciencias de la Salud San Rafael, Universidad Antonio de Nebrija, Madrid, Spain
- 3 Fundación San Juan de Dios, Madrid, Spain
| | | | | | - Juan Francisco Vazquez-Costa
- 5 Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- 6 Neuromuscular and Ataxias Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain
- 7 Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
| | - Francesc Medina-Mirapeix
- 4 Department of Physiotherapy, Facultad de Medicina, Universidad de Murcia, Espinardo, Murcia, Spain
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de Carvalho M, Kiernan MC, Swash M. Fasciculation in amyotrophic lateral sclerosis: origin and pathophysiological relevance. J Neurol Neurosurg Psychiatry 2017; 88:773-779. [PMID: 28490504 DOI: 10.1136/jnnp-2017-315574] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
Abstract
This review considers the origin and significance of fasciculations in neurological practice, with an emphasis on fasciculations in amyotrophic lateral sclerosis (ALS), and in benign fasciculation syndromes. Fasciculation represents a brief spontaneous contraction that affects a small number of muscle fibres, causing a flicker of movement under the skin. While an understanding of the role of fasciculation in ALS remains incomplete, fasciculations derive from ectopic activity generated in the motor system. A proximal origin seems likely to contribute to the generation of fasciculation in the early stages of ALS, while distal sites of origin become more prominent later in the disease, associated with distal motor axonal sprouting as part of the reinnervation response that develops secondary to loss of motor neurons. Fasciculations are distinct from the recurrent trains of axonal firing described in neuromyotonia. Fasciculation without weakness, muscle atrophy or increased tendon reflexes suggests a benign fasciculation syndrome, even when of sudden onset. Regardless of origin, fasciculations often present as the initial abnormality in ALS, an early harbinger of dysfunction and aberrant firing of motor neurons.
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Affiliation(s)
- Mamede de Carvalho
- Department of Neurosciences and Mental Health, Hospital de Santa Maria-CHLN, Lisbon, Portugal.,Institute of Physiology-IMM, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Matthew C Kiernan
- Bushell Chair of Neurology, Sydney Medical School, University of Sydney, Brain & Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Michael Swash
- Institute of Physiology-IMM, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Department of Neurology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Matta TTD, Pereira WCDA, Radaelli R, Pinto RS, Oliveira LFD. Texture analysis of ultrasound images is a sensitive method to follow-up muscle damage induced by eccentric exercise. Clin Physiol Funct Imaging 2017; 38:477-482. [DOI: 10.1111/cpf.12441] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/27/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Thiago Torres da Matta
- Universidade Federal do Rio de Janeiro - Programa de Engenharia Biomédica; Rio de Janeiro Brasil
- Universidade Federal do Rio de Janeiro - Escola de Educação Física e Desporto; Rio de Janeiro Brasil
| | | | - Regis Radaelli
- Universidade Federal do Rio Grande do Sul - Laboratório de Pesquisa e Exercício; Porto Alegre Brasil
| | - Ronei Silveira Pinto
- Universidade Federal do Rio Grande do Sul - Laboratório de Pesquisa e Exercício; Porto Alegre Brasil
| | - Liliam Fernandes de Oliveira
- Universidade Federal do Rio de Janeiro - Programa de Engenharia Biomédica; Rio de Janeiro Brasil
- Universidade Federal do Rio de Janeiro - Escola de Educação Física e Desporto; Rio de Janeiro Brasil
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Martínez-Payá JJ, Del Baño-Aledo ME, Ríos-Díaz J, Tembl-Ferrairó JI, Vázquez-Costa JF, Medina-Mirapeix F. Muscular Echovariation: A New Biomarker in Amyotrophic Lateral Sclerosis. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1153-1162. [PMID: 28395965 DOI: 10.1016/j.ultrasmedbio.2017.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/28/2016] [Accepted: 02/01/2017] [Indexed: 06/07/2023]
Abstract
The purpose of the work described here was to assess the characteristics of echovariation in amyotrophic lateral sclerosis (ALS) compared with other muscle ultrasonography parameters. Twenty-six ALS patients (8 women, mean age 58.9 y, standard deviation 12.02 y) and 26 healthy controls (17 women, mean age 59.6 y, standard deviation 6.41 y) were included in this observational study. They underwent bilateral and transverse ultrasound of the biceps/brachialis, forearm flexor group, quadriceps femoris and tibialis anterior. Muscular thickness, echo-intensity and echovariation were analyzed. Muscles affected by ALS had increased echo-intensity, decreased thickness and decreased echovariation. Echovariation in all muscles except the quadriceps femoris strongly correlated with muscle strength (explained variance between 21.8% in the biceps/brachialis and 37.5% in the tibialis anterior) and the ALS Functional Rating Scale Revised score (explained variance between 26% in the biceps/brachialis and 36.7% in the forearm flexor group). Echovariation is an easy-to-obtain quantitative muscle ultrasonography parameter that could distinguish ALS patients from healthy controls more accurately than previous described biomarkers.
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Affiliation(s)
- Jacinto J Martínez-Payá
- ECOFISTEM Research Group, Health Sciences Department, Facultad de Ciencias de la Salud, Universidad Católica de Murcia, Guadalupe, Murcia, Spain.
| | - María Elena Del Baño-Aledo
- ECOFISTEM Research Group, Health Sciences Department, Facultad de Ciencias de la Salud, Universidad Católica de Murcia, Guadalupe, Murcia, Spain
| | - José Ríos-Díaz
- ECOFISTEM Research Group, Health Sciences Department, Facultad de Ciencias de la Salud, Universidad Católica de Murcia, Guadalupe, Murcia, Spain; Centro Universitario de Ciencias de la Salud San Rafael-Nebrija, Madrid, Spain
| | - José I Tembl-Ferrairó
- Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan F Vázquez-Costa
- Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Neuromuscular and Ataxias Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain
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O'gorman CM, Weikamp JG, Baria M, Van Den Engel-hoek L, Kassardjian C, Van Alfen N, Boon AJ. Detecting fasciculations in cranial nerve innervated muscles with ultrasound in amyotrophic lateral sclerosis. Muscle Nerve 2017; 56:1072-1076. [DOI: 10.1002/mus.25676] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 11/10/2022]
Affiliation(s)
| | - Janneke G. Weikamp
- Department of Rehabilitation, Donders Centre for Neuroscience; Radboud University Medical Center; Nijmegen The Netherlands
| | - Michael Baria
- Department of Physical Medicine and Rehabilitation; The Ohio State University Wexner Medical Center; Columbus Ohio USA
| | - Lenie Van Den Engel-hoek
- Department of Rehabilitation, Donders Centre for Neuroscience; Radboud University Medical Center; Nijmegen The Netherlands
| | | | - Nens Van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Center for Neuroscience; Radboud University Medical Center; Nijmegen The Netherlands
| | - Andrea J. Boon
- Department of Neurology; Mayo Clinic; Rochester Minnesota 55905 USA
- Department of Physical Medicine and Rehabilitation; Mayo Clinic; Rochester Minnesota USA
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Sogawa K, Nodera H, Takamatsu N, Mori A, Yamazaki H, Shimatani Y, Izumi Y, Kaji R. Neurogenic and Myogenic Diseases: Quantitative Texture Analysis of Muscle US Data for Differentiation. Radiology 2017; 283:492-498. [PMID: 28156201 DOI: 10.1148/radiol.2016160826] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To assess the multiple texture features of skeletal muscles in neurogenic and myogenic diseases by using ultrasonography (US). Materials and Methods After institutional review board approval, muscle US studies of the medial head of the gastrocnemius were performed prospectively in patients with neurogenic diseases (n = 25 [18 men]; mean age, 66.0 years ± 12.3 [standard deviation]), in patients with myogenic diseases (n = 21 [12 men]; mean age, 68.3 years ± 11.5), and in healthy control subjects (n = 21 [11 men]; mean age, 70.5 years ± 8.4) between January 2013 and May 2016. Written informed consent was obtained. Muscle texture parameters were obtained, and five algorithms were used to classify the groups. Results The neurogenic and myogenic disease groups showed higher echo intensities than the control subjects. The histogram-derived texture parameters had overlaps between the neurogenic and myogenic groups and thus had a low discrimination rate. With assessment of more classes of texture parameters, three groups were correctly classified (100% correct, according to four of five classification algorithms). Tenfold cross validation showed 93.5%-95.7% correct classification between the neurogenic and myogenic groups. The run-length matrix, autoregressive model, and co-occurrence matrix were particularly useful in distinguishing the neurogenic and myogenic groups. Conclusion Texture analysis of muscle US data can enable differentiation between neurogenic and myogenic diseases and is useful in noninvasively assessing underlying disease mechanisms. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Kazuki Sogawa
- From the Faculty of Medicine (K.S.) and Department of Neurology (H.N., N.T., A.M., H.Y., Y.S., Y.I., R.K.), Tokushima University, 3-18-15 Kuramotocho, Tokushima 770-8503, Japan; and Department of Neurology, Vihara Hananosato Hospital, Hiroshima, Japan (N.T., Y.I.)
| | - Hiroyuki Nodera
- From the Faculty of Medicine (K.S.) and Department of Neurology (H.N., N.T., A.M., H.Y., Y.S., Y.I., R.K.), Tokushima University, 3-18-15 Kuramotocho, Tokushima 770-8503, Japan; and Department of Neurology, Vihara Hananosato Hospital, Hiroshima, Japan (N.T., Y.I.)
| | - Naoko Takamatsu
- From the Faculty of Medicine (K.S.) and Department of Neurology (H.N., N.T., A.M., H.Y., Y.S., Y.I., R.K.), Tokushima University, 3-18-15 Kuramotocho, Tokushima 770-8503, Japan; and Department of Neurology, Vihara Hananosato Hospital, Hiroshima, Japan (N.T., Y.I.)
| | - Atsuko Mori
- From the Faculty of Medicine (K.S.) and Department of Neurology (H.N., N.T., A.M., H.Y., Y.S., Y.I., R.K.), Tokushima University, 3-18-15 Kuramotocho, Tokushima 770-8503, Japan; and Department of Neurology, Vihara Hananosato Hospital, Hiroshima, Japan (N.T., Y.I.)
| | - Hiroki Yamazaki
- From the Faculty of Medicine (K.S.) and Department of Neurology (H.N., N.T., A.M., H.Y., Y.S., Y.I., R.K.), Tokushima University, 3-18-15 Kuramotocho, Tokushima 770-8503, Japan; and Department of Neurology, Vihara Hananosato Hospital, Hiroshima, Japan (N.T., Y.I.)
| | - Yoshimitsu Shimatani
- From the Faculty of Medicine (K.S.) and Department of Neurology (H.N., N.T., A.M., H.Y., Y.S., Y.I., R.K.), Tokushima University, 3-18-15 Kuramotocho, Tokushima 770-8503, Japan; and Department of Neurology, Vihara Hananosato Hospital, Hiroshima, Japan (N.T., Y.I.)
| | - Yuishin Izumi
- From the Faculty of Medicine (K.S.) and Department of Neurology (H.N., N.T., A.M., H.Y., Y.S., Y.I., R.K.), Tokushima University, 3-18-15 Kuramotocho, Tokushima 770-8503, Japan; and Department of Neurology, Vihara Hananosato Hospital, Hiroshima, Japan (N.T., Y.I.)
| | - Ryuji Kaji
- From the Faculty of Medicine (K.S.) and Department of Neurology (H.N., N.T., A.M., H.Y., Y.S., Y.I., R.K.), Tokushima University, 3-18-15 Kuramotocho, Tokushima 770-8503, Japan; and Department of Neurology, Vihara Hananosato Hospital, Hiroshima, Japan (N.T., Y.I.)
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Neuromuscular Ultrasound in the Assessment of Polyneuropathies and Motor Neuron Disease. J Clin Neurophysiol 2017; 33:86-93. [PMID: 27035248 DOI: 10.1097/wnp.0000000000000241] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Neuromuscular ultrasound is an emerging technology for the evaluation of conditions affecting nerve and muscle, with most of the research focusing on focal neuropathies. Despite this focus, researchers have also investigated the ultrasonographic changes that occur in the nerves and muscles of those with more diffuse polyneuropathies and motor neuron diseases, and this review will detail the findings in these conditions. Specific findings are discussed in this article, but general themes will also be presented and include the following: hereditary polyneuropathies show diffuse nerve enlargement, whereas immune-mediated polyneuropathies show more patchy involvement; nerve enlargement is more profound in demyelinating than axonal polyneuropathies; and muscle changes in motor neuron diseases include heterogeneous increases in echogenicity, atrophy, readily detectable fasciculations, and increased subcutaneous tissue thickness.
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Lee H, Jee S, Park SH, Ahn SC, Im J, Sohn MK. Quantitative Muscle Ultrasonography in Carpal Tunnel Syndrome. Ann Rehabil Med 2016; 40:1048-1056. [PMID: 28119835 PMCID: PMC5256332 DOI: 10.5535/arm.2016.40.6.1048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/26/2016] [Indexed: 12/13/2022] Open
Abstract
Objective To assess the reliability of quantitative muscle ultrasonography (US) in healthy subjects and to evaluate the correlation between quantitative muscle US findings and electrodiagnostic study results in patients with carpal tunnel syndrome (CTS). The clinical significance of quantitative muscle US in CTS was also assessed. Methods Twenty patients with CTS and 20 age-matched healthy volunteers were recruited. All control and CTS subjects underwent a bilateral median and ulnar nerve conduction study (NCS) and quantitative muscle US. Transverse US images of the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) were obtained to measure muscle cross-sectional area (CSA), thickness, and echo intensity (EI). EI was determined using computer-assisted, grayscale analysis. Inter-rater and intra-rater reliability for quantitative muscle US in control subjects, and differences in muscle thickness, CSA, and EI between the CTS patient and control groups were analyzed. Relationships between quantitative US parameters and electrodiagnostic study results were evaluated. Results Quantitative muscle US had high inter-rater and intra-rater reliability in the control group. Muscle thickness and CSA were significantly decreased, and EI was significantly increased in the APB of the CTS group (all p<0.05). EI demonstrated a significant positive correlation with latency of the median motor and sensory NCS in CTS patients (p<0.05). Conclusion These findings suggest that quantitative muscle US parameters may be useful for detecting muscle changes in CTS. Further study involving patients with other neuromuscular diseases is needed to evaluate peripheral muscle change using quantitative muscle US.
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Affiliation(s)
- Hyewon Lee
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Soo Ho Park
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seung-Chan Ahn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Juneho Im
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
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de Carvalho M, Swash M. Lower motor neuron dysfunction in ALS. Clin Neurophysiol 2016; 127:2670-81. [DOI: 10.1016/j.clinph.2016.03.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/08/2016] [Accepted: 03/01/2016] [Indexed: 12/11/2022]
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Tawfik EA. Vagus nerve ultrasound in a patient with amyotrophic lateral sclerosis. Muscle Nerve 2016; 54:978-979. [DOI: 10.1002/mus.25126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Eman A. Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine; Ain Shams University; Cairo Egypt
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Abstract
Muscle ultrasound is an ideal imaging modality that allows for noninvasive, radiation-free point-of-care neuromuscular imaging. There are many potential applications of muscle ultrasound, including identification of abnormal muscle movements such as fasciculations, evaluation of muscle trauma, identification of physiologic parameters such as pennation angle, accurate performance of chemodenervation, and improved accuracy of challenging electrodiagnostic studies such as phrenic nerve conduction studies or needle electromyogram (EMG) of the diaphragm. Tissue Doppler imaging can be used to help identify inflammatory myopathies. With computer-assisted quantification, muscle ultrasound has high sensitivity and specificity in the diagnosis of pediatric neuromuscular disease and amyotrophic lateral sclerosis, and is a valuable addition to other diagnostic techniques for neuromuscular disease. When used as a first-line screening tool it can obviate the need for more invasive procedures such as EMG or muscle biopsy in certain patients. This chapter provides an overview of the fundamentals, clinical applications, and validation of muscle ultrasound for patients with neuromuscular disorders.
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Affiliation(s)
- Sigrid Pillen
- Department of Sleep Medicine, Kempenhaeghe Expertise Center for Epileptology, Sleep Medicine and Neurocognition, Heeze, The Netherlands.
| | - Andrea Boon
- Department of Physical Medicine and Rehabilitation and Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Nens Van Alfen
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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Bickerstaffe A, Beelen A, Zwarts MJ, Nollet F, van Dijk JP. Quantitative muscle ultrasound and quadriceps strength in patients with post-polio syndrome. Muscle Nerve 2014; 51:24-9. [DOI: 10.1002/mus.24272] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 04/10/2014] [Accepted: 04/26/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Alice Bickerstaffe
- Department of Rehabilitation; Academic Medical Center; Postbus 22660 1100 DD Amsterdam The Netherlands
| | - Anita Beelen
- Department of Rehabilitation; Academic Medical Center; Postbus 22660 1100 DD Amsterdam The Netherlands
| | | | - Frans Nollet
- Department of Rehabilitation; Academic Medical Center; Postbus 22660 1100 DD Amsterdam The Netherlands
| | - Johannes P. van Dijk
- Department of Orthodontics; University of Ulm; Ulm Germany
- Epilepsy Centre Kempenhaeghe; Heeze The Netherlands
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Hobson-Webb LD, Padua L. Small steps … and leaps … toward big science: Multicenter studies in neuromuscular ultrasound. Clin Neurophysiol 2014; 125:2326-7. [DOI: 10.1016/j.clinph.2014.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 05/06/2014] [Accepted: 05/09/2014] [Indexed: 12/12/2022]
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Dengler R. Ultrasound assessment of nerve and nerve root thickness. Do they contribute to the diagnosis of ALS? Clin Neurophysiol 2014; 125:1719-20. [DOI: 10.1016/j.clinph.2014.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 02/12/2014] [Accepted: 02/13/2014] [Indexed: 12/12/2022]
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Ultrasound in ALS: is it a sound method? Clin Neurophysiol 2014; 126:651-2. [PMID: 25194224 DOI: 10.1016/j.clinph.2014.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 08/05/2014] [Accepted: 08/12/2014] [Indexed: 12/12/2022]
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Muscle ultrasonography as an additional diagnostic tool for the diagnosis of amyotrophic lateral sclerosis. Clin Neurophysiol 2014; 126:820-7. [PMID: 25204706 DOI: 10.1016/j.clinph.2014.06.052] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 06/22/2014] [Accepted: 06/27/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We aimed to determine the utility of muscle ultrasonography (MUS) in addition to electromyography (EMG) in the diagnosis of amyotrophic lateral sclerosis (ALS). METHODS In all, 60 patients with ALS and 20 with other neuromuscular disorders underwent MUS and EMG. In addition, 30 healthy controls underwent only MUS. Occurrence of fasciculations and fibrillations was evaluated. Ultrasonic echogenicity was graded semiquantitatively. RESULTS The incidence of fasciculations was significantly higher in patients undergoing MUS than in those undergoing EMG (p<0.05), even in muscles of full strength (p<0.001). However, EMG was more sensitive in detecting fibrillations (p<0.05). MUS had an overall higher sensitivity in detecting spontaneous activity in the tongue (p<0.05). Patients with ALS showed significantly increased muscle echo intensity (EI) compared to patients who were initially suspected as having ALS and normal controls (p<0.05), irrespective of the clinical or electrophysiological status. CONCLUSION Our results showed that the sensitivity and specificity of MUS in diagnosing ALS was almost equivalent to those of EMG, using the Awaji criteria. Combination of MUS and EMG enhances the diagnostic accuracy compared to EMG alone (p<0.05). SIGNIFICANCE The combination of EMG and MUS can be used to evaluate the lower motor neuron affection by reducing the use of the often painful and uncomfortable EMG examinations but without decreasing the diagnostic sensitivity and specificity.
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