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Zanotelli A, Rossi AP, Del Monte L, Vantini G, Stabile G, Urbani S, Giani A, Zoico E, Babbanini A, Fantin F, Zamboni M, Mazzali G. The Role of Combined Muscle Ultrasound and Bioimpedentiometry Parameters for Sarcopenia Diagnosis in a Population of Hospitalized Older Adults. Nutrients 2024; 16:2429. [PMID: 39125310 PMCID: PMC11313821 DOI: 10.3390/nu16152429] [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: 06/23/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND For the study of quantitative and qualitative muscle parameters, ultrasound and bioelectric impedance analysis are reliable, non-invasive, and reproducible. The aim of this study was to test the combined role of those techniques for the diagnosis of sarcopenia in a population of hospitalized older males and females. METHODS A total of 70 subjects were recruited, including 10 healthy adults and 60 hospitalized elderly patients with a good level of independence and cooperation, with and without sarcopenia. The rectus femoris cross-sectional area (CSA), thickness, echogenicity, and compressibility were measured with ultrasound echography. The phase angles (PhAs) and skeletal muscle mass were calculated by bioimpedence analysis. The muscle quality index (MQI) was calculated as the product of CSA and PhA. RESULTS Muscle compressibility was greater and PhA was lower in sarcopenic when compared with non-sarcopenic subjects. The threshold values for sarcopenia diagnosis in both sexes of CSA, of PhA, and of the MQI were identified. The obtained CSA values showed an AUC of 0.852 for women and 0.867 for men, PhA of 0.792 in women and 0.898 in men, while MQI was 0.900 for women and 0.969 for men. CONCLUSIONS The newly calculated cut-off values of CSA, PhA, and MQI predicted the presence of sarcopenia with good sensitivity and specificity values. The use of the MQI proved to be more promising than the separate use of CSA and PhA in both male and female subjects.
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Affiliation(s)
- Alfredo Zanotelli
- Section of Geriatric Medicine, Ospedale Santa Maria del Carmine, 38068 Rovereto, Italy;
| | - Andrea P. Rossi
- Division of Geriatrics, Department of Medicine, Ospedale Cà Foncello, 31100 Treviso, Italy
| | - Letizia Del Monte
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Gianluca Vantini
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Giovanni Stabile
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Silvia Urbani
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Anna Giani
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Elena Zoico
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Alessio Babbanini
- Division of Geriatrics, Department of Medicine, Dentistry, Pediatric and Gynecology, Healthy Aging Center, University of Verona, 37126 Verona, Italy;
| | - Francesco Fantin
- Division of Geriatrics, University of Trento, 38100 Trento, Italy;
| | - Mauro Zamboni
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Gloria Mazzali
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
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De Nordenflycht D, Figueroa K, Muñoz J, De la Torre Canales G. Ultrasonographic characteristics of myogenous temporomandibular disorders: A scoping review. J Oral Rehabil 2024. [PMID: 39003577 DOI: 10.1111/joor.13801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/22/2024] [Accepted: 07/03/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE To identify the available evidence on the ultrasonographic characteristics of masticatory muscles in subjects with myogenous TMD, as well as the potential use of ultrasonography as a diagnostic and treatment assessment outcomes tool. METHOD An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: 'ultrasonography', 'ultrasound', 'masseter', 'temporal', 'masticatory muscles', 'temporomandibular disorders', 'temporomandibular joint disorders'. Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. RESULTS Thirteen articles were included for analysis: one comparative cross-sectional study, five case-control studies, six clinical trials and one randomised clinical trial. Main ultrasonographic characteristic assessed were local cross-sectional dimension and intramuscular ultrasonographic appearance. Retrieved studies reported the use ultrasonography for diagnosis or treatment assessment purposes showing heterogeneous results. For diagnosis purposes, the results of local cross-sectional dimension are not consistent; therefore, its diagnostic value for myogenous TMD diagnosis is weak. However, more homogeneous results were observed for intramuscular ultrasonographic appearance showing a higher prevalence of type-II pattern in myogenous TMD subjects than non-TMD subjects. On the other hand, for treatment assessment purposes, muscles were observed thinner after treatment compared to pre-treatment. Also, results of intramuscular ultrasonographic appearance show disappearance or reduction of anechoic areas, higher prevalence of type-II pattern and significant distinction of echogenic bands were observed after treating TMD subjects. CONCLUSION Ultrasonography cannot be considered as a diagnostic instrument, but maybe as a complementary tool for treatment assessment of myogenous TMD subjects, even though future research is required to confirm its utility.
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Affiliation(s)
| | | | | | - Giancarlo De la Torre Canales
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
- Department of Dental Medicine, Karolinska Institutet and the Scandinavian Network for Orofacial Neurosciences (SCON), Huddinge, Sweden
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Ivanovic V, Peric S, Pesovic J, Tubic R, Bozovic I, Petrovic Djordjevic I, Savic-Pavicevic D, Meola G, Rakocevic-Stojanovic V. Clinical score for early diagnosis of myotonic dystrophy type 2. Neurol Sci 2023; 44:1059-1067. [PMID: 36401657 PMCID: PMC9925479 DOI: 10.1007/s10072-022-06507-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/12/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Myotonic dystrophy type 2 (DM2) is a rare, multisystemic, autosomal dominant disease with highly variable clinical presentation. DM2 is considered to be highly underdiagnosed. OBJECTIVE The aim of this study was to determine which symptoms, signs, and diagnostic findings in patients referred to neurological outpatient units are the most indicative to arouse suspicion of DM2. We tried to make a useful and easy-to-administer clinical scoring system for early diagnosis of DM2-DM2 early diagnosis score (DM2-EDS). PATIENTS AND METHODS Two hundred ninety-one patients with a clinical suspicion of DM2 were included: 69 were genetically confirmed to have DM2, and 222 patients were DM2 negative. Relevant history, neurological, and paraclinical data were obtained from the electronic medical records. RESULTS The following parameters appeared as significant predictors of DM2 diagnosis: cataracts (beta = 0.410, p < 0.001), myotonia on needle EMG (beta = 0.298, p < 0.001), hand tremor (beta = 0.211, p = 0.001), positive family history (beta = 0.171, p = 0.012), and calf hypertrophy (beta = 0.120, p = 0.043). In the final DM2-EDS, based on the beta values, symptoms were associated with the following values: cataracts (present 3.4, absent 0), myotonia (present 2.5, absent 0), tremor (present 1.7, absent 0), family history (positive 1.4, negative 0), and calf hypertrophy (present 1.0, absent 0). A cut-off value on DM2-EDS of 3.25 of maximum 10 points had a sensitivity of 84% and specificity of 81% to diagnose DM2. CONCLUSION Significant predictors of DM2 diagnosis in the neurology outpatient unit were identified. We made an easy-to-administer DM2-EDS score for early diagnosis of DM2.
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Affiliation(s)
- Vukan Ivanovic
- University of Belgrade - Faculty of Medicine, University Clinical Center of Serbia - Neurology Clinic, Dr. Subotic Street, 11 000, Belgrade, Serbia
| | - Stojan Peric
- University of Belgrade - Faculty of Medicine, University Clinical Center of Serbia - Neurology Clinic, Dr. Subotic Street, 11 000, Belgrade, Serbia.
| | - Jovan Pesovic
- University of Belgrade - Faculty of Biology, Center for Human Molecular Genetics, Belgrade, Serbia
| | - Radoje Tubic
- Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Ivo Bozovic
- University of Belgrade - Faculty of Medicine, University Clinical Center of Serbia - Neurology Clinic, Dr. Subotic Street, 11 000, Belgrade, Serbia
| | - Ivana Petrovic Djordjevic
- University of Belgrade - Faculty of Medicine, University Clinical Center of Serbia - Cardiology Clinic, Belgrade, Serbia
| | - Dusanka Savic-Pavicevic
- University of Belgrade - Faculty of Biology, Center for Human Molecular Genetics, Belgrade, Serbia
| | - Giovanni Meola
- Department of Neurorehabilitation Sciences - Casa Di Cura del Policlinico, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Vidosava Rakocevic-Stojanovic
- University of Belgrade - Faculty of Medicine, University Clinical Center of Serbia - Neurology Clinic, Dr. Subotic Street, 11 000, Belgrade, Serbia
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Pedersen JJ, Stemmerik MG, Jacobsen LN, Skriver SV, Wilms GR, Duno M, Vissing J. Muscle fat replacement and contractility in patients with skeletal muscle sodium channel disorders. Sci Rep 2023; 13:2538. [PMID: 36782059 PMCID: PMC9925746 DOI: 10.1038/s41598-023-29759-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Skeletal muscle sodium channel disorders give rise to episodic symptoms such as myotonia and/or periodic paralysis. Chronic symptoms with permanent weakness are not considered characteristic of the phenotypes. Muscle fat replacement represents irreversible damage that inevitably will impact on muscle strength. This study investigates muscle fat replacement and contractility in patients with pathogenic SCN4A variants compared to healthy controls. T1-weighted and 2-point Dixon MRI of the legs were conducted to assess fat replacement. Stationary dynamometry was used to assess muscle strength. Contractility was determined by maximal muscle contraction divided by cross-sectional muscle area. The average cross-sectional intramuscular fat fraction was greater in patients compared with controls by 2.5% in the calves (95% CI 0.74-4.29%, p = 0.007) and by 2.0% in the thighs (95% CI 0.75-3.2%, p = 0.003). Muscle contractility was less in patients vs. controls by 14-27% (p < 0.05). Despite greater fat fraction and less contractility, absolute strength was not significantly less. This study quantitatively documents greater fat fraction and additionally describes difference in muscle contractility in a large cohort of patients with skeletal muscle sodium channel disorders. The clinical impact of these abnormal findings is likely limited as muscle hypertrophy in the patients served to preserve absolute muscle strength. Subgroup analysis indicated significant difference in phenotype by genotype, however these findings lack statistical significance and serve as inspiration for future researchers to probe into the geno- phenotype relationship in these disorders.Trial registration: The study was registered at http://clinicaltrials.gov (identifier: NCT04808388).
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Affiliation(s)
- Jonas Jalili Pedersen
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 7-9, 2100, Copenhagen, Denmark.
| | - Mads Godtfeldt Stemmerik
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 7-9, 2100, Copenhagen, Denmark
| | - Laura Nørager Jacobsen
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 7-9, 2100, Copenhagen, Denmark
| | - Sofie Vinther Skriver
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 7-9, 2100, Copenhagen, Denmark
| | - Gustav Rhode Wilms
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 7-9, 2100, Copenhagen, Denmark
| | - Morten Duno
- Clinical Genetic Laboratory, Department of Biochemical Genetics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 7-9, 2100, Copenhagen, Denmark
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Hannaford A, Vucic S, van Alfen N, Simon NG. Muscle ultrasound in hereditary muscle disease. Neuromuscul Disord 2022; 32:851-863. [PMID: 36323605 DOI: 10.1016/j.nmd.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/31/2022]
Abstract
In this review we summarise the key techniques of muscle ultrasound as they apply to hereditary muscle disease. We review the diagnostic utility of muscle ultrasound including its role in guiding electromyography and muscle biopsy sampling. We summarize the different patterns of sonographic muscle involvement in the major categories of genetic muscle disorders and discuss the limitations of the technique. We hope to encourage others to adopt ultrasound in their care for patients with hereditary muscle diseases.
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Affiliation(s)
- Andrew Hannaford
- Brain and Nerve Research Center, Concord Clinical School, University of Sydney, Sydney, Australia
| | - Steve Vucic
- Brain and Nerve Research Center, Concord Clinical School, University of Sydney, Sydney, Australia
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Neil G Simon
- Northern Beaches Clinical School, Macquarie University, Suite 6a, 105 Frenchs Forest Rd W, Frenchs Forest, Sydney, NSW 2086, Australia.
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Salaffi F, Carotti M, Di Matteo A, Ceccarelli L, Farah S, Villota-Eraso C, Di Carlo M, Giovagnoni A. Ultrasound and magnetic resonance imaging as diagnostic tools for sarcopenia in immune-mediated rheumatic diseases (IMRDs). Radiol Med 2022; 127:1277-1291. [DOI: 10.1007/s11547-022-01560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/12/2022] [Indexed: 01/10/2023]
Abstract
AbstractSarcopenia is characterized by loss of muscle mass, altered muscle composition, fat and fibrous tissue infiltration, and abnormal innervation, especially in older individuals with immune-mediated rheumatic diseases (IMRDs). Several techniques for measuring muscle mass, strength, and performance have emerged in recent decades. The portable dynamometer and gait speed represent the most frequently used tools for the evaluation of muscle strength and physical efficiency, respectively. Aside from dual-energy, X-ray, absorptiometry, and bioelectrical impedance analysis, ultrasound (US) and magnetic resonance imaging (MRI) techniques appear to have a potential role in evaluating muscle mass and composition. US and MRI have been shown to accurately identify sarcopenic biomarkers such as inflammation (edema), fatty infiltration (myosteatosis), alterations in muscle fibers, and muscular atrophy in patients with IMRDs. US is a low-cost, easy-to-use, and safe imaging method for assessing muscle mass, quality, architecture, and biomechanical function. This review summarizes the evidence for using US and MRI to assess sarcopenia.
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Sutaria TV, Chaudhari RK, Sutaria PT. Ultrasonographic diagnosis of adhesions, quantification of uterine wall and managerial perspectives of uterine torsion in buffaloes. Reprod Domest Anim 2022; 57:1505-1519. [PMID: 35947504 DOI: 10.1111/rda.14226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
The present study aimed to diagnose uterine adhesion using ultrasonography to decide the treatment approach for better survival of buffaloes suffering from uterine torsion. The peculiar visceral slide against the other abdominal organs induced by breathing was considered an absence of uterine adhesion, while the total absence of visceral slide was considered the presence of uterine adhesions on ultrasonographic examination. The 59 Mehsana buffaloes suffering from uterine torsion were divided into two groups based on the presence (Group I; n=27) or absence (group II; n=32) of adhesions. The mean pixel values (MPV) and thickness of uterine wall were also quantified in both the groups. In group I, sever type adhesions (n=16/27) were directly subjected to cesarean section (CS), while fibrinous adhesions (n=11/27) were subject to rolling by Sharma's modified Schaffer's method, and if rolling failed were further, subjected to CS and adhesions were confirm during CS. In Group II, 28 buffaloes were subjected to rolling by Sharma's modified Schaffer's method and 4 buffaloes were directly subjected to CS because of longer duration of illness (≥3 days), higher degree (≥180°), and previous field handling. The incidence of adhesions was 45.76 per cent (27/59) in buffaloes with uterine torsion. The degenerative changes such as oedematous (hyperedema - hypoechoic with anechoic trabeculae) or thin (homogenous hypoechoic), sloughing of serosa, and wall separation were observed in the uterine wall. The significantly thinner uterine wall (P=0.017) and higher MPV (P=0.001) were evident in group I than group II. The weak negative non-significant correlation between uterine wall thickness and MPV was observed in group I (r = -0.250, P = 0.147) and group II (r = -0.235, P = 0.089). The dam survival rate was 48.15 per cent (13/27) in group I and 81.25 % (26/32) in group II. There was a significant (P=0.04) association between the treatment approach and dam survival. Ultrasonography has synergistic diagnostic value for uterine adhesions by evaluating uterine surfaces beyond the reach of obstetricians during a manual clinical examination. Thereby avoiding futile efforts to relieve uterine torsion by rolling might help to improve dam survival by planning a better obstetrical maneuver to salvage buffaloes suffering from uterine torsion.
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Affiliation(s)
- T V Sutaria
- Department of Gynaecology & Obstetrics, College of Veterinary Science & A.H., Kamdhenu University, Gujarat, India
| | - Ravjibhai K Chaudhari
- Department of Gynaecology & Obstetrics, College of Veterinary Science & A.H., Kamdhenu University, Gujarat, India
| | - Prajwalita T Sutaria
- Department of Surgery & Radiology, College of Veterinary Science & A.H., Kamdhenu University, Gujarat, India
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Kiriaev L, Kueh S, Morley JW, North KN, Houweling PJ, Head SI. Lifespan Analysis of Dystrophic mdx Fast-Twitch Muscle Morphology and Its Impact on Contractile Function. Front Physiol 2021; 12:771499. [PMID: 34950049 PMCID: PMC8689589 DOI: 10.3389/fphys.2021.771499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Duchenne muscular dystrophy is caused by the absence of the protein dystrophin from skeletal muscle and is characterized by progressive cycles of necrosis/regeneration. Using the dystrophin deficient mdx mouse model, we studied the morphological and contractile chronology of dystrophic skeletal muscle pathology in fast-twitch Extensor Digitorum Longus muscles from animals 4–22 months of age containing 100% regenerated muscle fibers. Catastrophically, the older age groups lost ∼80% of their maximum force after one eccentric contraction (EC) of 20% strain with the greatest loss of ∼92% recorded in senescent 22-month-old mdx mice. In old age groups, there was minimal force recovery ∼24% after 120 min, correlated with a dramatic increase in the number and complexity of branched fibers. This data supports our two-phase model where a “tipping point” is reached when branched fibers rupture irrevocably on EC. These findings have important implications for pre-clinical drug studies and genetic rescue strategies.
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Affiliation(s)
- Leonit Kiriaev
- Myogenica Laboratory, School of Medicine, Western Sydney University, Sydney, NSW, Australia
- *Correspondence: Leonit Kiriaev,
| | - Sindy Kueh
- Myogenica Laboratory, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - John W. Morley
- Myogenica Laboratory, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Kathryn N. North
- Muscle Research Group, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Peter J. Houweling
- Muscle Research Group, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Stewart I. Head
- Myogenica Laboratory, School of Medicine, Western Sydney University, Sydney, NSW, Australia
- Muscle Research Group, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
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Myopathie de Becker à révélation tardive : difficultés diagnostiques. À propos de deux observations. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Wilkinson TJ, Ashman J, Baker LA, Watson EL, Smith AC. Quantitative Muscle Ultrasonography Using 2D Textural Analysis: A Novel Approach to Assess Skeletal Muscle Structure and Quality in Chronic Kidney Disease. ULTRASONIC IMAGING 2021; 43:139-148. [PMID: 33853450 PMCID: PMC8114433 DOI: 10.1177/01617346211009788] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Chronic kidney disease (CKD) is characterized by progressive reductions in skeletal muscle function and size. The concept of muscle quality is increasingly being used to assess muscle health, although the best means of assessment remains unidentified. The use of muscle echogenicity is limited by an inability to be compared across devices. Gray level of co-occurrence matrix (GLCM), a form of image texture analysis, may provide a measure of muscle quality, robust to scanner settings. This study aimed to identify GLCM values from skeletal muscle images in CKD and investigate their association with physical performance and strength (a surrogate of muscle function). Transverse images of the rectus femoris muscle were obtained using B-mode 2D ultrasound imaging. Texture analysis (GLCM) was performed using ImageJ. Five different GLCM features were quantified: energy or angular second moment (ASM), entropy, homogeneity, or inverse difference moment (IDM), correlation, and contrast. Physical function and strength were assessed using tests of handgrip strength, sit to stand-60, gait speed, incremental shuttle walk test, and timed up-and-go. Correlation coefficients between GLCM indices were compared to each objective functional measure. A total of 90 CKD patients (age 64.6 (10.9) years, 44% male, eGFR 33.8 (15.7) mL/minutes/1.73 m2) were included. Better muscle function was largely associated with those values suggestive of greater image texture homogeneity (i.e., greater ASM, correlation, and IDM, lower entropy and contrast). Entropy showed the greatest association across all the functional assessments (r = -.177). All GLCM parameters, a form of higher-order texture analysis, were associated with muscle function, although the largest association as seen with image entropy. Image homogeneity likely indicates lower muscle infiltration of fat and fibrosis. Texture analysis may provide a novel indicator of muscle quality that is robust to changes in scanner settings. Further research is needed to substantiate our findings.
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Affiliation(s)
| | - Jed Ashman
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Luke A. Baker
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Emma L. Watson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Alice C. Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
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Ikezoe T, Kobayashi T, Nakamura M, Ichihashi N. Effects of Low-Load, Higher-Repetition vs. High-Load, Lower-Repetition Resistance Training Not Performed to Failure on Muscle Strength, Mass, and Echo Intensity in Healthy Young Men: A Time-Course Study. J Strength Cond Res 2021; 34:3439-3445. [PMID: 29016473 DOI: 10.1519/jsc.0000000000002278] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ikezoe, T, Kobayashi, T, Nakamura, M, and Ichihashi, N. Effects of low-load, higher-repetition vs. high-load, lower-repetition resistance training not performed to failure on muscle strength, mass, and echo intensity in healthy young men: A time-course study. J Strength Cond Res 34(12): 3439-3445, 2020-The aim of this study was to compare the effects of low-load, higher-repetition training (LLHR) with those of high-load, lower-repetition training (HLLR) on muscle strength, mass, and echo intensity in healthy young men. Fifteen healthy men (age, 23.1 ± 2.6 years) were randomly assigned to 1 of the 2 groups: LLHR or HLLR group. Resistance training on knee extensor muscles was performed 3 days per week for 8 weeks. One repetition maximum (1RM) strength, maximum isometric strength, muscle thickness, and muscle echo intensity on ultrasonography of the rectus femoris muscle were assessed every 2 weeks. Analysis of variance showed no significant group × time interaction, and only a significant main effect of time was observed for all variables. The 8-week resistance training increased 1RM, maximum isometric muscle strength, and muscle thickness by 36.2-40.9%, 24.0-25.5%, and 11.3-20.4%, respectively, whereas it decreased echo intensity by 8.05-16.3%. Significant improvements in muscle strength, thickness, and echo intensity were observed at weeks 2, 4, and 8, respectively. The lack of difference in time-course changes between LLHR and HLLR programs suggests that low-load training can exert similar effects on muscle mass and characteristics as high-load training by increasing the number of repetitions, even when not performed to failure.
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Affiliation(s)
- Tome Ikezoe
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Hassan I, Bhanudeep S, Madaan P, Chhajed M, Saini L. Bilateral Calf Hypertrophy and Isolated Motor Delay: Think Beyond Muscular Dystrophy. J Pediatr Neurosci 2021; 16:173-174. [PMID: 35018192 PMCID: PMC8706592 DOI: 10.4103/jpn.jpn_171_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/22/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ijas Hassan
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Singanamalla Bhanudeep
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Priyanka Madaan
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.,Council of Scientific and Industrial Research, CSIR Complex, Library Avenue, Pusa, New Delhi, India
| | | | - Lokesh Saini
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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13
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Coiffard B, Riegler S, Sklar MC, Dres M, Vorona S, Reid WD, Brochard LJ, Ferguson ND, Goligher EC. Diaphragm echodensity in mechanically ventilated patients: a description of technique and outcomes. Crit Care 2021; 25:64. [PMID: 33593412 PMCID: PMC7884870 DOI: 10.1186/s13054-021-03494-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Acute increases in muscle sonographic echodensity reflect muscle injury. Diaphragm echodensity has not been measured in mechanically ventilated patients. We undertook to develop a technique to characterize changes in diaphragm echodensity during mechanical ventilation and to assess whether these changes are correlated with prolonged mechanical ventilation. Methods Diaphragm ultrasound images were prospectively collected in mechanically ventilated patients and in 10 young healthy subjects. Echodensity was quantified based on the right-skewed distribution of grayscale values (50th percentile, ED50; 85th percentile, ED85). Intra- and inter-analyzer measurement reproducibility was determined. Outcomes recorded included duration of ventilation and ICU complications (including reintubation, tracheostomy, prolonged ventilation, or death). Results Echodensity measurements were obtained serially in 34 patients comprising a total of 104 images. Baseline (admission) diaphragm ED85 was increased in mechanically ventilated patients compared to younger healthy subjects (median 56, interquartile range (IQR) 42–84, vs. 39, IQR 36–52, p = 0.04). Patients with an initial increase in median echodensity over time (≥ + 10 in ED50 from baseline) had fewer ventilator-free days to day 60 (n = 13, median 46, IQR 0–52) compared to patients without this increase (n = 21, median 53 days, IQR 49–56, unadjusted p = 0.03). Both decreases and increases in diaphragm thickness during mechanical ventilation were associated with increases in ED50 over time (adjusted p = 0.03, conditional R2 = 0.80) and the association between increase in ED50 and outcomes persisted after adjusting for changes in diaphragm thickness. Conclusions Many patients exhibit increased diaphragm echodensity at the outset of mechanical ventilation. Increases in diaphragm echodensity during the early course of mechanical ventilation are associated with prolonged mechanical ventilation. Both decreases and increases in diaphragm thickness during mechanical ventilation are associated with increased echodensity.
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Affiliation(s)
- Benjamin Coiffard
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada
| | - Stephen Riegler
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada
| | - Michael C Sklar
- Inter-Departmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Martin Dres
- AP-HP, Service de Pneumologie, Médecine Intensive-Réanimation (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Stefannie Vorona
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Laurent J Brochard
- Inter-Departmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Niall D Ferguson
- Inter-Departmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada.,Toronto General Hospital Research Institute, Toronto, Canada
| | - Ewan C Goligher
- Inter-Departmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. .,Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada. .,Toronto General Hospital Research Institute, Toronto, Canada.
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14
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Ikezoe T. Age-Related Change in Muscle Characteristics and Resistance Training for Older Adults. Phys Ther Res 2021; 23:99-105. [PMID: 33489646 DOI: 10.1298/ptr.r0009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/13/2020] [Indexed: 11/23/2022]
Abstract
In older adults, muscle weakness contributes greatly to functional restrictions on daily living activities, increased risk of falls, and adverse physiological changes. It has been suggested that not only muscle mass but also muscular infiltration of noncontractile elements may influence muscular performance such as strength and rapid force production. It is proved that resistance training may provoke substantial increases in muscle size even if it is performed at low intensities in older individuals. Also, recent studies have demonstrated the effectiveness of resistance training on muscle quality such as muscular infiltration of noncontractile elements for older people. This review shows the age-related changes in muscle mass and muscle quality, which were measured by muscle echo intensity on ultrasound images, and low-intensity resistance training effects on muscle volume and muscle quality.
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Affiliation(s)
- Tome Ikezoe
- Human Health Sciences, Graduate School of Medicine, Kyoto University
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15
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Paramalingam S, Morgan K, Becce F, Diederichsen LP, Ikeda K, Mandl P, Ohrndorf S, Sedie AD, Sharp V, Tan AL, Terslev L, Wakefield RJ, Bruyn GAW, D'Agostino MA, Keen HI. Conventional ultrasound and elastography as imaging outcome tools in autoimmune myositis: A systematic review by the OMERACT ultrasound group. Semin Arthritis Rheum 2020; 51:661-676. [PMID: 33386164 DOI: 10.1016/j.semarthrit.2020.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/11/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
AIMS To analyze whether there is sufficient data from published literature to demonstrate that ultrasound, including elastography, present good metric properties (truth, discrimination and feasibility) in autoimmune myositis (AIM). METHODS A population, intervention, comparator and outcome-structured (PICO) search was performed in Medline, Cochrane Library and Embase database from 01/01/1973 to 08/05/2019. The inclusion criteria required original research involving adult humans, reported in English, assessing ultrasound and elastography in patients with an AIM. Conference abstracts and computer-assisted diagnostics that focused on technique and not ultrasound domains were excluded. RESULTS Approximately 2670 articles were identified. Forty-one full-text articles were included in the final analysis. There were 551 AIM patients studied. Eighteen studies (43.9%) had a control group, of which 15 (63.3%) were healthy controls. The age of participants (including controls) varied from 18 to 86 years, and most were females (59%). Diagnosis of AIM was largely biopsy-proven, although some were derived through clinical presentation, positive clinical imaging (ultrasound or otherwise) and/or electromyography and steroid responsiveness. The features examined with ultrasound in the 41 included articles consisted of: muscle echogenicity, bulk, atrophy, architecture, power Doppler, perfusion characteristics, shear wave modulus, shear wave velocity, elasticity index and fasciculations. Twelve studies (29.2%) used quantitative methods to assess these characteristics, whilst others used semi-quantitative, dichotomous/binary and descriptive scoring systems. Criterion validity was met in 14 studies (12/14, 85.7%) and construct validity in 22 studies (22/25, 88.0%). Most published articles reported Level 3b to Level 5 evidence with varying degrees of bias. There was only one longitudinal study examining discrimination. Reliability and feasibility were under-reported. CONCLUSION This is the first systematic review studying the utility of ultrasound, including elastography, in AIM. There is some evidence for criterion and construct validity, suggesting that ultrasound may be a promising outcome measurement instrument in AIM. Agreement on the standardization of acquisition, and the definitions of target domains, is required. Additionally, further validation studies are required to determine discrimination, reliability and feasibility.
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Affiliation(s)
- Shereen Paramalingam
- Department of Rheumatology, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, Western Australia 6150, Australia; University of Notre Dame Australia, Western Australia, Australia.
| | - Kelly Morgan
- Department of Rheumatology, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, Western Australia 6150, Australia
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Switzerland; University of Lausanne, Lausanne, Switzerland
| | | | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Peter Mandl
- Medical Department III, Rheumatology, Medical University Vienna, Vienna, Austria
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Veronika Sharp
- Santa Clara Valley Medical Center, San Jose, CA 94025, USA
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - Richard J Wakefield
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - George A W Bruyn
- Department of Rheumatology, MC Hospital Group, Lelystad, the Netherlands
| | - Maria-Antonietta D'Agostino
- UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, 78180 Montigny-Le-Bretonneux, France; Rheumatology Department, Ambroise Paré Hospital, AP-HP-Paris Saclay, 92100 Boulogne-Billancourt, France
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16
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Lifetime analysis of mdx skeletal muscle reveals a progressive pathology that leads to myofiber loss. Sci Rep 2020; 10:17248. [PMID: 33057110 PMCID: PMC7560899 DOI: 10.1038/s41598-020-74192-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023] Open
Abstract
The muscular dystrophy X-linked mouse (mdx) is the most commonly used preclinical model for Duchenne muscular dystrophy. Although disease progression in the mouse does not perfectly model the human disease, it shares many pathological features. Early characterizations of the model reported severe pathology through early adulthood followed by disease stabilization. As a result, research in the mdx mouse has largely focused on early adulthood. The overarching goal of this study is to improve the understanding of the mdx mouse model by tracking pathological features of the disease throughout life. We performed a thorough characterization of myofiber pathology in mdx mice from 2 weeks to 2 years of age. We report that individual mdx muscle fibers undergo progressive hypertrophy that continues through the lifespan. Despite massive hypertrophy on the myofiber level, we report no hypertrophy on the muscle level. These seemingly contradictory findings are explained by previously underappreciated myofiber loss in mdx mice. We conclude that due to myofiber loss, in combination with the progressive nature of other pathological features, aged mdx muscle tissue provides reliable benchmarks for disease progression that may be valuable in testing the efficacy of therapeutics for Duchenne muscular dystrophy.
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17
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Panadés-de Oliveira L, Bermejo-Guerrero L, de Fuenmayor-Fernández de la Hoz CP, Cantero Montenegro D, Hernández Lain A, Martí P, Muelas N, Vilchez JJ, Domínguez-González C. Persistent asymptomatic or mild symptomatic hyperCKemia due to mutations in ANO5: the mildest end of the anoctaminopathies spectrum. J Neurol 2020; 267:2546-2555. [PMID: 32367299 DOI: 10.1007/s00415-020-09872-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The ANO5 gene encodes for anoctamin-5, a chloride channel involved in muscle cell membrane repair. Recessive mutations in ANO5 are associated with muscular diseases termed anoctaminopathies, which are characterized by proximal or distal weakness, or isolated hyperCKemia. We present the largest series of patients with asymptomatic/paucisymptomatic anoctaminopathy reported so far, highlighting their clinical and radiological characteristics. METHODS Twenty subjects were recruited retrospectively from the Neuromuscular Disorders Units database of two national reference centers. All had a confirmed genetic diagnosis (mean age of diagnosis was 48 years) established between 2015 and 2019. Clinical and complementary data were evaluated through clinical records. RESULTS None of the patients complained about weakness or showed abnormal muscular balance. Among paucisymptomatic patients, the main complaints or findings were generalized myalgia, exercise intolerance and calf hypertrophy, occasionally associated with calf pain. All patients showed persistent hyperCKemia, ranging from mild-moderate to severe. Muscle biopsy revealed inflammatory changes in three cases. Muscle magnetic resonance imaging revealed typical signs (preferential involvement of adductor and gastrocnemius muscles) in all but one patient. In two cases, abnormal findings were detectable only in STIR sequences (not in T1). Three patients showed radiological progression despite remaining asymptomatic. Twelve different mutations in ANO5 were detected, of which seven are novel. CONCLUSIONS Recessive mutations in ANO5 are a frequent cause of undiagnosed asymptomatic/paucisymptomatic hyperCKemia. Patients with an apparent indolent phenotype may show muscle involvement in complementary tests (muscle biopsy and imaging), which may progress over time. Awareness of anoctaminopathy as the cause of nonspecific muscular complaints or of isolated hyperCKemia is essential to correctly diagnose affected patients.
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Affiliation(s)
- Luísa Panadés-de Oliveira
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n, 28041, Madrid, Spain.
| | - Laura Bermejo-Guerrero
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n, 28041, Madrid, Spain
| | - Carlos Pablo de Fuenmayor-Fernández de la Hoz
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n, 28041, Madrid, Spain.,Department of Neurology, Neuromuscular Disorders Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Pilar Martí
- Department of Neurology and IIS La Fe, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Neuromuscular Reference Center ERN-EURO-NMD, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Nuria Muelas
- Department of Neurology and IIS La Fe, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Neuromuscular Reference Center ERN-EURO-NMD, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Juan J Vilchez
- Department of Neurology and IIS La Fe, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Neuromuscular Reference Center ERN-EURO-NMD, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Cristina Domínguez-González
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n, 28041, Madrid, Spain.,Department of Neurology, Neuromuscular Disorders Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Hospital 12 de Octubre Research Institute (imas12), Madrid, Spain
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18
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Ultrasonography-Based Qualitative and Quantitative Evaluation Approaches for Pompe Disease. J Med Biol Eng 2019. [DOI: 10.1007/s40846-019-00502-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Purpose
The aim of this study was to propose the qualitative and quantitative approaches to evaluate the skeletal muscle ultrasound images of 23 Pompe disease (i.e., acid maltase deficiency, AMD) patients and 14 normal subjects.
Methods
A cohort of 23 AMD patients and 14 normal subjects has been investigated. We compared the B-mode echo intensity of the rectus femoris muscle with that of its surrounding fat (subcutaneous fat) and proposed a qualitative grading method. Quantitative analysis of the region of interest (ROI) with the echo intensity and the segmented area was also performed.
Results
Qualitative results showed that AMD patients without clinical symptoms (without undergoing ERT) had the highest distribution of Grade 1, and AMD patients undergoing ERT had the widest distribution of Grade 2, and control group (n = 14) with the highest distribution of Grade 1. Using the segmented area approach, quantitative results showed that AMD patients undergoing ERT had the largest and widest distribution. Meanwhile the control subjects (normal subjects) had the lowest and the narrowest areas. The echo intensity of the segmented ROI of AMD patients undergoing ERT displayed the highest and widest (inhomogeneous) distributions. By contrast, the echo intensity of AMD patients without clinical symptoms was slightly increased and with low inhomogeneity.
Conclusion
The proposed ultrasonography-based qualitative and quantitative approach may be used to evaluate the severity of muscle destruction for AMD patients. Besides, the quantitative segmented area with regression analysis could help predict the incidence of onset of Pompe disease patients.
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19
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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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20
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Muscle Hypertrophy in a Child With Progressive Weakness-Thinking Beyond Muscular Dystrophy. J Clin Neuromuscul Dis 2019; 20:140-141. [PMID: 30801487 DOI: 10.1097/cnd.0000000000000227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Watanabe Y, Ikenaga M, Yoshimura E, Yamada Y, Kimura M. Association between echo intensity and attenuation of skeletal muscle in young and older adults: a comparison between ultrasonography and computed tomography. Clin Interv Aging 2018; 13:1871-1878. [PMID: 30323573 PMCID: PMC6174294 DOI: 10.2147/cia.s173372] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Skeletal muscle experiences both quantitative and qualitative changes with aging. Echo intensity (EI) of the skeletal muscle obtained by ultrasonography (US) has been considered to reflect muscle quality. This technique is noninvasive, easily accessible, and is relatively inexpensive than that of other imaging techniques such as computed tomography (CT). Previous studies have reported that EI is related to several physical performances. However, few studies have investigated the validity of EI against other imaging methods in case of imaging of the skeletal muscle. We compared quantitative and qualitative indices evaluated by the US and CT imaging systems to strengthen their validity. Participants and methods A total of 40 adults participated in this study: 19 young (10 men and 9 women; their mean (±SD) age was 22.7±1.5 years) and 21 older adults (13 men and 8 women; their mean age was 70.6±4.8 years). Both thighs of each participant were evaluated using US and CT imaging systems. Results With respect to the US indices, the young group had significantly higher muscle thickness (MT) of the front thigh (P<0.001) and lower EI (P=0.001) than that of the older group. With respect to the CT indices, the cross-sectional area (CSA) and mean CT value (Hounsfield unit [HU]) of the muscle were found to be significantly higher in the young group (P<0.001) than that of the older group, whereas the percentage of low-density muscle area (%LDMA) was found to be significantly higher in the older group (P<0.001) than that of the young group. A significant, strong, and positive correlation was observed between MT and CSA, which reflects the muscle quantity (r=0.774; P<0.001). With respect to the indices of muscle quality, we found significant and moderate correlations between EI and CT values (r=−0.502; P<0.001) and between EI and %LDMA (r=0.441; P<0.001). However, these correlations were found to be decreased in the older group [between EI and CT value (r=−0.363; P=0.018) and between EI and %LDMA (r=0.257; P=0.100)]. Conclusion Results of this study indicate that the EI is moderately associated with muscle attenuation as assessed by CT, which means that higher EI at least partly reflects intramuscular lipid infiltration.
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Affiliation(s)
- Yuya Watanabe
- Faculty of Health and Sports Science, Doshisha University, Kyotanabe, Japan, .,Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan, .,Department of Health and Sports, Faculty of Health and Medical Sciences, Kyoto Gakuen University, Kameoka, Japan,
| | - Masahiro Ikenaga
- Central Research Institute for Physical Activity, Fukuoka University, Fukuoka, Japan
| | - Eiichi Yoshimura
- Department of Food and Health Sciences, Prefectural University of Kumamoto, Kumamoto, Japan
| | - Yosuke Yamada
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan, .,Laboratory of Healthy Longevity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Misaka Kimura
- Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan, .,Department of Health and Sports, Faculty of Health and Medical Sciences, Kyoto Gakuen University, Kameoka, Japan,
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22
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Mul K, Horlings CGC, Vincenten SCC, Voermans NC, van Engelen BGM, van Alfen N. Quantitative muscle MRI and ultrasound for facioscapulohumeral muscular dystrophy: complementary imaging biomarkers. J Neurol 2018; 265:2646-2655. [PMID: 30191320 PMCID: PMC6182682 DOI: 10.1007/s00415-018-9037-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/14/2018] [Accepted: 08/27/2018] [Indexed: 11/11/2022]
Abstract
Objective To assess the overlap of and differences between quantitative muscle MRI and ultrasound in characterizing structural changes in leg muscles of facioscapulohumeral muscular dystrophy (FSHD) patients. Methods We performed quantitative MRI and quantitative ultrasound of ten leg muscles in 27 FSHD patients and assessed images, both quantitatively and visually, for fatty infiltration, fibrosis and edema. Results The MRI fat fraction and ultrasound echogenicity z-score correlated strongly (CC 0.865, p < 0.05) and both correlated with clinical severity (MRI CC 0.828, ultrasound CC 0.767, p < 0.001). Ultrasound detected changes in muscle architecture in muscles that looked normal on MRI. MRI was better in detecting late stages of fatty infiltration and was more suitable to assess muscle edema. Correlations between quantitative and semi-quantitative scores were strong for MRI (CC 0.844–0.982, p < 0.05), and varied for ultrasound (CC 0.427–0.809, p = 0.026–p < 0.001). Conclusions Quantitative muscle MRI and ultrasound are both promising imaging biomarkers for differentiating between degrees of structural muscle changes. As ultrasound is more sensitive to detect subtle structural changes and MRI is more accurate in end stage muscles and detecting edema, the techniques are complementary. Hence, the choice for a particular technique should be considered in light of the trial design.
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Affiliation(s)
- Karlien Mul
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Corinne G C Horlings
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sanne C C Vincenten
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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23
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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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24
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Park DY, Kang S, Jeong JS, Yoon JS. Muscle echogenicity ratio can indicate severity of carpal tunnel syndrome. Muscle Nerve 2018; 58:304-306. [PMID: 29510442 DOI: 10.1002/mus.26116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/21/2018] [Accepted: 03/04/2018] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate the usefulness of the echogenicity (EI) ratio of the thenar to hypothenar muscle measured using ultrasonography in assessing the severity of carpal tunnel syndrome (CTS). METHODS Fifty-nine hands of 30 patients electrodiagnostically confirmed as having CTS were classified into 3 subgroups (mild, moderate, and severe). The EI of the thenar and hypothenar muscles was measured with ultrasonography, and the EI ratio was calculated in the patients and 13 normal participants (26 hands). RESULTS The average EI ratio was higher in the CTS group than in the control group. We also found a positive correlation between the severity of CTS and a high EI ratio measured with ultrasonography. DISCUSSION The EI ratio of the thenar to hypothenar muscle is a useful parameter that can indicate the severity of CTS. Muscle Nerve 58: 304-306, 2018.
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Affiliation(s)
- Dong Yoon Park
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, Korea
| | - Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, Korea
| | - Jin Seok Jeong
- Cheonan Chungmu Hospital, 8 Dagamal 3-gil, Seobuk-gu, Cheonan, Chungcheongnam-do, Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, Korea
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Laughlin RS, Niu Z, Wieben E, Milone M. RYR1 causing distal myopathy. Mol Genet Genomic Med 2017; 5:800-804. [PMID: 29178655 PMCID: PMC5702567 DOI: 10.1002/mgg3.338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/25/2017] [Accepted: 08/29/2017] [Indexed: 12/31/2022] Open
Abstract
Background Congenital myopathies due to ryanodine receptor (RYR1) mutations are increasingly identified and correlate with a wide range of phenotypes, most commonly that of malignant hyperthermia susceptibility and central cores on muscle biopsy with rare reports of distal muscle weakness, but in the setting of early onset global weakness. Methods We report a case of a patient presenting with childhood onset hand stiffness and adult onset progressive hand weakness and jaw contractures discovered to have two variants in the RYR1 gene. Results The patient manifested with distal upper limb weakness which progressed to involve the distal lower limb, proximal upper limb, as well as the face in addition to limited jaw opening. Creatine kinase was mildly elevated with EMG findings supporting a myopathy. Muscle biopsy showed features consistent with centronuclear myopathy. Whole exome sequencing revealed a novel heterozygous pathogenic variant in RYR1 (c.12315_12328delAGAAATCCAGTTCC, p.Glu4106Alafs*8), and a heterozygous missense variant (c.10648C>T, p.Arg3550Trp) of unknown significance in compound heterozygous state. Conclusion We expand the spectrum of RYR1‐related myopathy with the description of a novel phenotype in an adult patient presenting with hand weakness and suggest considering RYR1 analysis in the diagnosis of distal myopathies.
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Affiliation(s)
| | - Zhiyv Niu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.,Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota
| | - Eric Wieben
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
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Abstract
Neuromuscular ultrasound (US) augments a careful physical examination and electrodiagnostic evaluation in the evaluation of suspected myopathy. Ultrasound evaluation of muscle can identify abnormal echo intensity, size, and movement. Because it is painless and noninvasive, US can be used to evaluate multiple muscles to direct the electrodiagnostic examination or muscle biopsy. Some patterns of muscle involvement can suggest specific etiologies. Most muscular dystrophies show homogenously increased muscle echo intensity with attenuation of the US signal, likely resultant from increased intramuscular fat and fibrosis. Inflammatory myopathies can also show homogenously increased echogenicity but lack the signal attenuation seen in muscular dystrophies. In contrast, denervation can show "moth-eaten," atrophic muscles with fasciculations. Advanced age and obesity also impacts muscle size and echo intensity and can hamper efforts to detect mild pathologies. The sensitivity and specificity of US for detecting neuromuscular disease have been best studied in children and depend on the type and severity of the disorder. In general, muscle US yields sensitivities and specificities of 67% to 100% for detecting neuromuscular disorders in children and is similar to electromyogram for detection of myopathy. Ultrasound is most sensitive for detecting muscular dystrophies and is less sensitive in metabolic myopathies and very young children.
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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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Nadeau MJ, Desrochers A, Lamontagne M, Larivière C, Gagnon DH. Quantitative ultrasound imaging of Achilles tendon integrity in symptomatic and asymptomatic individuals: reliability and minimal detectable change. J Foot Ankle Res 2016; 9:30. [PMID: 27540416 PMCID: PMC4989299 DOI: 10.1186/s13047-016-0164-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/11/2016] [Indexed: 12/13/2022] Open
Abstract
Background Quantifying the integrity of the Achilles tendon (AT) is a rehabilitation challenge. Adopting quantitative ultrasound measurements (QUS measurements) of the AT could fill this gap by 1) evaluating the test-retest reliability and accuracy of QUS measurements of the AT; 2) determining the best protocol for collecting QUS measurements in clinical practice. Methods A total of 23 ATs with symptoms of Achilles tendinopathy and 63 asymptomatic ATs were evaluated. Eight images were recorded for each AT (2 visits × 2 evaluators × 2 images). Multiple sets of QUS measurements were taken: geometric (thickness, width, area), first-order statistics (computed from a grayscale histogram distribution: echogenicity, variance, skewness, kurtosis, entropy) and texture features (computed from co-occurrence matrices: contrast, energy, homogeneity). A generalizability study quantified the reliability and standard error of measurement (accuracy) of each QUS measurement, and a decision study identified the best measurement taking protocols. Results Geometric QUS measurements demonstrated excellent accuracy and reliability. QUS measurements computed from the grayscale histogram distribution revealed poor accuracy and reliability. QUS measurements derived from co-occurrence matrices showed variable accuracy and moderate to excellent reliability. In clinical practice, using an average of the results of three images collected by a single evaluator during a single visit is recommended. Conclusions The use of geometric QUS measurements enables quantification of AT integrity in clinical practice and research settings. More studies on QUS measurements derived from co-occurrence matrices are warranted.
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Affiliation(s)
- Marie-Josée Nadeau
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; School of Rehabilitation, Université de Montréal, Pavillon 7077 Avenue du Parc, Station Centre-Ville, P.O. Box 6128, Montreal, Quebec H3C 3J7 Canada
| | - Amélie Desrochers
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | - Christian Larivière
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; Occupational Health and Safety Research Institute Robert-Sauvé (IRSST), Montreal, Canada
| | - Dany H Gagnon
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; School of Rehabilitation, Université de Montréal, Pavillon 7077 Avenue du Parc, Station Centre-Ville, P.O. Box 6128, Montreal, Quebec H3C 3J7 Canada
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The significance of muscle echo intensity on ultrasound for focal neuropathy: The median- to ulnar-innervated muscle echo intensity ratio in carpal tunnel syndrome. Clin Neurophysiol 2016; 127:880-885. [DOI: 10.1016/j.clinph.2015.04.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 03/26/2015] [Accepted: 04/08/2015] [Indexed: 11/22/2022]
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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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Young HJ, Jenkins NT, Zhao Q, Mccully KK. Measurement of intramuscular fat by muscle echo intensity. Muscle Nerve 2015; 52:963-71. [PMID: 25787260 DOI: 10.1002/mus.24656] [Citation(s) in RCA: 268] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 03/06/2015] [Accepted: 03/11/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim of this study was to compare ultrasound echo intensity (EI) with high-resolution T1 -weighted MRI and to establish calibration equations to estimate percent intramuscular fat from EI. METHODS Thirty-one participants underwent both ultrasound and MRI testing of 4 muscles: rectus femoris (RF); biceps femoris (BF); tibialis anterior (TA); and medial gastrocnemius (MG). RESULTS Strong correlations were found between MRI percent fat and muscle EI after correcting for subcutaneous fat thickness (r = 0.91 in RF, r = 0.80 in BF, r = 0.80 in TA, r = 0.76 in MG). Three types of calibration equations were established. CONCLUSIONS Muscle ultrasound is a practical and reproducible method that can be used as an imaging technique for examination of percent intramuscular fat. Future ultrasound studies are needed to establish equations for other muscle groups to enhance its use in both research and clinical settings.
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Affiliation(s)
- Hui-Ju Young
- Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Nathan T Jenkins
- Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Qun Zhao
- Department of Physics and BioImaging Research Center, University of Georgia, Athens, Georgia, USA
| | - Kevin K Mccully
- Department of Kinesiology, University of Georgia, Athens, Georgia, USA
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Magnetic Resonance Assessment of Hypertrophic and Pseudo-Hypertrophic Changes in Lower Leg Muscles of Boys with Duchenne Muscular Dystrophy and Their Relationship to Functional Measurements. PLoS One 2015; 10:e0128915. [PMID: 26103164 PMCID: PMC4477876 DOI: 10.1371/journal.pone.0128915] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 05/01/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction The primary objectives of this study were to evaluate contractile and non-contractile content of lower leg muscles of boys with Duchenne muscular dystrophy (DMD) and determine the relationships between non-contractile content and functional abilities. Methods Lower leg muscles of thirty-two boys with DMD and sixteen age matched unaffected controls were imaged. Non-contractile content, contractile cross sectional area and non-contractile cross sectional area of lower leg muscles (tibialis anterior, extensor digitorum longus, peroneal, medial gastrocnemius and soleus) were assessed by magnetic resonance imaging (MRI). Muscle strength, timed functional tests and the Brooke lower extremity score were also assessed. Results Non-contractile content of lower leg muscles (peroneal, medial gastrocnemius, and soleus) was significantly greater than control group (p<0.05). Non-contractile content of lower leg muscles correlated with Brooke score (rs = 0.64-0.84) and 30 feet walk (rs = 0.66-0.80). Dorsiflexor (DF) and plantarflexor (PF) specific torque was significantly different between the groups. Discussion Overall, non-contractile content of the lower leg muscles was greater in DMD than controls. Furthermore, there was an age dependent increase in contractile content in the medial gastrocnemius of boys with DMD. The findings of this study suggest that T1 weighted MR images can be used to monitor disease progression and provide a quantitative estimate of contractile and non-contractile content of tissue in children with DMD.
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Straathof CSM, Van Heusden D, Ippel PF, Post JG, Voermans NC, De Visser M, Brusse E, Van Den Bergen JC, Van Der Kooi AJ, Verschuuren JJGM, Ginjaar HB. Diagnosis of becker muscular dystrophy: Results of Re-analysis of DNA samples. Muscle Nerve 2015; 53:44-8. [PMID: 25900853 DOI: 10.1002/mus.24691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The phenotype of Becker muscular dystrophy (BMD) is highly variable, and the disease may be underdiagnosed. We searched for new mutations in the DMD gene in a cohort of previously undiagnosed patients who had been referred in the period 1985-1995. METHODS All requests for DNA analysis of the DMD gene in probands with suspected BMD were re-evaluated. If the phenotype was compatible with BMD, and no deletions or duplications were detected, DNA samples were screened for small mutations. RESULTS In 79 of 185 referrals, no mutation was found. Analysis could be performed on 31 DNA samples. Seven different mutations, including 3 novel ones, were found. Long-term clinical follow-up is described. CONCLUSIONS Refining DNA analysis in previously undiagnosed cases can identify mutations in the DMD gene and provide genetic diagnosis of BMD. A delayed diagnosis can still be valuable for the proband or the relatives of BMD patients.
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Affiliation(s)
- Chiara S M Straathof
- Department of Neurology, Leiden University Medical Center, P.O. Box 9600, 2300RC, Leiden, The Netherlands
| | - Dave Van Heusden
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieternella F Ippel
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan G Post
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marianne De Visser
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janneke C Van Den Bergen
- Department of Neurology, Leiden University Medical Center, P.O. Box 9600, 2300RC, Leiden, The Netherlands
| | - Anneke J Van Der Kooi
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan J G M Verschuuren
- Department of Neurology, Leiden University Medical Center, P.O. Box 9600, 2300RC, Leiden, The Netherlands
| | - Hendrika B Ginjaar
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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Shklyar I, Geisbush TR, Mijialovic AS, Pasternak A, Darras BT, Wu JS, Rutkove SB, Zaidman CM. Quantitative muscle ultrasound in Duchenne muscular dystrophy: a comparison of techniques. Muscle Nerve 2014; 51:207-13. [PMID: 24862337 DOI: 10.1002/mus.24296] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2014] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Muscle pathology in Duchenne muscular dystrophy (DMD) can be quantified using ultrasound by measuring either the amplitudes of sound-waves scattered back from the tissue [quantitative backscatter analysis (QBA)] or by measuring these backscattered amplitudes after compression into grayscale levels (GSL) obtained from the images. METHODS We measured and compared QBA and GSL from 6 muscles of 25 boys with DMD and 25 healthy subjects, aged 2-14 years, with age and, in DMD, with function (North Star Ambulatory Assessment). RESULTS Both QBA and GSL were measured reliably (intraclass correlation ≥ 0.87) and were higher in DMD than controls (P < 0.0001). In DMD, average QBA and GSL measured from superficial regions of muscle increased (rho ≥ 0.47, P < 0.05) with both higher age and worse function; in contrast, GSL measured from whole regions of muscle did not. CONCLUSIONS QBA and GSL measured from superficial regions of muscle can similarly quantify muscle pathology in DMD.
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Affiliation(s)
- Irina Shklyar
- The Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Whitmore C, Morgan J. What do mouse models of muscular dystrophy tell us about the DAPC and its components? Int J Exp Pathol 2014; 95:365-77. [PMID: 25270874 PMCID: PMC4285463 DOI: 10.1111/iep.12095] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/16/2014] [Indexed: 12/17/2022] Open
Abstract
There are over 30 mouse models with mutations or inactivations in the dystrophin-associated protein complex. This complex is thought to play a crucial role in the functioning of muscle, as both a shock absorber and signalling centre, although its role in the pathogenesis of muscular dystrophy is not fully understood. The first mouse model of muscular dystrophy to be identified with a mutation in a component of the dystrophin-associated complex (dystrophin) was the mdx mouse in 1984. Here, we evaluate the key characteristics of the mdx in comparison with other mouse mutants with inactivations in DAPC components, along with key modifiers of the disease phenotype. By discussing the differences between the individual phenotypes, we show that the functioning of the DAPC and consequently its role in the pathogenesis is more complicated than perhaps currently appreciated.
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Affiliation(s)
- Charlotte Whitmore
- Dubowitz Neuromuscular Centre, Molecular Neurosciences Section, Developmental Neurosciences Programme, Institute of Child Health, University College LondonLondon, UK
| | - Jennifer Morgan
- Dubowitz Neuromuscular Centre, Molecular Neurosciences Section, Developmental Neurosciences Programme, Institute of Child Health, University College LondonLondon, UK
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Calf muscle involvement in Becker muscular dystrophy: When size does not matter. J Neurol Sci 2014; 347:301-4. [DOI: 10.1016/j.jns.2014.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/08/2014] [Accepted: 10/16/2014] [Indexed: 11/18/2022]
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Reus L, Pillen S, Pelzer BJ, van Alfen-van der Velden JAAEM, Hokken-Koelega ACS, Zwarts M, Otten BJ, Nijhuis-van der Sanden MWG. Growth hormone therapy, muscle thickness, and motor development in Prader-Willi syndrome: an RCT. Pediatrics 2014; 134:e1619-27. [PMID: 25422026 DOI: 10.1542/peds.2013-3607] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate the effect of physical training combined with growth hormone (GH) on muscle thickness and its relationship with muscle strength and motor development in infants with Prader-Willi syndrome (PWS). METHODS In a randomized controlled trial, 22 infants with PWS (12.9 ± 7.1 months) were followed over 2 years to compare a treatment group (n = 10) with a waiting-list control group (n = 12). Muscle thickness of 4 muscle groups was measured by using ultrasound. Muscle strength was evaluated by using the Infant Muscle Strength meter. Motor performance was measured with the Gross Motor Function Measurement. Analyses of variance were used to evaluate between-group effects of GH on muscle thickness at 6 months and to compare pre- and posttreatment (after 12 months of GH) values. Multilevel analyses were used to evaluate effects of GH on muscle thickness over time, and multilevel bivariate analyses were used to test relationships between muscle thickness, muscle strength, and motor performance. RESULTS A significant positive effect of GH on muscle thickness (P < .05) was found. Positive relationships were found between muscle thickness and muscle strength (r = 0.61, P < .001), muscle thickness and motor performance (r = 0.81, P < .001), and muscle strength and motor performance (r = 0.76, P < .001). CONCLUSIONS GH increased muscle thickness, which was related to muscle strength and motor development in infants with PWS. Catch-up growth was faster in muscles that are most frequently used in early development. Because this effect was independent of GH, it suggests a training effect.
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Affiliation(s)
- Linda Reus
- Department of Rehabilitation, Pediatric Physical Therapy, Scientific Institute for Quality of Healthcare,
| | - Sigrid Pillen
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | - Anita C S Hokken-Koelega
- Dutch Growth Research Foundation, Rotterdam, Netherlands; Department of Pediatric Endocrinology, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands; and
| | | | - Barto J Otten
- Department of Pediatric Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands
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van Bruggen H, van de Engel-Hoek L, Steenks M, Bronkhorst E, Creugers N, de Groot I, Kalaykova S. Predictive factors for masticatory performance in Duchenne muscular dystrophy. Neuromuscul Disord 2014; 24:684-92. [DOI: 10.1016/j.nmd.2014.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/19/2014] [Accepted: 05/22/2014] [Indexed: 12/17/2022]
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Walter U, Dressler D. Ultrasound-guided botulinum toxin injections in neurology: technique, indications and future perspectives. Expert Rev Neurother 2014; 14:923-36. [PMID: 25046267 DOI: 10.1586/14737175.2014.936387] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Botulinum toxin (BT) therapy is used in neurology to treat muscle hyperactivity disorders including dystonia, spasticity, cerebral palsy, hemifacial spasms and re-innervation synkinesias as well as exocrine gland hyperactivity disorders. To increase its therapeutic effect and to decrease adverse effects in adjacent tissues, exact BT placement is important. Ultrasonography (US) allows non-invasive, real-time imaging of muscular and glandular tissues and their surrounding structures. It can visualize, guide, and standardize the entire procedure of BT application. Small randomized studies suggest that US-guidance can improve therapeutic efficacy and reduce adverse effects of BT therapy when compared to conventional placement. US-guidance should be used in forearm muscles when functionality is important, and in selected leg muscles. It may be used for targeting distinct neck muscles in cervical dystonia. It is helpful for targeting the salivary glands. Here we review the technique, indications and future developments of US-guidance for BT injection in neurological disorders.
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Affiliation(s)
- Uwe Walter
- Department of Neurology, University of Rostock, Gehlsheimer Str. 20, D-18147, Rostock, Germany
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Harris-Love MO, Monfaredi R, Ismail C, Blackman MR, Cleary K. Quantitative ultrasound: measurement considerations for the assessment of muscular dystrophy and sarcopenia. Front Aging Neurosci 2014; 6:172. [PMID: 25071570 PMCID: PMC4094839 DOI: 10.3389/fnagi.2014.00172] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 07/01/2014] [Indexed: 12/30/2022] Open
Affiliation(s)
- Michael O Harris-Love
- Geriatrics and Extended Care Service, Veterans Affairs Medical Center , Washington, DC , USA ; Research Service, Veterans Affairs Medical Center , Washington, DC , USA ; Department of Exercise Science, School of Public Health and Health Services, The George Washington University , Washington, DC , USA
| | - Reza Monfaredi
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital , Washington, DC , USA
| | - Catheeja Ismail
- Department of Medicine, School of Medicine and Health Sciences, The George Washington University , Washington, DC , USA
| | - Marc R Blackman
- Geriatrics and Extended Care Service, Veterans Affairs Medical Center , Washington, DC , USA ; Department of Medicine, School of Medicine and Health Sciences, The George Washington University , Washington, DC , USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital , Washington, DC , USA
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Nghiem PP, Hoffman EP, Mittal P, Brown KJ, Schatzberg SJ, Ghimbovschi S, Wang Z, Kornegay JN. Sparing of the dystrophin-deficient cranial sartorius muscle is associated with classical and novel hypertrophy pathways in GRMD dogs. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 183:1411-24. [PMID: 24160322 DOI: 10.1016/j.ajpath.2013.07.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 07/19/2013] [Accepted: 07/22/2013] [Indexed: 12/28/2022]
Abstract
Both Duchenne and golden retriever muscular dystrophy (GRMD) are caused by dystrophin deficiency. The Duchenne muscular dystrophy sartorius muscle and orthologous GRMD cranial sartorius (CS) are relatively spared/hypertrophied. We completed hierarchical clustering studies to define molecular mechanisms contributing to this differential involvement and their role in the GRMD phenotype. GRMD dogs with larger CS muscles had more severe deficits, suggesting that selective hypertrophy could be detrimental. Serial biopsies from the hypertrophied CS and other atrophied muscles were studied in a subset of these dogs. Myostatin showed an age-dependent decrease and an inverse correlation with the degree of GRMD CS hypertrophy. Regulators of myostatin at the protein (AKT1) and miRNA (miR-539 and miR-208b targeting myostatin mRNA) levels were altered in GRMD CS, consistent with down-regulation of myostatin signaling, CS hypertrophy, and functional rescue of this muscle. mRNA and proteomic profiling was used to identify additional candidate genes associated with CS hypertrophy. The top-ranked network included α-dystroglycan and like-acetylglucosaminyltransferase. Proteomics demonstrated increases in myotrophin and spectrin that could promote hypertrophy and cytoskeletal stability, respectively. Our results suggest that multiple pathways, including decreased myostatin and up-regulated miRNAs, α-dystroglycan/like-acetylglucosaminyltransferase, spectrin, and myotrophin, contribute to hypertrophy and functional sparing of the CS. These data also underscore the muscle-specific responses to dystrophin deficiency and the potential deleterious effects of differential muscle involvement.
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Affiliation(s)
- Peter P Nghiem
- Department of Integrative Systems Biology, George Washington University School of Medicine, Washington, District of Columbia; Research Center for Genetic Medicine, Children's National Medical Center, Washington, District of Columbia
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42
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Faber RM, Hall JK, Chamberlain JS, Banks GB. Myofiber branching rather than myofiber hyperplasia contributes to muscle hypertrophy in mdx mice. Skelet Muscle 2014; 4:10. [PMID: 24910770 PMCID: PMC4047439 DOI: 10.1186/2044-5040-4-10] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 05/06/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Muscle hypertrophy in the mdx mouse model of Duchenne muscular dystrophy (DMD) can partially compensate for the loss of dystrophin by maintaining peak force production. Histopathology examination of the hypertrophic muscles suggests the hypertrophy primarily results from the addition of myofibers, and is accompanied by motor axon branching. However, it is unclear whether an increased number of innervated myofibers (myofiber hyperplasia) contribute to muscle hypertrophy in the mdx mice. METHODS To better understand the cellular mechanisms of muscle hypertrophy in mdx mice, we directly compared the temporal progression of the dystrophic pathology in the extensor digitorum longus (EDL) muscle to myofiber number, myofiber branching, and innervation, from 3 to 20 weeks of age. RESULTS We found that a 28% increase in the number of fibers in transverse sections of muscle correlated with a 31% increase in myofiber branching. Notably, the largest increases in myofiber number and myofiber branching occurred after 12 weeks of age when the proportion of myofibers with central nuclei had stabilized and the mdx mouse had reached maturity. The dystrophic pathology coincided with profound changes to innervation of the muscles that included temporary denervation of necrotic fibers, fragmentation of synapses, and ultra-terminal axon sprouting. However, there was little evidence of synapse formation in the mdx mice from 3 to 20 weeks of age. Only 4.4% of neuromuscular junctions extended ultra-terminal synapses, which failed to mature, and the total number of neuromuscular junctions remained constant. CONCLUSIONS Muscle hypertrophy in mdx mice results from myofiber branching rather than myofiber hyperplasia.
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Affiliation(s)
- Rachel M Faber
- Department of Neurology, University of Washington, Seattle, WA 98195-7720, USA
| | - John K Hall
- Department of Neurology, University of Washington, Seattle, WA 98195-7720, USA
| | - Jeffrey S Chamberlain
- Department of Neurology, University of Washington, Seattle, WA 98195-7720, USA ; Department of Biochemistry, University of Washington, Seattle, WA 98195-7720, USA ; Department of Medicine, University of Washington, Seattle, WA 98195-7720, USA
| | - Glen B Banks
- Department of Neurology, University of Washington, Seattle, WA 98195-7720, USA
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43
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Alfen NV, Gilhuis HJ, Keijzers JP, Pillen S, Van Dijk JP. Quantitative facial muscle ultrasound: Feasibility and reproducibility. Muscle Nerve 2013; 48:375-80. [DOI: 10.1002/mus.23769] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2012] [Indexed: 12/13/2022]
Affiliation(s)
- Nens Van Alfen
- Department of Neurology and Clinical Neurophysiology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - H. Jacobus Gilhuis
- Department of Neurology; Reinier de Graaf Group; Reinier de Graafweg 3-11, 2625 AD Delft The Netherlands
| | - Jurre P. Keijzers
- Department of Neurology and Clinical Neurophysiology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Sigrid Pillen
- Department of Neurology and Clinical Neurophysiology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Johannes P. Van Dijk
- Department of Neurology and Clinical Neurophysiology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
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44
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Watanabe Y, Yamada Y, Fukumoto Y, Ishihara T, Yokoyama K, Yoshida T, Miyake M, Yamagata E, Kimura M. Echo intensity obtained from ultrasonography images reflecting muscle strength in elderly men. Clin Interv Aging 2013; 8:993-8. [PMID: 23926426 PMCID: PMC3732157 DOI: 10.2147/cia.s47263] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It is well known that loss of muscle mass (quantitative change) is a major change that occurs with aging. Qualitative changes in skeletal muscle, such as increased intramuscular fat, also occur as one ages. Enhanced echo intensity (EI) on ultrasonography images of skeletal muscle is believed to reflect muscle quality. Recent studies evaluating the quality of skeletal muscle using computer-aided gray scale analysis showed that EI is associated with muscle strength independently of age or muscle size in middle-aged and elderly women. The aim of the present study was to investigate whether muscle quality based on EI is associated with muscle strength independently of muscle size for elderly men. Methods A total of 184 elderly men (65–91 years) living independently in Kyoto, Japan, participated in this study. The EI, muscle thickness (MT), and subcutaneous fat thickness (FT) of the anterior compartment of the right thigh were determined by assessing ultrasonography images. The maximum isometric torque of knee extension at a knee angle of 90° was measured. Results The EI showed a significant negative correlation with muscle strength (r = −0.333, P < 0.001). Multivariate regression analysis revealed that the MT and EI of the knee extensor muscle were independently associated with maximum isometric knee extension strength. Even when partial correlation analysis was performed with age, height, weight, and FT as control variables, EI was still significantly correlated with muscle strength. Conclusion The results of this study indicate that aging-related changes in muscle quality contribute to diminishing muscle strength. Ultrasonography is a low-cost, easily accessible, and safe method suitable for the assessment of EI as an index of muscle quality.
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Affiliation(s)
- Yuya Watanabe
- Laboratory of Sports and Health Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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45
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Cross-Sectional Area of the Anterior Belly of the Digastric Muscle: Comparison of MRI and Ultrasound Measures. Dysphagia 2013; 28:375-80. [DOI: 10.1007/s00455-012-9443-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
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46
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Ikezoe T. [Exercise for preventing physical disability in older people based on sarcopenia study]. Nihon Ronen Igakkai Zasshi 2013; 50:770-772. [PMID: 24622222 DOI: 10.3143/geriatrics.50.770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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47
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McDonald CM. Clinical approach to the diagnostic evaluation of hereditary and acquired neuromuscular diseases. Phys Med Rehabil Clin N Am 2012; 23:495-563. [PMID: 22938875 PMCID: PMC3482409 DOI: 10.1016/j.pmr.2012.06.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
For diagnostic evaluation of a neuromuscular disease, the clinician must be able to obtain a relevant patient and family history and perform focused general, musculoskeletal, neurologic, and functional physical examinations to direct further diagnostic evaluations. Laboratory studies for hereditary neuromuscular diseases include the relevant molecular genetic studies. The electromyogram and nerve-conduction studies remain an extension of the physical examination, and help to guide further diagnostic studies such as molecular genetics and muscle and nerve biopsies. All diagnostic information needs are to be interpreted within the context of relevant historical information, family history, physical examination, laboratory data, electrophysiology, pathology, and molecular genetics.
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Affiliation(s)
- Craig M McDonald
- Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, 4860 Y Street, Suite 3850, Sacramento, CA 95817, USA.
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48
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Skeletal muscle involvement in myotonic dystrophy type 2. A comparative muscle ultrasound study. Neuromuscul Disord 2012; 22:492-9. [DOI: 10.1016/j.nmd.2012.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 12/22/2011] [Accepted: 01/10/2012] [Indexed: 12/13/2022]
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49
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Kornegay JN, Childers MK, Bogan DJ, Bogan JR, Nghiem P, Wang J, Fan Z, Howard JF, Schatzberg SJ, Dow JL, Grange RW, Styner MA, Hoffman EP, Wagner KR. The paradox of muscle hypertrophy in muscular dystrophy. Phys Med Rehabil Clin N Am 2012; 23:149-72, xii. [PMID: 22239881 DOI: 10.1016/j.pmr.2011.11.014] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Mutations in the dystrophin gene cause Duchenne and Becker muscular dystrophy in humans and syndromes in mice, dogs, and cats. Affected humans and dogs have progressive disease that leads primarily to muscle atrophy. Mdx mice progress through an initial phase of muscle hypertrophy followed by atrophy. Cats have persistent muscle hypertrophy. Hypertrophy in humans has been attributed to deposition of fat and connective tissue (pseudohypertrophy). Increased muscle mass (true hypertrophy) has been documented in animal models. Muscle hypertrophy can exaggerate postural instability and joint contractures. Deleterious consequences of muscle hypertrophy should be considered when developing treatments for muscular dystrophy.
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Affiliation(s)
- Joe N Kornegay
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA.
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50
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Triandafilou KM, Kamper DG. Investigation of hand muscle atrophy in stroke survivors. Clin Biomech (Bristol, Avon) 2012; 27:268-72. [PMID: 22033224 PMCID: PMC3299934 DOI: 10.1016/j.clinbiomech.2011.10.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 09/26/2011] [Accepted: 10/04/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Weakness is often profound in the contralesional hand after stroke. Relative contributions of various neural and mechanical mechanisms to this impairment, however, have not been quantified. In this study, the extent of one potential contributor, muscle atrophy, was noninvasively assessed in index finger musculature using ultrasonographic techniques. METHODS Twenty-five stroke survivors (45-65 years old) with severe hand impairment resulting from a stroke occurring 2-4 years prior participated, along with 10 age-matched control subjects. Muscle cross sectional area and thickness were geometrically measured from ultrasound images on both limbs of participants. FINDINGS Muscle size on the paretic limb of stroke survivors was smaller for all 7 hand muscles investigated. An average difference of 15% (SD 4) was seen for muscle cross sectional area and 11% (SD 2) for muscle thickness, while the difference between the dominant and non-dominant limbs for control subjects (6% (SD 2) and 1% (SD 4) for the muscle cross sectional area and muscle thickness, respectively) was not significant. INTERPRETATION Although muscle atrophy was detected in the paretic limb following stroke, it is not explanatory of the marked impairment in strength seen in this stroke population. However, other alterations in muscle morphology, such as fatty infiltrations and changes in fiber structure, may contribute to the emergent muscle weakness post-stroke.
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Affiliation(s)
| | - Derek G. Kamper
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, Illinois,Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
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