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Bourke G, Wade RG, van Alfen N. Updates in diagnostic tools for diagnosing nerve injury and compressions. J Hand Surg Eur Vol 2024; 49:668-680. [PMID: 38534079 DOI: 10.1177/17531934241238736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Predicting prognosis after nerve injury and compression can be challenging, even for the experienced clinician. Although thorough clinical assessment can aid diagnosis, we cannot always be precise about long-term functional recovery of either motor or sensory nerves. To evaluate the severity of nerve injury, surgical exploration remains the gold standard, particularly after iatrogenic injury and major nerve injury from trauma, such as brachial plexus injury. Recently, advances in imaging techniques (ultrasound, magnetic resonance imaging [MRI] and MR neurography) along with multimodality assessment, including electrodiagnostic testing, have allowed us to have a better preoperative understanding of nerve continuity and prediction of nerve health and possible recovery. This article outlines the current and potential roles for clinical assessment, exploratory surgery, electrodiagnostic testing ultrasound and MRI in entrapment neuropathies, inflammatory neuritis and trauma. Emphasis is placed on those modalities that are improving in diagnostic accuracy of nerve assessment before any surgical intervention.
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Affiliation(s)
- Gráinne Bourke
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Ryckie G Wade
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Nens van Alfen
- Department of Neurology, Clinical Neuromuscular Imaging Group, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
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Wade RG, Tam W, Perumal A, Pepple S, Griffiths TT, Flather R, Haroon HA, Shelley D, Plein S, Bourke G, Teh I. Comparison of distortion correction preprocessing pipelines for DTI in the upper limb. Magn Reson Med 2024; 91:773-783. [PMID: 37831659 PMCID: PMC10952179 DOI: 10.1002/mrm.29881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE DTI characterizes tissue microstructure and provides proxy measures of nerve health. Echo-planar imaging is a popular method of acquiring DTI but is susceptible to various artifacts (e.g., susceptibility, motion, and eddy currents), which may be ameliorated via preprocessing. There are many pipelines available but limited data comparing their performance, which provides the rationale for this study. METHODS DTI was acquired from the upper limb of heathy volunteers at 3T in blip-up and blip-down directions. Data were independently corrected using (i) FSL's TOPUP & eddy, (ii) FSL's TOPUP, (iii) DSI Studio, and (iv) TORTOISE. DTI metrics were extracted from the median, radial, and ulnar nerves and compared (between pipelines) using mixed-effects linear regression. The geometric similarity of corrected b = 0 images and the slice matched T1-weighted (T1w) images were computed using the Sörenson-Dice coefficient. RESULTS Without preprocessing, the similarity coefficient of the blip-up and blip-down datasets to the T1w was 0·80 and 0·79, respectively. Preprocessing improved the geometric similarity by 1% with no difference between pipelines. Compared to TOPUP & eddy, DSI Studio and TORTOISE generated 2% and 6% lower estimates of fractional anisotropy, and 6% and 13% higher estimates of radial diffusivity, respectively. Estimates of anisotropy from TOPUP & eddy versus TOPUP were not different but TOPUP reduced radial diffusivity by 3%. The agreement of DTI metrics between pipelines was poor. CONCLUSIONS Preprocessing DTI from the upper limb improves geometric similarity but the choice of the pipeline introduces clinically important variability in diffusion parameter estimates from peripheral nerves.
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Affiliation(s)
- Ryckie G. Wade
- Leeds Institute for Medical Research, University of Leeds
LeedsUK
- Department of Plastic, Reconstructive and Hand SurgeryLeeds Teaching Hospitals TrustLeedsUK
| | - Winnie Tam
- Leeds Institute for Medical Research, University of Leeds
LeedsUK
| | - Antonia Perumal
- Leeds Institute for Medical Research, University of Leeds
LeedsUK
| | - Sophanit Pepple
- Leeds Institute for Medical Research, University of Leeds
LeedsUK
| | - Timothy T. Griffiths
- Leeds Institute for Medical Research, University of Leeds
LeedsUK
- Department of Plastic, Reconstructive and Hand SurgeryLeeds Teaching Hospitals TrustLeedsUK
| | - Robert Flather
- Leeds Institute for Medical Research, University of Leeds
LeedsUK
- Department of Plastic, Reconstructive and Hand SurgeryLeeds Teaching Hospitals TrustLeedsUK
| | - Hamied A. Haroon
- Division of Psychology, Communication & Human NeuroscienceThe University of ManchesterManchesterUK
| | | | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of LeedsLeedsUK
| | - Grainne Bourke
- Leeds Institute for Medical Research, University of Leeds
LeedsUK
- Department of Plastic, Reconstructive and Hand SurgeryLeeds Teaching Hospitals TrustLeedsUK
| | - Irvin Teh
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of LeedsLeedsUK
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Dahlin LB. The Dynamics of Nerve Degeneration and Regeneration in a Healthy Milieu and in Diabetes. Int J Mol Sci 2023; 24:15241. [PMID: 37894921 PMCID: PMC10607341 DOI: 10.3390/ijms242015241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Appropriate animal models, mimicking conditions of both health and disease, are needed to understand not only the biology and the physiology of neurons and other cells under normal conditions but also under stress conditions, like nerve injuries and neuropathy. In such conditions, understanding how genes and different factors are activated through the well-orchestrated programs in neurons and other related cells is crucial. Knowledge about key players associated with nerve regeneration intended for axonal outgrowth, migration of Schwann cells with respect to suitable substrates, invasion of macrophages, appropriate conditioning of extracellular matrix, activation of fibroblasts, formation of endothelial cells and blood vessels, and activation of other players in healthy and diabetic conditions is relevant. Appropriate physical and chemical attractions and repulsions are needed for an optimal and directed regeneration and are investigated in various nerve injury and repair/reconstruction models using healthy and diabetic rat models with relevant blood glucose levels. Understanding dynamic processes constantly occurring in neuropathies, like diabetic neuropathy, with concomitant degeneration and regeneration, requires advanced technology and bioinformatics for an integrated view of the behavior of different cell types based on genomics, transcriptomics, proteomics, and imaging at different visualization levels. Single-cell-transcriptional profile analysis of different cells may reveal any heterogeneity among key players in peripheral nerves in health and disease.
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Affiliation(s)
- Lars B. Dahlin
- Department of Translational Medicine—Hand Surgery, Lund University, SE-205 02 Malmö, Sweden; ; Tel.: +46-40-33-17-24
- Department of Hand Surgery, Skåne University Hospital, SE-205 02 Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83 Linköping, Sweden
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Deng J, Sun J, Lu S, Yue K, Liu W, Shi H, Zou L. Exploring neural activity in inflammatory bowel diseases using functional connectivity and DKI-fMRI fusion. Behav Brain Res 2023; 443:114325. [PMID: 36736668 DOI: 10.1016/j.bbr.2023.114325] [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: 11/03/2022] [Revised: 01/02/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Although MRI has made considerable progress in Inflammatory bowel disease (IBD), most studies have concentrated on data information from a single modality, and a better understanding of the interplay between brain function and structure, as well as appropriate clinical aids to diagnosis, is required. We calculated functional connectivity through fMRI time series using resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion kurtosis imaging (DKI) data from 27 IBD patients and 29 healthy controls. Through the DKI data of each subject, its unique structure map is obtained, and the relevant indicators are projected onto the structure map corresponding to each subject by using the graph Fourier transform in the grasp signal processing (GSP) technology. After the features are optimized, a classical support vector machine is used to classify the features. IBD patients have altered functional connectivity in the default mode network (DMN) and subcortical network (SCN). At the same time, compared with the traditional brain network analysis, in the test of some indicators, the average classification accuracy produced by the framework method is 12.73% higher than that of the traditional analysis method. This paper found that the brain network structure of IBD patients in DMN and SCN has changed. Simultaneously, the application of GSP technology to fuse functional information and structural information is superior to the traditional framework in classification, providing a new perspective for subsequent clinical auxiliary diagnosis.
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Affiliation(s)
- Jianjun Deng
- School of Computer and Artificial Intelligence, Changzhou University, Changzhou, Jiangsu 213164, China
| | - Jingwen Sun
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Shuangshuang Lu
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Kecen Yue
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China
| | - Wenjia Liu
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China.
| | - Haifeng Shi
- The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Department of Radiology, China.
| | - Ling Zou
- School of Computer and Artificial Intelligence, Changzhou University, Changzhou, Jiangsu 213164, China; School of Microelectronics and Control Engineering, Changzhou University, Changzhou, Jiangsu 213164, China; Key Laboratory of Brain Machine Collaborative Intelligence Foundation of Zhejiang Province, Hangzhou, Zhejiang 310018, China.
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Wade RG, Lu F, Poruslrani Y, Karia C, Feltbower RG, Plein S, Bourke G, Teh I. Meta-analysis of the normal diffusion tensor imaging values of the peripheral nerves in the upper limb. Sci Rep 2023; 13:4852. [PMID: 36964186 PMCID: PMC10039047 DOI: 10.1038/s41598-023-31307-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 03/09/2023] [Indexed: 03/26/2023] Open
Abstract
Peripheral neuropathy affects 1 in 10 adults over the age of 40 years. Given the absence of a reliable diagnostic test for peripheral neuropathy, there has been a surge of research into diffusion tensor imaging (DTI) because it characterises nerve microstructure and provides reproducible proxy measures of myelination, axon diameter, fibre density and organisation. Before researchers and clinicians can reliably use diffusion tensor imaging to assess the 'health' of the major nerves of the upper limb, we must understand the "normal" range of values and how they vary with experimental conditions. We searched PubMed, Embase, medRxiv and bioRxiv for studies which reported the findings of DTI of the upper limb in healthy adults. Four review authors independently triple extracted data. Using the meta suite of Stata 17, we estimated the normal fractional anisotropy (FA) and diffusivity (mean, MD; radial, RD; axial AD) values of the median, radial and ulnar nerve in the arm, elbow and forearm. Using meta-regression, we explored how DTI metrics varied with age and experimental conditions. We included 20 studies reporting data from 391 limbs, belonging to 346 adults (189 males and 154 females, ~ 1.2 M:1F) of mean age 34 years (median 31, range 20-80). In the arm, there was no difference in the FA (pooled mean 0.59 mm2/s [95% CI 0.57, 0.62]; I2 98%) or MD (pooled mean 1.13 × 10-3 mm2/s [95% CI 1.08, 1.18]; I2 99%) of the median, radial and ulnar nerves. Around the elbow, the ulnar nerve had a 12% lower FA than the median and radial nerves (95% CI - 0.25, 0.00) and significantly higher MD, RD and AD. In the forearm, the FA (pooled mean 0.55 [95% CI 0.59, 0.64]; I2 96%) and MD (pooled mean 1.03 × 10-3 mm2/s [95% CI 0.94, 1.12]; I2 99%) of the three nerves were similar. Multivariable meta regression showed that the b-value, TE, TR, spatial resolution and age of the subject were clinically important moderators of DTI parameters in peripheral nerves. We show that subject age, as well as the b-value, TE, TR and spatial resolution are important moderators of DTI metrics from healthy nerves in the adult upper limb. The normal ranges shown here may inform future clinical and research studies.
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Affiliation(s)
- Ryckie G Wade
- Leeds Institute for Medical Research, The Advanced Imaging Centre, Leeds General Infirmary, University of Leeds, Leeds, LS1 3EX, UK.
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK.
| | - Fangqing Lu
- Leeds Institute for Medical Research, The Advanced Imaging Centre, Leeds General Infirmary, University of Leeds, Leeds, LS1 3EX, UK
| | - Yohan Poruslrani
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Chiraag Karia
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | | | - Sven Plein
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- The Advanced Imaging Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Grainne Bourke
- Leeds Institute for Medical Research, The Advanced Imaging Centre, Leeds General Infirmary, University of Leeds, Leeds, LS1 3EX, UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Irvin Teh
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- The Advanced Imaging Centre, Leeds Teaching Hospitals Trust, Leeds, UK
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Diffusion-weighted MR imaging and utility of ADC measurements in characterizing nerve and muscle changes in diabetic patients on ankle DWI studies: a cross-sectional study. Eur Radiol 2023:10.1007/s00330-023-09466-7. [PMID: 36806567 DOI: 10.1007/s00330-023-09466-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/17/2022] [Accepted: 01/22/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To evaluate the utility of apparent diffusion coefficient (ADC) measurements from ankle MRI diffusion-weighted imaging (DWI) studies in identifying neuropathic changes in diabetic patients. METHODS In total, 109 consecutive ankle MRI scans (n = 101 patients) at a single tertiary care county hospital from November 1, 2019, to July 11, 2021, who met the inclusion criteria were identified. Patients were divided into 2 cohorts: diabetic (n = 62) and non-diabetic (n = 39). Demographics, HgbA1c, neuropathy diagnosis, and image quality data were collected. Abductor hallucis (AH) ADC mean and minimum (min) values and posterior tibial nerve (PTN) ADC mean and minimum values were measured. Student t-test and Pearson's correlation coefficient analysis were performed using R. RESULTS Diabetic patients had significantly higher mean and min ADC values (× 10-3 mm2/s) of the AH muscle (mean: 1.77 vs 1.39, p < 0.001; min: 1.51 vs 1.06, p < 0.001) and PTN (mean: 1.65 vs 1.18, p < 0.001; min: 1.33 vs 0.95, p < 0.001) compared to non-diabetic patients. HgbA1c positively correlated with AH and PTN ADC mean values (AH: p = 0.036; PTN: p = 0.004). CONCLUSION Our data suggests that an increasing diffusivity of water as quantified by ADC across neuronal and muscular membranes is a consequence of the pathophysiology of the disease. Thus, ankle MRI-DWI studies are useful in identifying neuropathic changes in diabetic patients and quantifying the severity noninvasively. KEY POINTS • Diabetic patients had significantly higher mean and minimum ADC values of the abductor hallucis muscle and posterior tibial nerve compared to non-diabetic patients. • HgbA1c positively correlated with ADC mean values (AH: p = 0.036; PTN: p = 0.004) suggesting that an increasing diffusivity of water across neuronal and muscular membranes is a consequence of the pathophysiology of diabetic neuropathy. • Ankle MRI DWI can be used clinically to non-invasively identify neuropathic changes due to diabetes mellitus.
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Towards a Whole Sample Imaging Approach Using Diffusion Tensor Imaging to Examine the Foreign Body Response to Explanted Medical Devices. Polymers (Basel) 2022; 14:polym14224819. [PMID: 36432947 PMCID: PMC9698821 DOI: 10.3390/polym14224819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/12/2022] Open
Abstract
Analysing the composition and organisation of the fibrous capsule formed as a result of the Foreign Body Response (FBR) to medical devices, is imperative for medical device improvement and biocompatibility. Typically, analysis is performed using histological techniques which often involve random sampling strategies. This method is excellent for acquiring representative values but can miss the unique spatial distribution of features in 3D, especially when analysing devices used in large animal studies. To overcome this limitation, we demonstrate a non-destructive method for high-resolution large sample imaging of the fibrous capsule surrounding human-sized implanted devices using diffusion tensor imaging (DTI). In this study we analyse the fibrous capsule surrounding two unique macroencapsulation devices that have been implanted in a porcine model for 21 days. DTI is used for 3D visualisation of the microstructural organisation and validated using the standard means of fibrous capsule investigation; histological analysis and qualitative micro computed tomography (microCT) and scanning electron microscopy (SEM) imaging. DTI demonstrated the ability to distinguish microstructural differences in the fibrous capsules surrounding two macroencapsulation devices made from different materials and with different surface topographies. DTI-derived metrics yielded insight into the microstructural organisation of both capsules which was corroborated by microCT, SEM and histology. The non-invasive characterisation of the integration of implants in the body has the potential to positively influence analysis methods in pre-clinical studies and accelerate the clinical translation of novel implantable devices.
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Efficacy of Nerve-Derived Hydrogels to Promote Axon Regeneration Is Influenced by the Method of Tissue Decellularization. Int J Mol Sci 2022; 23:ijms23158746. [PMID: 35955880 PMCID: PMC9369339 DOI: 10.3390/ijms23158746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Injuries to large peripheral nerves are often associated with tissue defects and require reconstruction using autologous nerve grafts, which have limited availability and result in donor site morbidity. Peripheral nerve-derived hydrogels could potentially supplement or even replace these grafts. In this study, three decellularization protocols based on the ionic detergents sodium dodecyl sulfate (P1) and sodium deoxycholate (P2), or the organic solvent tri-n-butyl phosphate (P3), were used to prepare hydrogels. All protocols resulted in significantly decreased amounts of genomic DNA, but the P2 hydrogel showed the best preservation of extracellular matrix proteins, cytokines, and chemokines, and reduced levels of sulfated glycosaminoglycans. In vitro P1 and P2 hydrogels supported Schwann cell viability, secretion of VEGF, and neurite outgrowth. Surgical repair of a 10 mm-long rat sciatic nerve gap was performed by implantation of tubular polycaprolactone conduits filled with hydrogels followed by analyses using diffusion tensor imaging and immunostaining for neuronal and glial markers. The results demonstrated that the P2 hydrogel considerably increased the number of axons and the distance of regeneration into the distal nerve stump. In summary, the method used to decellularize nerve tissue affects the efficacy of the resulting hydrogels to support regeneration after nerve injury.
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Im SJ, Suh JY, Shim JH, Baek HM. Deterministic Tractography Analysis of Rat Brain Using SIGMA Atlas in 9.4T MRI. Brain Sci 2021; 11:brainsci11121656. [PMID: 34942958 PMCID: PMC8699268 DOI: 10.3390/brainsci11121656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022] Open
Abstract
Preclinical studies using rodents have been the choice for many neuroscience researchers due totheir close reflection of human biology. In particular, research involving rodents has utilized MRI to accurately identify brain regions and characteristics by acquiring high resolution cavity images with different contrasts non-invasively, and this has resulted in high reproducibility and throughput. In addition, tractographic analysis using diffusion tensor imaging to obtain information on the neural structure of white matter has emerged as a major methodology in the field of neuroscience due to its contribution in discovering significant correlations between altered neural connections and various neurological and psychiatric diseases. However, unlike image analysis studies with human subjects where a myriad of human image analysis programs and procedures have been thoroughly developed and validated, methods for analyzing rat image data using MRI in preclinical research settings have seen significantly less developed. Therefore, in this study, we present a deterministic tractographic analysis pipeline using the SIGMA atlas for a detailed structural segmentation and structural connectivity analysis of the rat brain’s structural connectivity. In addition, the structural connectivity analysis pipeline presented in this study was preliminarily tested on normal and stroke rat models for initial observation.
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Affiliation(s)
- Sang-Jin Im
- Department of Core Facility for Cell to In-Vivo Imaging, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Korea; (S.-J.I.); (J.-Y.S.)
| | - Ji-Yeon Suh
- Department of Core Facility for Cell to In-Vivo Imaging, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Korea; (S.-J.I.); (J.-Y.S.)
| | - Jae-Hyuk Shim
- Department of BioMedical Science, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Korea;
| | - Hyeon-Man Baek
- Department of Core Facility for Cell to In-Vivo Imaging, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Korea; (S.-J.I.); (J.-Y.S.)
- Department of Molecular Medicine, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Korea
- Correspondence: ; Tel.: +82-32-899-6678
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Rojoa D, Raheman F, Rassam J, Wade RG. Meta-analysis of the normal diffusion tensor imaging values of the median nerve and how they change in carpal tunnel syndrome. Sci Rep 2021; 11:20935. [PMID: 34686721 PMCID: PMC8536657 DOI: 10.1038/s41598-021-00353-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023] Open
Abstract
Carpal tunnel syndrome (CTS) leads to distortion of axonal architecture, demyelination and fibrosis within the median nerve. Diffusion tensor imaging (DTI) characterises tissue microstructure and generates reproducible proxy measures of nerve 'health' which are sensitive to myelination, axon diameter, fiber density and organisation. This meta-analysis summarises the normal DTI values of the median nerve, and how they change in CTS. This systematic review included studies reporting DTI of the median nerve at the level of the wrist in adults. The primary outcome was to determine the normal fractional anisotropy (FA) and mean diffusivity (MD) of the median nerve. Secondarily, we show how the FA and MD differ between asymptomatic adults and patients with CTS, and how these differences are independent of the acquisition methods. We included 32 studies of 2643 wrists, belonging to 1575 asymptomatic adults and 1068 patients with CTS. The normal FA was 0.58 (95% CI 0.56, 0.59) and the normal MD was 1.138 × 10-3 mm2/s (95% CI 1.101, 1.174). Patients with CTS had a significantly lower FA than controls (mean difference 0.12 [95% CI 0.09, 0.16]). Similarly, the median nerve of patients with CTS had a significantly higher mean diffusivity (mean difference 0.16 × 10-3 mm2/s [95% CI 0.05, 0.27]). The differences were independent of experimental factors. We provide summary estimates of the normal FA and MD of the median nerve in asymptomatic adults. Furthermore, we show that diffusion throughout the length of the median nerve becomes more isotropic in patients with CTS.
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Affiliation(s)
- Djamila Rojoa
- grid.419248.20000 0004 0400 6485Department of Plastic and Reconstructive Surgery, Leicester Royal Infirmary, Leicester, UK
| | - Firas Raheman
- grid.419248.20000 0004 0400 6485Department of Plastic and Reconstructive Surgery, Leicester Royal Infirmary, Leicester, UK
| | - Joseph Rassam
- grid.419248.20000 0004 0400 6485Department of Plastic and Reconstructive Surgery, Leicester Royal Infirmary, Leicester, UK
| | - Ryckie G. Wade
- grid.415967.80000 0000 9965 1030Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK ,grid.9909.90000 0004 1936 8403Leeds Institute for Medical Research, Advanced Imaging Centre, University of Leeds, Leeds, LS1 3EX UK
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Wan Q, Yu Y, Bao Y, Hu J, Wang P, Peng Y, Xia X, Liao Y, Liu J, Xie X, Li X. Evaluation of peripheral nerve acute crush injury in rabbits: comparison among diffusion kurtosis imaging, diffusion tensor imaging and electromyography. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2021; 35:291-299. [PMID: 34374905 DOI: 10.1007/s10334-021-00952-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 05/01/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Diffusion kurtosis imaging (DKI) has been proven to provide additional value for assessing many central nervous system diseases compared with conventional diffusion tensor imaging (DTI); however, whether it has the same value in peripheral nerve injury is unclear. This study aimed to investigate the performance of DKI, DTI, and electromyography (EMG) in evaluating peripheral nerve crush injury (PNCI) in rabbits. MATERIALS AND METHODS A total of 27 New Zealand white rabbits were selected to establish a PNCI model. Longitudinal DTI, DKI, and EMG were evaluated before surgery and 1 day, 3 days, 1 week, 2 weeks, 4 weeks, 6 weeks, and 8 weeks after surgery. At each time point, two rabbits were randomly selected for pathological examination. RESULTS The results showed that fractional anisotropy (FA) derived from both DKI and DTI demonstrated a significant difference between injured and control nerves at all time points (all P < 0.005) mean kurtosis of the injured nerve was lower than that on the control side after 2-8 weeks (all P < 0.05). No statistically significant difference was found in radial kurtosis, axial kurtosis, and apparent diffusion coefficient at almost every time point. The difference in compound muscle action potential (CMAP) of the bilateral gastrocnemius at each time point was statistically significant (all P < 0.001). CONCLUSIONS CMAP was a sensitive and reliable method to assess acute PNCI without being affected by perineural edema. DKI may not be superior to DTI in evaluating peripheral nerves, DTI with a shorter scanning time was preferred as an effective choice for evaluating acute peripheral nerve traumatic injury.
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Affiliation(s)
- Qi Wan
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Yanjiangxilu No. 151, Guangzhou, 510120, China
| | - Yudong Yu
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Yanjiangxilu No. 151, Guangzhou, 510120, China.,Department of Radiology, Huizhou Central People's Hospital, Huizhou, China
| | - Yingying Bao
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Yanjiangxilu No. 151, Guangzhou, 510120, China
| | - Jianfeng Hu
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Yanjiangxilu No. 151, Guangzhou, 510120, China
| | - Peng Wang
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Yanjiangxilu No. 151, Guangzhou, 510120, China
| | - Yu Peng
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Yanjiangxilu No. 151, Guangzhou, 510120, China
| | - Xiaoying Xia
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Yanjiangxilu No. 151, Guangzhou, 510120, China
| | | | - Jieqiong Liu
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Yanjiangxilu No. 151, Guangzhou, 510120, China
| | - Xiaobin Xie
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Yanjiangxilu No. 151, Guangzhou, 510120, China
| | - Xinchun Li
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Yanjiangxilu No. 151, Guangzhou, 510120, China.
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Griffiths TT, Flather R, Teh I, Haroon HA, Shelley D, Plein S, Bourke G, Wade RG. Diffusion tensor imaging in cubital tunnel syndrome. Sci Rep 2021; 11:14982. [PMID: 34294771 PMCID: PMC8298404 DOI: 10.1038/s41598-021-94211-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/25/2021] [Indexed: 11/09/2022] Open
Abstract
Cubital tunnel syndrome (CuTS) is the 2nd most common compressive neuropathy. To improve both diagnosis and the selection of patients for surgery, there is a pressing need to develop a reliable and objective test of ulnar nerve 'health'. Diffusion tensor imaging (DTI) characterises tissue microstructure and may identify differences in the normal ulnar from those affected by CuTS. The aim of this study was to compare the DTI metrics from the ulnar nerves of healthy (asymptomatic) adults and patients with CuTS awaiting surgery. DTI was acquired at 3.0 T using single-shot echo-planar imaging (55 axial slices, 3 mm thick, 1.5 mm2 in-plane) with 30 diffusion sensitising gradient directions, a b-value of 800 s/mm2 and 4 signal averages. The sequence was repeated with the phase-encoding direction reversed. Data were combined and corrected using the FMRIB Software Library (FSL) and reconstructed using generalized q-sampling imaging in DSI Studio. Throughout the length of the ulnar nerve, the fractional anisotropy (FA), quantitative anisotropy (QA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were extracted, then compared using mixed-effects linear regression. Thirteen healthy controls (8 males, 5 females) and 8 patients with CuTS (6 males, 2 females) completed the study. Throughout the length of the ulnar nerve, diffusion was more isotropic in patients with CuTS. Overall, patients with CuTS had a 6% lower FA than controls, with the largest difference observed proximal to the cubital tunnel (mean difference 0.087 [95% CI 0.035, 0.141]). Patients with CuTS also had a higher RD than controls, with the largest disparity observed within the forearm (mean difference 0.252 × 10-4 mm2/s [95% CI 0.085 × 10-4, 0.419 × 10-4]). There were no significant differences between patients and controls in QA, MD or AD. Throughout the length of the ulnar nerve, the fractional anisotropy and radial diffusivity in patients with CuTS are different to healthy controls. These findings suggest that DTI may provide an objective assessment of the ulnar nerve and potentially, improve the management of CuTS.
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Affiliation(s)
- Timothy T Griffiths
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic, Reconstructive and Hand Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Robert Flather
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic, Reconstructive and Hand Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Irvin Teh
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Hamied A Haroon
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - David Shelley
- The Advanced Imaging Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Sven Plein
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Grainne Bourke
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic, Reconstructive and Hand Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Ryckie G Wade
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK.
- Department of Plastic, Reconstructive and Hand Surgery, Leeds Teaching Hospitals Trust, Leeds, UK.
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Advances in imaging technologies for the assessment of peripheral neuropathies in rheumatoid arthritis. Rheumatol Int 2021; 41:519-528. [PMID: 33427917 DOI: 10.1007/s00296-020-04780-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/26/2020] [Indexed: 12/22/2022]
Abstract
Peripheral neuropathy in patients with rheumatoid arthritis is associated with a maladaptive autoimmune response that may cause chronic pain and disability. Nerve conduction studies are the routine method performed when rheumatologists presume its presence. However, this approach is invasive, may not reveal subtle malfunctions in the early stages of the disease, and does not expose abnormalities in structures surrounding the nerves and muscles, limiting the possibility of a timely diagnosis. This work aims to present a narrative review of new technologies for the clinical assessment of peripheral neuropathy in Rheumatoid Arthritis. Through a bibliographic search carried out in five repositories, from 1990 to 2020, we identified three technologies that could detect peripheral nerve lesions and perform quantitative evaluations: (1) magnetic resonance neurography, (2) functional magnetic resonance imaging, and (3) high-resolution ultrasonography of peripheral nerves. We found these tools can overcome the main constraints imposed by the previous electrophysiologic methods, enabling early diagnosis.
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Diffusion tensor imaging of the roots of the brachial plexus: a systematic review and meta-analysis of normative values. Clin Transl Imaging 2020; 8:419-431. [PMID: 33282795 PMCID: PMC7708343 DOI: 10.1007/s40336-020-00393-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023]
Abstract
Purpose Diffusion tensor magnetic resonance imaging (DTI) characterises tissue microstructure and provides proxy measures of myelination, axon diameter, fibre density and organisation. This may be valuable in the assessment of the roots of the brachial plexus in health and disease. Therefore, there is a need to define the normal DTI values. Methods The literature was systematically searched for studies of asymptomatic adults who underwent DTI of the brachial plexus. Participant characteristics, scanning protocols, and measurements of the fractional anisotropy (FA) and mean diffusivity (MD) of each spinal root were extracted by two independent review authors. Generalised linear modelling was used to estimate the effect of experimental conditions on the FA and MD. Meta-analysis of root-level estimates was performed using Cohen's method with random effects. Results Nine articles, describing 316 adults (1:1 male:female) of mean age 35 years (SD 6) were included. Increments of ten diffusion sensitising gradient directions reduced the mean FA by 0.01 (95% CI 0.01, 0.03). Each year of life reduced the mean MD by 0.03 × 10-3 mm2/s (95% CI 0.01, 0.04). At 3-T, the pooled mean FA of the roots was 0.36 (95% CI 0.34, 0.38; I 2 98%). The pooled mean MD of the roots was 1.51 × 10-3 mm2/s (95% CI 1.45, 1.56; I 2 99%). Conclusions The FA and MD of the roots of the brachial plexus vary according to experimental conditions and participant factors. We provide summary estimates of the normative values in different conditions which may be valuable to researchers and clinicians alike.
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Xing XX, Hua XY, Zheng MX, Ma ZZ, Huo BB, Wu JJ, Ma SJ, Ma J, Xu JG. Intra and inter: Alterations in functional brain resting-state networks after peripheral nerve injury. Brain Behav 2020; 10:e01747. [PMID: 32657022 PMCID: PMC7507705 DOI: 10.1002/brb3.1747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/18/2020] [Accepted: 06/04/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Numerous treatments suggest that brain plasticity changes after peripheral nerve injury (PNI), and most studies examining functional magnetic resonance imaging focused on abnormal changes in specific brain regions. However, it is the large-scale interaction of neuronal networks instead of isolated brain regions contributed to the functional recovery after PNI. In the present study, we examined the intra- and internetworks alterations between the related functional resting-state networks (RSNs) in a sciatic nerve injury rat model. METHODS Ninety-six female rats were divided into a control and model group. Unilateral sciatic nerve transection and direct anastomosis were performed in the latter group. We used an independent component analysis (ICA) algorithm to observe the changes in RSNs and assessed functional connectivity between different networks using the functional networks connectivity (FNC) toolbox. RESULTS Six RSNs related to PNI were identified, including the basal ganglia network (BGN), sensorimotor network (SMN), salience network (SN), interoceptive network (IN), cerebellar network (CN), and default mode network (DMN). The model group showed significant changes in whole-brain FC changes within these resting-state networks (RSNs), but four of these RSNs exhibited a conspicuous decrease. The interalterations performed that significantly decreased FNC existed between the BGN and SMN, BGN and IN, and BGN and DMN (p < .05, corrected). A significant increase in FNC existed between DMN and CN and between CN and SN (p < .05, corrected). CONCLUSION The results showed the large-scale functional reorganization at the network level after PNI. This evidence reveals new implications to the pathophysiological mechanisms in brain plasticity of PNI.
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Affiliation(s)
- Xiang-Xin Xing
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- Department of Traumatology and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Yangzhi Rehabilitation Hospital, Tongji University, Shanghai, China
| | - Mou-Xiong Zheng
- Department of Traumatology and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhen-Zhen Ma
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bei-Bei Huo
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Jia Wu
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shu-Jie Ma
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Ma
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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16
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Wade RG, Tanner SF, Teh I, Ridgway JP, Shelley D, Chaka B, Rankine JJ, Andersson G, Wiberg M, Bourke G. Diffusion Tensor Imaging for Diagnosing Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Proof-of-Concept Study. Front Surg 2020; 7:19. [PMID: 32373625 PMCID: PMC7177010 DOI: 10.3389/fsurg.2020.00019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/23/2020] [Indexed: 01/09/2023] Open
Abstract
Cross-sectional MRI has modest diagnostic accuracy for diagnosing traumatic brachial plexus root avulsions. Consequently, patients either undergo major exploratory surgery or months of surveillance to determine if and what nerve reconstruction is needed. This study aimed to develop a diffusion tensor imaging (DTI) protocol at 3 Tesla to visualize normal roots and identify traumatic root avulsions of the brachial plexus. Seven healthy adults and 12 adults with known (operatively explored) unilateral traumatic brachial plexus root avulsions were scanned. DTI was acquired using a single-shot echo-planar imaging sequence at 3 Tesla. The brachial plexus was visualized by deterministic tractography. Fractional anisotropy (FA) and mean diffusivity (MD) were calculated for injured and avulsed roots in the lateral recesses of the vertebral foramen. Compared to healthy nerves roots, the FA of avulsed nerve roots was lower (mean difference 0.1 [95% CI 0.07, 0.13]; p < 0.001) and the MD was greater (mean difference 0.32 × 10-3 mm2/s [95% CI 0.11, 0.53]; p < 0.001). Deterministic tractography reconstructed both normal roots and root avulsions of the brachial plexus; the negative-predictive value for at least one root avulsion was 100% (95% CI 78, 100). Therefore, DTI might help visualize both normal and injured roots of the brachial plexus aided by tractography. The precision of this technique and how it relates to neural microstructure will be further investigated in a prospective diagnostic accuracy study of patients with acute brachial plexus injuries.
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Affiliation(s)
- Ryckie G. Wade
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Steven F. Tanner
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds, United Kingdom
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Irvin Teh
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - John P. Ridgway
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds, United Kingdom
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - David Shelley
- The Advanced Imaging Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Brian Chaka
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds, United Kingdom
| | - James J. Rankine
- Department of Radiology, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Gustav Andersson
- Department of Integrative Medical Biology (Anatomy), Faculty of Medicine, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Science (Hand and Plastic Surgery), Faculty of Medicine, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Mikael Wiberg
- Department of Integrative Medical Biology (Anatomy), Faculty of Medicine, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Science (Hand and Plastic Surgery), Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Grainne Bourke
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, United Kingdom
- Department of Integrative Medical Biology (Anatomy), Faculty of Medicine, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Science (Hand and Plastic Surgery), Faculty of Medicine, Umeå University, Umeå, Sweden
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17
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Farinas AF, Manzanera Esteve IV, Pollins AC, Cardwell NL, Does MD, Dortch RD, Thayer WP. Diffusion Tensor Tractrography Visualizes Partial Nerve Laceration Severity as Early as 1 Week After Surgical Repair in a Rat Model Ex Vivo. Mil Med 2020; 185:35-41. [PMID: 32074298 PMCID: PMC7029835 DOI: 10.1093/milmed/usz360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Previous studies in our laboratory have demonstrated that a magnetic resonance imaging method called diffusion tensor imaging (DTI) can differentiate between crush and complete transection peripheral nerve injuries in a rat model ex vivo. DTI measures the directionally dependent effect of tissue barriers on the random diffusion of water molecules. In ordered tissues such as nerves, this information can be used to reconstruct the primary direction of diffusion along fiber tracts, which may provide information on fiber tract continuity after nerve injury and surgical repair. METHODS Sprague-Dawley rats were treated with different degrees of partial transection of the sciatic nerve followed by immediate repair and euthanized after 1 week of recovery. Nerves were then harvested, fixed, and scanned with a 7 Tesla magnetic resonance imaging to obtain DTIand fiber tractography in each sample. Additional behavioral (sciatic function index, foot fault asymmetry) and histological (Toluidine blue staining) assessments were performed for validation. RESULTS Tractography yielded a visual representation of the degree of injury that correlated with behavioral and histological evaluations. CONCLUSIONS DTI tractography is a noninvasive tool that can yield a visual representation of a partial nerve transection as early as 1 week after surgical repair.
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Affiliation(s)
- Angel F Farinas
- Department of Plastic Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, MCN D4207, Nashville, TN 37232-2345
| | - Isaac V Manzanera Esteve
- Department Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Ave S, MCN CC-1121, Nashville, TN 37232-2345
- The Department is the Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Vanderbilt University, Institute of Imaging Science, 1161 21st Ave S, MCN AA-1105, Nashville, TN 37232-2345
| | - Alonda C Pollins
- Department of Plastic Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, MCN D4207, Nashville, TN 37232-2345
| | - Nancy L Cardwell
- Department of Plastic Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, MCN D4207, Nashville, TN 37232-2345
| | - Mark D Does
- Department of Biomedical Engineering, Vanderbilt University, 2301 Vanderbilt Place PMB 351631, Nashville, TN 37235-1631
- Department Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Ave S, MCN CC-1121, Nashville, TN 37232-2345
- The Department is the Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Vanderbilt University, Institute of Imaging Science, 1161 21st Ave S, MCN AA-1105, Nashville, TN 37232-2345
| | - Richard D Dortch
- Department of Biomedical Engineering, Vanderbilt University, 2301 Vanderbilt Place PMB 351631, Nashville, TN 37235-1631
- Department Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Ave S, MCN CC-1121, Nashville, TN 37232-2345
- The Department is the Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Vanderbilt University, Institute of Imaging Science, 1161 21st Ave S, MCN AA-1105, Nashville, TN 37232-2345
| | - Wesley P Thayer
- Department of Plastic Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, MCN D4207, Nashville, TN 37232-2345
- Department of Biomedical Engineering, Vanderbilt University, 2301 Vanderbilt Place PMB 351631, Nashville, TN 37235-1631
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18
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Manzanera Esteve IV, Farinas AF, Pollins AC, Nussenbaum ME, Cardwell NL, Kang H, Does MD, Thayer WP, Dortch RD. Probabilistic Assessment of Nerve Regeneration with Diffusion MRI in Rat Models of Peripheral Nerve Trauma. Sci Rep 2019; 9:19686. [PMID: 31873165 PMCID: PMC6928159 DOI: 10.1038/s41598-019-56215-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 12/05/2019] [Indexed: 11/22/2022] Open
Abstract
Nerve regeneration after injury must occur in a timely fashion to restore function. Unfortunately, current methods (e.g., electrophysiology) provide limited information following trauma, resulting in delayed management and suboptimal outcomes. Herein, we evaluated the ability of diffusion MRI to monitor nerve regeneration after injury/repair. Sprague-Dawley rats were divided into three treatment groups (sham = 21, crush = 23, cut/repair = 19) and ex vivo diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) was performed 1-12 weeks post-surgery. Behavioral data showed a distinction between crush and cut/repair nerves at 4 weeks. This was consistent with DTI, which found that thresholds based on the ratio of radial and axial diffusivities (RD/AD = 0.40 ± 0.02) and fractional anisotropy (FA = 0.53 ± 0.01) differentiated crush from cut/repair injuries. By the 12th week, cut/repair nerves whose behavioral data indicated a partial recovery were below the RD/AD threshold (and above the FA threshold), while nerves that did not recover were on the opposite side of each threshold. Additional morphometric analysis indicated that DTI-derived normalized scalar indices report on axon density (RD/AD: r = -0.54, p < 1e-3; FA: r = 0.56, p < 1e-3). Interestingly, higher-order DKI analyses did not improve our ability classify recovery. These findings suggest that DTI may provide promising biomarkers for distinguishing successful/unsuccessful nerve repairs and potentially identify cases that require reoperation.
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Affiliation(s)
- Isaac V Manzanera Esteve
- Vanderbilt University Medical Center, Department Radiology and Radiological Sciences, Nashville, TN, USA
- Vanderbilt University Medical Center, Institute of Imaging Science, Nashville, TN, USA
| | - Angel F Farinas
- Vanderbilt University Medical Center, Department of Plastic Surgery, Nashville, TN, USA
| | - Alonda C Pollins
- Vanderbilt University Medical Center, Department of Plastic Surgery, Nashville, TN, USA
| | - Marlieke E Nussenbaum
- Vanderbilt University Medical Center, Department of Plastic Surgery, Nashville, TN, USA
| | - Nancy L Cardwell
- Vanderbilt University Medical Center, Department of Plastic Surgery, Nashville, TN, USA
| | - Hakmook Kang
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN, USA
| | - Mark D Does
- Vanderbilt University Medical Center, Department Radiology and Radiological Sciences, Nashville, TN, USA
- Vanderbilt University Medical Center, Institute of Imaging Science, Nashville, TN, USA
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN, USA
| | - Wesley P Thayer
- Vanderbilt University Medical Center, Department of Plastic Surgery, Nashville, TN, USA
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN, USA
| | - Richard D Dortch
- Vanderbilt University Medical Center, Department Radiology and Radiological Sciences, Nashville, TN, USA.
- Vanderbilt University Medical Center, Institute of Imaging Science, Nashville, TN, USA.
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN, USA.
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19
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Luzhansky ID, Sudlow LC, Brogan DM, Wood MD, Berezin MY. Imaging in the repair of peripheral nerve injury. Nanomedicine (Lond) 2019; 14:2659-2677. [PMID: 31612779 PMCID: PMC6886568 DOI: 10.2217/nnm-2019-0115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022] Open
Abstract
Surgical intervention followed by physical therapy remains the major way to repair damaged nerves and restore function. Imaging constitutes promising, yet underutilized, approaches to improve surgical and postoperative techniques. Dedicated methods for imaging nerve regeneration will potentially provide surgical guidance, enable recovery monitoring and postrepair intervention, elucidate failure mechanisms and optimize preclinical procedures. Herein, we present an outline of promising innovations in imaging-based tracking of in vivo peripheral nerve regeneration. We emphasize optical imaging because of its cost, versatility, relatively low toxicity and sensitivity. We discuss the use of targeted probes and contrast agents (small molecules and nanoparticles) to facilitate nerve regeneration imaging and the engineering of grafts that could be used to track nerve repair. We also discuss how new imaging methods might overcome the most significant challenges in nerve injury treatment.
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Affiliation(s)
- Igor D Luzhansky
- Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
- The Institute of Materials Science & Engineering, Washington University, St Louis, MO 63130, USA
| | - Leland C Sudlow
- Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - David M Brogan
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Matthew D Wood
- Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Mikhail Y Berezin
- Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
- The Institute of Materials Science & Engineering, Washington University, St Louis, MO 63130, USA
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20
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Chung S, Wang X, Fieremans E, Rath JF, Amorapanth P, Foo FYA, Morton CJ, Novikov DS, Flanagan SR, Lui YW. Altered Relationship between Working Memory and Brain Microstructure after Mild Traumatic Brain Injury. AJNR Am J Neuroradiol 2019; 40:1438-1444. [PMID: 31371359 DOI: 10.3174/ajnr.a6146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/19/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Working memory impairment is one of the most troubling and persistent symptoms after mild traumatic brain injury (MTBI). Here we investigate how working memory deficits relate to detectable WM microstructural injuries to discover robust biomarkers that allow early identification of patients with MTBI at the highest risk of working memory impairment. MATERIALS AND METHODS Multi-shell diffusion MR imaging was performed on a 3T scanner with 5 b-values. Diffusion metrics of fractional anisotropy, diffusivity and kurtosis (mean, radial, axial), and WM tract integrity were calculated. Auditory-verbal working memory was assessed using the Wechsler Adult Intelligence Scale, 4th ed, subtests: 1) Digit Span including Forward, Backward, and Sequencing; and 2) Letter-Number Sequencing. We studied 19 patients with MTBI within 4 weeks of injury and 20 healthy controls. Tract-Based Spatial Statistics and ROI analyses were performed to reveal possible correlations between diffusion metrics and working memory performance, with age and sex as covariates. RESULTS ROI analysis found a significant positive correlation between axial kurtosis and Digit Span Backward in MTBI (Pearson r = 0.69, corrected P = .04), mainly present in the right superior longitudinal fasciculus, which was not observed in healthy controls. Patients with MTBI also appeared to lose the normal associations typically seen in fractional anisotropy and axonal water fraction with Letter-Number Sequencing. Tract-Based Spatial Statistics results also support our findings. CONCLUSIONS Differences between patients with MTBI and healthy controls with regard to the relationship between microstructure measures and working memory performance may relate to known axonal perturbations occurring after injury.
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Affiliation(s)
- S Chung
- From the Center for Advanced Imaging Innovation and Research & Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology (S.C., X.W., E.F., C.J.M., D.S.N., Y.W.L.)
| | - X Wang
- From the Center for Advanced Imaging Innovation and Research & Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology (S.C., X.W., E.F., C.J.M., D.S.N., Y.W.L.)
| | - E Fieremans
- From the Center for Advanced Imaging Innovation and Research & Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology (S.C., X.W., E.F., C.J.M., D.S.N., Y.W.L.)
| | - J F Rath
- Department of Rehabilitation Medicine (J.F.R., P.A., S.R.F.), New York University School of Medicine, New York, New York
| | - P Amorapanth
- Department of Rehabilitation Medicine (J.F.R., P.A., S.R.F.), New York University School of Medicine, New York, New York
| | - F-Y A Foo
- Department of Neurology (F.-Y.A.F.), New York University Langone Health, New York, New York
| | - C J Morton
- From the Center for Advanced Imaging Innovation and Research & Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology (S.C., X.W., E.F., C.J.M., D.S.N., Y.W.L.)
| | - D S Novikov
- From the Center for Advanced Imaging Innovation and Research & Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology (S.C., X.W., E.F., C.J.M., D.S.N., Y.W.L.)
| | - S R Flanagan
- Department of Rehabilitation Medicine (J.F.R., P.A., S.R.F.), New York University School of Medicine, New York, New York
| | - Y W Lui
- From the Center for Advanced Imaging Innovation and Research & Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology (S.C., X.W., E.F., C.J.M., D.S.N., Y.W.L.)
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