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Gaeta M, Galletta K, Cavallaro M, Mormina E, Cannizzaro MT, Lanzafame LRM, D'Angelo T, Blandino A, Vinci SL, Granata F. T1 relaxation: Chemo-physical fundamentals of magnetic resonance imaging and clinical applications. Insights Imaging 2024; 15:200. [PMID: 39120775 PMCID: PMC11315875 DOI: 10.1186/s13244-024-01744-2] [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: 02/24/2024] [Accepted: 06/07/2024] [Indexed: 08/10/2024] Open
Abstract
A knowledge of the complex phenomena that regulate T1 signal on Magnetic Resonance Imaging is essential in clinical practice for a more effective characterization of pathological processes. The authors review the physical basis of T1 Relaxation Time and the fundamental aspects of physics and chemistry that can influence this parameter. The main substances (water, fat, macromolecules, methemoglobin, melanin, Gadolinium, calcium) that influence T1 and the different MRI acquisition techniques that can be applied to enhance their presence in diagnostic images are then evaluated. An extensive case illustration of the different phenomena and techniques in the areas of CNS, abdomino-pelvic, and osteoarticular pathology is also proposed. CRITICAL RELEVANCE STATEMENT: T1 relaxation time is strongly influenced by numerous factors related to tissue characteristics and the presence in the context of the lesions of some specific substances. An examination of these phenomena with extensive MRI exemplification is reported. KEY POINTS: The purpose of the paper is to illustrate the chemical-physical basis of T1 Relaxation Time. MRI methods in accordance with the various clinical indications are listed. Several examples of clinical application in abdominopelvic and CNS pathology are reported.
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Affiliation(s)
- Michele Gaeta
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Karol Galletta
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Marco Cavallaro
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Enricomaria Mormina
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | | | | | - Tommaso D'Angelo
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy.
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD, Rotterdam, The Netherlands.
| | - Alfredo Blandino
- Radiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
| | - Francesca Granata
- Neuroradiology Unit - Biomorf Department, University of Messina, Messina, Italy
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2
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Morrow JM, Shah S, Cristiano L, Evans MRB, Doherty CM, Alnaemi T, Saab A, Emira A, Klickovic U, Hammam A, Altuwaijri A, Wastling S, Reilly MM, Hanna MG, Yousry TA, Thornton JS. Development of an initial training and evaluation programme for manual lower limb muscle MRI segmentation. Eur Radiol Exp 2024; 8:85. [PMID: 39060637 PMCID: PMC11282017 DOI: 10.1186/s41747-024-00475-9] [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: 01/08/2024] [Accepted: 04/26/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) quantification of intramuscular fat accumulation is a responsive biomarker in neuromuscular diseases. Despite emergence of automated methods, manual muscle segmentation remains an essential foundation. We aimed to develop a training programme for new observers to demonstrate competence in lower limb muscle segmentation and establish reliability benchmarks for future human observers and machine learning segmentation packages. METHODS The learning phase of the training programme comprised a training manual, direct instruction, and eight lower limb MRI scans with reference standard large and small regions of interest (ROIs). The assessment phase used test-retest scans from two patients and two healthy controls. Interscan and interobserver reliability metrics were calculated to identify underperforming outliers and to determine competency benchmarks. RESULTS Three experienced observers undertook the assessment phase, whilst eight new observers completed the full training programme. Two of the new observers were identified as underperforming outliers, relating to variation in size or consistency of segmentations; six had interscan and interobserver reliability equivalent to those of experienced observers. The calculated benchmark for the Sørensen-Dice similarity coefficient between observers was greater than 0.87 and 0.92 for individual thigh and calf muscles, respectively. Interscan and interobserver reliability were significantly higher for large than small ROIs (all p < 0.001). CONCLUSIONS We developed, implemented, and analysed the first formal training programme for manual lower limb muscle segmentation. Large ROI showed superior reliability to small ROI for fat fraction assessment. RELEVANCE STATEMENT Observers competent in lower limb muscle segmentation are critical to application of quantitative muscle MRI biomarkers in neuromuscular diseases. This study has established competency benchmarks for future human observers or automated segmentation methods. KEY POINTS • Observers competent in muscle segmentation are critical for quantitative muscle MRI biomarkers. • A training programme for muscle segmentation was undertaken by eight new observers. • We established competency benchmarks for future human observers or automated segmentation methods.
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Affiliation(s)
- Jasper M Morrow
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UCLH, London, WC1N 3BG, UK
| | - Sachit Shah
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, UCLH, London, UK
| | - Lara Cristiano
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK
- Department of Radiology and Pediatric Neurology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matthew R B Evans
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology, London, UK
| | - Carolynne M Doherty
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology, London, UK
| | - Talal Alnaemi
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK
| | - Abeer Saab
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK
| | - Ahmed Emira
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK
| | - Uros Klickovic
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology, London, UK
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ahmed Hammam
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK
| | - Afnan Altuwaijri
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK
| | - Stephen Wastling
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, UCLH, London, UK
| | - Mary M Reilly
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UCLH, London, WC1N 3BG, UK
| | - Michael G Hanna
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UCLH, London, WC1N 3BG, UK
| | - Tarek A Yousry
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, UCLH, London, UK.
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK.
| | - John S Thornton
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, UCLH, London, UK
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, UK
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3
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Ricci G, Govoni A, Torri F, Astrea G, Buchignani B, Marinella G, Battini R, Manca ML, Castiglione V, Giannoni A, Emdin M, Siciliano G. Characterization of Phenotypic Variability in Becker Muscular Dystrophy for Clinical Practice and Towards Trial Readiness: A Two-Years Follow up Study. J Neuromuscul Dis 2024; 11:375-387. [PMID: 38189759 DOI: 10.3233/jnd-221513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Becker muscular dystrophy (BMD) is a dystrophinopathy due to in-frame mutations in the dystrophin gene (DMD) which determines a reduction of dystrophin at muscle level. BMD has a wide spectrum of clinical variability with different degrees of disability. Studies of natural history are needed also in view of up-coming clinical trials. Objectives From an initial cohort of 32 BMD adult subjects, we present a detailed phenotypic characterization of 28 patients, then providing a description of their clinical natural history over the course of 12 months for 18 and 24 months for 13 of them. Methods Each patient has been genetically characterized. Baseline, and 1-year and 2 years assessments included North Star Ambulatory Assessment (NSAA), timed function tests (time to climb and descend four stairs), 6-minute walk test (6MWT), Walton and Gardner-Medwin Scale and Medical Research Council (MRC) scale. Muscle magnetic resonance imaging (MRI) was acquired at baseline and in a subgroup of 9 patients after 24 months. Data on cardiac function (electrocardiogram, echocardiogram, and cardiac MRI) were also collected. Results and conclusions Among the clinical heterogeneity, a more severe involvement is often observed in patients with 45-X del, with a disease progression over two years. The 6MWT appears sensitive to detect modification from baseline during follow up while no variation was observed by MRC testing. Muscle MRI of the lower limbs correlates with clinical parameters.Our study further highlights how the phenotypic variability of BMD adult patients makes it difficult to describe an uniform course and substantiates the need to identify predictive parameters and biomarkers to stratify patients.
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Affiliation(s)
- Giulia Ricci
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Alessandra Govoni
- Neuromuscular and Rare Disease Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Francesca Torri
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Guja Astrea
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone, Pisa, Italy
| | - Bianca Buchignani
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone, Pisa, Italy
- Department of Translational Research and of New Surgical and Medical Technologies Pisa University, Pisa, Italy
| | - Gemma Marinella
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone, Pisa, Italy
| | - Roberta Battini
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
- Department of Developmental Neuroscience, IRCCS Stella Maris, Calambrone, Pisa, Italy
| | - Maria Laura Manca
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
- Department of Mathematics, University of Pisa, Pisa, Italy
| | - Vincenzo Castiglione
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Alberto Giannoni
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Emdin
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
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4
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Wang F, Fang S, Li J, Yuan L, Hou B, Zhu J, Jiao Y, Liu Z, Qian M, Santini F, Wang Q, Chen L, Feng F. Correlation analysis of quantitative MRI measurements of thigh muscles with histopathology in patients with idiopathic inflammatory myopathy. Eur Radiol Exp 2023; 7:51. [PMID: 37589922 PMCID: PMC10435435 DOI: 10.1186/s41747-023-00350-z] [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: 01/01/2023] [Accepted: 04/29/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES To validate the correlation between histopathological findings and quantitative magnetic resonance imaging (qMRI) fat fraction (FF) and water T2 mapping in patients with idiopathic inflammatory myopathy (IIM). METHODS The study included 13 patients with histopathologically confirmed IIM who underwent dedicated thigh qMRI scanning within 1 month before open muscle biopsy. For the biopsied muscles, FF derived from the iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation (IDEAL-IQ) and T2 time from T2 mapping with chemical shift selective fat saturation were measured using a machine learning software. Individual histochemical and immunohistochemical slides were evaluated using a 5-point Likert score. Inter-reader agreement and the correlation between qMRI markers and histopathological scores were analyzed. RESULTS Readers showed good to perfect agreement in qMRI measurements and most histopathological scores. FF of the biopsied muscles was positively correlated with the amount of fat in histopathological slides (p = 0.031). Prolonged T2 time was associated with the degree of variation in myofiber size, inflammatory cell infiltration, and amount of connective tissues (p ≤ 0.008 for all). CONCLUSIONS Using the machine learning-based muscle segmentation method, a positive correlation was confirmed between qMRI biomarkers and histopathological findings of patients with IIM. This finding provides a basis for using qMRI as a non-invasive tool in the diagnostic workflow of IIM. RELEVANCE STATEMENT By using ML-based muscle segmentation, a correlation between qMRI biomarkers and histopathology was found in patients with IIM: qMRI is a potential non-invasive tool in this clinical setting. KEY POINTS • Quantitative magnetic resonance imaging measurements using machine learning-based muscle segmentation have good consistency and reproductivity. • Fat fraction of idiopathic inflammatory myopathy (IIM) correlated with the amount of fat at histopathology. • Prolonged T2 time was associated with muscle inflammation in IIM.
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Affiliation(s)
- Fengdan Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Shiyuan Fang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ling Yuan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Yang Jiao
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Qian
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Francesco Santini
- Department of Research and Analytic Services, University Hospital Basel, Basel, Switzerland.
- Radiological Physics, University Hospital Basel, Basel, Switzerland.
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.
| | - Qian Wang
- Department of Rheumatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Chen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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5
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Zubair AS, Salam S, Dimachkie MM, Machado PM, Roy B. Imaging biomarkers in the idiopathic inflammatory myopathies. Front Neurol 2023; 14:1146015. [PMID: 37181575 PMCID: PMC10166883 DOI: 10.3389/fneur.2023.1146015] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Idiopathic inflammatory myopathies (IIMs) are a group of acquired muscle diseases with muscle inflammation, weakness, and other extra-muscular manifestations. IIMs can significantly impact the quality of life, and management of IIMs often requires a multi-disciplinary approach. Imaging biomarkers have become an integral part of the management of IIMs. Magnetic resonance imaging (MRI), muscle ultrasound, electrical impedance myography (EIM), and positron emission tomography (PET) are the most widely used imaging technologies in IIMs. They can help make the diagnosis and assess the burden of muscle damage and treatment response. MRI is the most widely used imaging biomarker of IIMs and can assess a large volume of muscle tissue but is limited by availability and cost. Muscle ultrasound and EIM are easy to administer and can even be performed in the clinical setting, but they need further validation. These technologies may complement muscle strength testing and laboratory studies and provide an objective assessment of muscle health in IIMs. Furthermore, this is a rapidly progressing field, and new advances are going to equip care providers with a better objective assessment of IIMS and eventually improve patient management. This review discusses the current state and future direction of imaging biomarkers in IIMs.
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Affiliation(s)
- Adeel S. Zubair
- Division of Neuromuscular Diseases, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Sharfaraz Salam
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Mazen M. Dimachkie
- Department of Neurology, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Pedro M. Machado
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Centre for Rheumatology, Division of Medicine, University College London, London, United Kingdom
| | - Bhaskar Roy
- Division of Neuromuscular Diseases, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
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Abstract
ABSTRACT This review summarizes the existing techniques and methods used to generate synthetic contrasts from magnetic resonance imaging data focusing on musculoskeletal magnetic resonance imaging. To that end, the different approaches were categorized into 3 different methodological groups: mathematical image transformation, physics-based, and data-driven approaches. Each group is characterized, followed by examples and a brief overview of their clinical validation, if present. Finally, we will discuss the advantages, disadvantages, and caveats of synthetic contrasts, focusing on the preservation of image information, validation, and aspects of the clinical workflow.
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7
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Gaeta M, Cavallaro M, Vinci SL, Mormina E, Blandino A, Marino MA, Granata F, Tessitore A, Galletta K, D'Angelo T, Visalli C. Magnetism of materials: theory and practice in magnetic resonance imaging. Insights Imaging 2021; 12:179. [PMID: 34862955 PMCID: PMC8643382 DOI: 10.1186/s13244-021-01125-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/08/2021] [Indexed: 02/03/2023] Open
Abstract
All substances exert magnetic properties in some extent when placed in an external magnetic field. Magnetic susceptibility represents a measure of the magnitude of magnetization of a certain substance when the external magnetic field is applied. Depending on the tendency to be repelled or attracted by the magnetic field and in the latter case on the magnitude of this effect, materials can be classified as diamagnetic or paramagnetic, superparamagnetic and ferromagnetic, respectively. Knowledge of type and extent of susceptibility of common endogenous and exogenous substances and how their magnetic properties affect the conventional sequences used in magnetic resonance imaging (MRI) can help recognize them and exalt or minimize their presence in the acquired images, so as to improve diagnosis in a wide variety of benign and malignant diseases. Furthermore, in the context of diamagnetic susceptibility, chemical shift imaging enables to assess the intra-voxel ratio between water and fat content, analyzing the tissue composition of various organs and allowing a precise fat quantification. The following article reviews the fundamental physical principles of magnetic susceptibility and examines the magnetic properties of the principal endogenous and exogenous substances of interest in MRI, providing potential through representative cases for improved diagnosis in daily clinical routine.
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Affiliation(s)
- Michele Gaeta
- Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Marco Cavallaro
- Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Sergio Lucio Vinci
- Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Enricomaria Mormina
- Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Maria Adele Marino
- Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Francesca Granata
- Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Agostino Tessitore
- Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Karol Galletta
- Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Carmela Visalli
- Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
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8
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Hodges PW, Bailey JF, Fortin M, Battié MC. Paraspinal muscle imaging measurements for common spinal disorders: review and consensus-based recommendations from the ISSLS degenerative spinal phenotypes group. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3428-3441. [PMID: 34542672 DOI: 10.1007/s00586-021-06990-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 09/05/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Paraspinal muscle imaging is of growing interest related to improved phenotyping, prognosis, and treatment of common spinal disorders. We reviewed issues related to paraspinal muscle imaging measurement that contribute to inconsistent findings between studies and impede understanding. METHODS Three key contributors to inconsistencies among studies of paraspinal muscle imaging measurements were reviewed: failure to consider possible mechanisms underlying changes in paraspinal muscles, lack of control of confounding factors, and variations in spinal muscle imaging modalities and measurement protocols. Recommendations are provided to address these issues to improve the quality and coherence of future research. RESULTS Possible pathophysiological responses of paraspinal muscle to various common spinal disorders in acute or chronic phases are often overlooked, yet have important implications for the timing, distribution, and nature of changes in paraspinal muscle. These considerations, as well as adjustment for possible confounding factors, such as sex, age, and physical activity must be considered when planning and interpreting paraspinal muscle measurements in studies of spinal conditions. Adoption of standardised imaging measurement protocols for paraspinal muscle morphology and composition, considering the strengths and limitations of various imaging modalities, is critically important to interpretation and synthesis of research. CONCLUSION Study designs that consider physiological and pathophysiological responses of muscle, adjust for possible confounding factors, and use common, standardised measures are needed to advance knowledge of the determinants of variations or changes in paraspinal muscle and their influence on spinal health.
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Affiliation(s)
- Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Jeannie F Bailey
- Department of Orthopedic Surgery, University of California, San Francisco, CA, USA
| | - Maryse Fortin
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Michele C Battié
- Faculty of Health Sciences and Western's Bone and Joint Institute, Western University, London, ON, Canada
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9
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Marunowski K, Świętoń D, Bzyl W, Grzywińska M, Kaszubowski M, Bandosz P, Khrichenko D, Piskunowicz M. MRI-Derived Subcutaneous and Visceral Adipose Tissue Reference Values for Children Aged 6 to Under 18 Years. Front Nutr 2021; 8:757274. [PMID: 34660672 PMCID: PMC8517194 DOI: 10.3389/fnut.2021.757274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/03/2021] [Indexed: 11/20/2022] Open
Abstract
The assessment of body composition in pediatric population is essential for proper nutritional support during hospitalization. However, currently available methods have limitations. This study aims to propose a novel approach for nutrition status assessment and introduce magnetic resonance imaging (MRI)-derived subcutaneous and visceral fat normative reference values. A total of 262 healthy subjects aged from 6 to 18 years underwent MRI examinations and anthropometric measurements. MRI images at the second lumbar vertebrae were used by two radiologists to perform the semi-automatic tissue segmentation. Based on obtained adipose tissue surface areas and body mass index (BMI) scores sex-specific standard percentile curves (3rd, 10th, 25th, 50th, 75th, 90th, 97th) and z-scores were constructed using LMS method. Additionally, 85th and 95th centiles of subcutaneous and visceral adipose tissue were proposed as equivalents of overweight and obesity. Bland-Altman plots revealed an excellent intra-observer reproducibility and inter-observer agreement. In conclusion, our findings demonstrate highly reproducible method and suggest that MRI-derived reference values can be implemented in clinical practice.
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Affiliation(s)
- Kacper Marunowski
- Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Dominik Świętoń
- Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Włodzimierz Bzyl
- Faculty of Mathematics, Physics and Informatics, University of Gdańsk, Gdańsk, Poland
| | | | - Mariusz Kaszubowski
- Department of Economic Sciences, Faculty of Management and Economics, Institute of Statistics, Gdansk University of Technology, Gdańsk, Poland
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
- Department of Prevention and Medical Education, Medical University of Gdańsk, Gdańsk, Poland
| | - Dmitry Khrichenko
- Division of Body Imaging, Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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10
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Beale CC, Secrest SA. MRI assessment of epaxial myosteatosis in dogs with intervertebral disc extrusions and associations with patient factors and outcome. Vet Radiol Ultrasound 2021; 62:687-696. [PMID: 34510632 DOI: 10.1111/vru.13019] [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: 01/26/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022] Open
Abstract
Fat infiltration of skeletal muscle (myosteatosis) is a characteristic of reduced muscle quality. Objectives of this retrospective, observer agreement, methods comparison, cross-sectional study were to compare epaxial myosteatosis of dogs with surgically confirmed intervertebral disc extrusion (IVDE) using a visual semi-quantitative method and quantitative 2-point Dixon fat-water chemical-shift separation MRI method. Thoracolumbar MRI studies of 86 dogs were reviewed. Assessed locations were the site of extrusion and the adjacent intervertebral disc space immediately cranial. A visual fat score (VFS) was assigned to fat infiltration of the epaxial muscles. Quantitative assessment of fat infiltration was determined by calculating a muscle-fat fraction (MFF). There was moderate agreement between the two reviewers for VFS assessment (weighted Kappa 0.60, 95%CI 0.53-0.66) with moderate to strong correlation between scoring methods (P ≤ .001). Both VFS (P = .023, P = .02) and MFF (P = .041, P = .043) were significantly correlated with neurologic grade at presentation for the erector spinae muscle group at both sites. Higher VFS in the multifidus muscle increased the odds of a successful outcome when assessed at the extrusion site (odds ratio and 95%CI 4.3 (1.02-78.7), P = .0461). In summary, the visual and Dixon method of epaxial muscle-fat assessment are feasible in dogs with IVDE with moderate to strong correlation. Increased VFS of myosteatosis in the multifidus muscle at the extrusion site significantly increased the odds of a successful outcome. Further studies are indicated to assess the utility of myosteatosis as an MRI imaging biomarker in the preoperative imaging assessment of dogs with IVDE.
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Affiliation(s)
- Chelsea C Beale
- Department of Veterinary Biosciences and Diagnostic Imaging, College of Veterinary Medicine, Athens, Georgia, USA
| | - Scott A Secrest
- Department of Veterinary Biosciences and Diagnostic Imaging, College of Veterinary Medicine, Athens, Georgia, USA
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11
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Pacicco T, Ratner S, Xi Y, Yokoo T, Fetzer D, Oz OK, Rubin CD, Chhabra A. Pelvic muscle size and myosteatosis: Relationship with age, gender, and obesity. Indian J Radiol Imaging 2021; 29:155-162. [PMID: 31367086 PMCID: PMC6639865 DOI: 10.4103/ijri.ijri_414_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate interreader performance in the measurement of the cross-sectional area and myosteatosis of pelvic skeletal muscles using fat quantification magnetic resonance imaging (MRI) and correlate with patient anthropomorphic characteristics. Materials and Methods A Health Insurance Portability and Accountability Act-compliant retrospective cross-sectional study was performed. Between January and April 2016, 61 patients (26 males and 35 females) underwent a lumbosacral plexus 3T MRI with a modified three-dimensional spoiled gradient echo sequence dedicated to fat quantification (mDixon Quant; Philips Healthcare). Two independent reviewers outlined muscle cross-sectional area on axial images using a freehand region of interest tool and documented proton-density fat fraction (FF) and muscle area (cm2) of the psoas, gluteus medius, gluteus maximus, and rectus femoris muscles on each side. Interreader agreement was assessed by intraclass correlation coefficient (ICC), and correlation between the measurements and subject's age, gender, and body mass index (BMI) was assessed using multiple linear regression analysis. Results Excellent interreader agreement was obtained (ICC ≥0.74) for all muscle groups except for the left gluteus medius area and right psoas FF which showed good agreement (0.65 and 0.61, respectively). Statistically significant (P ≤ 0.05) positive correlation was seen between the gluteal muscle FF and area with BMI, and rectus muscle FF with age and BMI. Statistically significant negative correlation between the rectus femoris area and age was also observed. Conclusion Fat quantification MRI is a highly reproducible imaging technique for the assessment of myosteatosis and muscle size. Intramuscular FF and cross-sectional area were correlated with age and BMI across multiple muscle groups.
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Affiliation(s)
- Thomas Pacicco
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shayna Ratner
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yin Xi
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Takeshi Yokoo
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA.,Advanced Imaging Research Center, UT Southwestern School of Medicine, Dallas, TX, USA
| | - David Fetzer
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Orhan K Oz
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Craig D Rubin
- Geriatric Division, Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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12
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Sheikh AM, Rudolf K, de Stricker Borch J, Khawajazada T, Witting N, Vissing J. Patients With Becker Muscular Dystrophy Have Severe Paraspinal Muscle Involvement. Front Neurol 2021; 12:613483. [PMID: 34093388 PMCID: PMC8177107 DOI: 10.3389/fneur.2021.613483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 04/27/2021] [Indexed: 01/26/2023] Open
Abstract
Introduction: Paraspinal muscles are important for gross motor functions. Impairment of these muscles can lead to poor postural control and ambulation difficulty. Little knowledge exists about the involvement of paraspinal muscles in Becker muscular dystrophy. Objective: In this cross-sectional study, we investigated the involvement of paraspinal muscles with quantitative trunk strength measure and quantitative muscle MRI. Methods and Materials: Eighteen patients with Becker muscular dystrophy underwent trunk, hip, and thigh strength assessment using a Biodex dynamometer and an MRI Dixon scan. Fourteen age- and body mass index-matched healthy men were included for comparison. Results: Muscle fat fraction (FF) of the paraspinal muscles (multifidus and erector spinae) was higher in participants with Becker muscular dystrophy vs. healthy controls at all three examined spinal levels (C6, Th12, and L4/L5) (p < 0.05). There was a strong and inverse correlation between paraspinal muscle FF and trunk extension strength (ρ = −0.829, p < 0.001), gluteus maximus FF and hip extension strength (ρ = −0.701, p = 0.005), FF of the knee extensor muscles (quadriceps and sartorius) and knee extension strength (ρ = −0.842, p < 0.001), and FF of the knee flexor muscles (hamstring muscles) and knee flexion strength (ρ = −0.864, p < 0.001). Fat fraction of the paraspinal muscles also correlated with muscle FF of the thigh muscles and lower leg muscles. Conclusion: In conclusion, patients with Becker muscular dystrophy demonstrate severe paraspinal muscular involvement indicated by low back extension strength and high levels of fat replacement, which parallel involvement of lower limb muscles. Assessment of paraspinal muscle strength and fat replacement may serve as a possible biomarker for both the clinical management and further study of the disease.
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Affiliation(s)
- Aisha M Sheikh
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Karen Rudolf
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Josefine de Stricker Borch
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tahmina Khawajazada
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Witting
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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13
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De Munck TJI, Verhaegh P, Lodewick T, Bakers F, Jonkers D, Masclee AAM, Verbeek J, Koek GH. Myosteatosis in nonalcoholic fatty liver disease: An exploratory study. Clin Res Hepatol Gastroenterol 2021; 45:101500. [PMID: 32828745 DOI: 10.1016/j.clinre.2020.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/22/2020] [Accepted: 06/19/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Insulin resistance (IR) plays a central role in the complex pathophysiology of nonalcoholic fatty liver disease (NAFLD). IR is linked to fat infiltration in skeletal muscle (myosteatosis) and loss of skeletal muscle mass and function (sarcopenia). The clinical significance of myosteatosis in NAFLD is not well investigated. In this exploratory study we aimed to investigate the association between myosteatosis and NAFLD related hepatic and systemic variables in a well characterized NAFLD cohort. METHODS We cross-sectionally studied forty-five NAFLD patients. The muscle fat fraction (MFF) was measured with chemical shift gradient echo MRI. In addition, the hepatic fat fraction (MRI), liver stiffness (FibroScan) and appendicular skeletal muscle mass (Dual-energy X-ray absorptiometry) were analyzed. RESULTS The median hepatic fat fraction was 15.64% (IQR 12.05-25.13) and significant (F2-F3) liver fibrosis (liver stiffness ≥7kPa) was diagnosed in 18 NAFLD patients (40%). MFF was not correlated with hepatic fat fraction (r=-0.035, P=0.823) and did not differ between subjects with or without significant fibrosis (P=0.980). No patient was diagnosed with sarcopenia based on the skeletal muscle mass index. In a linear regression model, anthropometric parameters, including body mass index (BMI) (P=0.018) and total body fat percentage (P=0.005), were positively associated with MFF while no association with insulin resistance (HOMA-IR) was observed. CONCLUSION Myosteatosis did not correlate with the degree of hepatic steatosis or fibrosis in this well characterized NAFLD cohort, but was positively correlated with total body fat percentage and BMI.
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Affiliation(s)
- Toon J I De Munck
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
| | - Pauline Verhaegh
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Toine Lodewick
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Frans Bakers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Daisy Jonkers
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Ad A M Masclee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Jef Verbeek
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; Department of Gastroenterology and Hepatology and Metabolic Centre, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Ger H Koek
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Department of Visceral and Transplantation Surgery, Klinikum, RWTH, Pauwelsstraße 30, 52074 Aachen, Germany
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14
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Farrow M, Biglands J, Tanner S, Hensor EMA, Buch MH, Emery P, Tan AL. Muscle deterioration due to rheumatoid arthritis: assessment by quantitative MRI and strength testing. Rheumatology (Oxford) 2021; 60:1216-1225. [PMID: 32910153 PMCID: PMC7937015 DOI: 10.1093/rheumatology/keaa364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/22/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES RA patients often present with low muscle mass and decreased strength. Quantitative MRI offers a non-invasive measurement of muscle status. This study assessed whether MRI-based measurements of T2, fat fraction, diffusion tensor imaging and muscle volume can detect differences between the thigh muscles of RA patients and healthy controls, and assessed the muscle phenotype of different disease stages. METHODS Thirty-nine RA patients (13 'new RA'-newly diagnosed, treatment naïve, 13 'active RA'-persistent DAS28 >3.2 for >1 year, 13 'remission RA'-persistent DAS28 <2.6 for >1 year) and 13 age and gender directly matched healthy controls had an MRI scan of their dominant thigh. All participants had knee extension and flexion torque and grip strength measured. RESULTS MRI T2 and fat fraction were higher in the three groups of RA patients compared with healthy controls in the thigh muscles. There were no clinically meaningful differences in the mean diffusivity. The muscle volume, handgrip strength, knee extension and flexion were lower in all three groups of RA patients compared with healthy controls. CONCLUSION Quantitative MRI and muscle strength measurements can potentially detect differences within the muscles between RA patients and healthy controls. These differences may be seen in RA patients who are yet to start treatment, those with persistent active disease, and those who were in clinical remission. This suggests that the muscles in RA patients are affected in the early stages of the disease and that signs of muscle pathology and muscle weakness are still observed in clinical remission.
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Affiliation(s)
- Matthew Farrow
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - John Biglands
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Steven Tanner
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Elizabeth M A Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ai Lyn Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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15
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Farrow M, Biglands J, Alfuraih AM, Wakefield RJ, Tan AL. Novel Muscle Imaging in Inflammatory Rheumatic Diseases-A Focus on Ultrasound Shear Wave Elastography and Quantitative MRI. Front Med (Lausanne) 2020; 7:434. [PMID: 32903395 PMCID: PMC7434835 DOI: 10.3389/fmed.2020.00434] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/06/2020] [Indexed: 12/31/2022] Open
Abstract
In recent years, imaging has played an increasing role in the clinical management of patients with rheumatic diseases with respect to aiding diagnosis, guiding therapy and monitoring disease progression. These roles have been underpinned by research which has enhanced our understanding of disease pathogenesis and pathophysiology of rheumatology conditions, in addition to their key role in outcome measurement in clinical trials. However, compared to joints, imaging research of muscles is less established, despite the fact that muscle symptoms are very common and debilitating in many rheumatic diseases. Recently, it has been shown that even though patients with rheumatoid arthritis may achieve clinical remission, defined by asymptomatic joints, many remain affected by lingering constitutional systemic symptoms like fatigue, tiredness, weakness and myalgia, which may be attributed to changes in the muscles. Recent improvements in imaging technology, coupled with an increasing clinical interest, has started to ignite new interest in the area. This perspective discusses the rationale for using imaging, particularly ultrasound and MRI, for investigating muscle pathology involved in common inflammatory rheumatic diseases. The muscles associated with rheumatic diseases can be affected in many ways, including myositis-an inflammatory muscle condition, and myopathy secondary to medications, such as glucocorticoids. In addition to non-invasive visual assessment of muscles in these conditions, novel imaging techniques like shear wave elastography and quantitative MRI can provide further useful information regarding the physiological and biomechanical status of the muscle.
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Affiliation(s)
- Matthew Farrow
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, United Kingdom.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,School of Pharmacy and Medical Sciences, University of Bradford, Bradford, United Kingdom
| | - John Biglands
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Abdulrahman M Alfuraih
- Radiology and Medical Imaging Department, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, United Kingdom.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Ai Lyn Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, United Kingdom.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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16
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DiLiberto FE, Nawoczenski DA, Tome J, Tan RK, DiGiovanni BF. Changes in Muscle Morphology Following Gastrocnemius Recession for Achilles Tendinopathy: A Prospective Cohort Imaging Study. Foot Ankle Spec 2020; 13:297-305. [PMID: 31230471 DOI: 10.1177/1938640019857805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The purpose of this study was to evaluate changes in posterior compartment muscle volume and intramuscular fat content following gastrocnemius recession in people with Achilles tendinopathy (AT). Methods. Eight patients diagnosed with unilateral recalcitrant AT and an isolated gastrocnemius contracture participated in this prospective cohort study. Magnetic resonance imaging was performed on both limbs of each participant before and 6 months following an isolated gastrocnemius recession. Involved limb muscle volumes and fat fractions (FFs) of the medial gastrocnemius, lateral gastrocnemius, and soleus muscle were normalized to the uninvolved limb. Preoperative to postoperative comparisons were made with Wilcoxon signed-rank tests. Results. Soleus or lateral gastrocnemius muscle volumes or FFs were not significantly different between study time points. A significant difference was found in medial gastrocnemius muscle volume (decrease; P = .012) and FF (increase; P = .017). Conclusion. A major goal of the Strayer gastrocnemius recession, selective lengthening of the posterior compartment while preserving soleus muscle morphology, was supported. The observed changes isolated to the medial gastrocnemius muscle may reduce ankle plantarflexion torque capacity. Study findings may help inform selection of surgical candidates, refine anticipated outcomes, and better direct postoperative rehabilitation following gastrocnemius recession for AT.Levels of Evidence: Level IV: Prospective cohort study.
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Affiliation(s)
- Frank E DiLiberto
- Department of Physical Therapy, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois (FED).,Department of Orthopaedics, School of Medicine and Dentistry, University of Rochester, University of Rochester Medical Center, Rochester, New York (DAN, BFD).,School of Health Science and Human Performance, Movement Analysis Laboratory, Ithaca College, Ithaca, New York (JT).,Department of Imaging Sciences, University of Rochester Medical Center, Highland Hospital, Rochester, New York (RKT)
| | - Deborah A Nawoczenski
- Department of Physical Therapy, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois (FED).,Department of Orthopaedics, School of Medicine and Dentistry, University of Rochester, University of Rochester Medical Center, Rochester, New York (DAN, BFD).,School of Health Science and Human Performance, Movement Analysis Laboratory, Ithaca College, Ithaca, New York (JT).,Department of Imaging Sciences, University of Rochester Medical Center, Highland Hospital, Rochester, New York (RKT)
| | - Josh Tome
- Department of Physical Therapy, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois (FED).,Department of Orthopaedics, School of Medicine and Dentistry, University of Rochester, University of Rochester Medical Center, Rochester, New York (DAN, BFD).,School of Health Science and Human Performance, Movement Analysis Laboratory, Ithaca College, Ithaca, New York (JT).,Department of Imaging Sciences, University of Rochester Medical Center, Highland Hospital, Rochester, New York (RKT)
| | - Raymond K Tan
- Department of Physical Therapy, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois (FED).,Department of Orthopaedics, School of Medicine and Dentistry, University of Rochester, University of Rochester Medical Center, Rochester, New York (DAN, BFD).,School of Health Science and Human Performance, Movement Analysis Laboratory, Ithaca College, Ithaca, New York (JT).,Department of Imaging Sciences, University of Rochester Medical Center, Highland Hospital, Rochester, New York (RKT)
| | - Benedict F DiGiovanni
- Department of Physical Therapy, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois (FED).,Department of Orthopaedics, School of Medicine and Dentistry, University of Rochester, University of Rochester Medical Center, Rochester, New York (DAN, BFD).,School of Health Science and Human Performance, Movement Analysis Laboratory, Ithaca College, Ithaca, New York (JT).,Department of Imaging Sciences, University of Rochester Medical Center, Highland Hospital, Rochester, New York (RKT)
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17
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Senesac CR, Barnard AM, Lott DJ, Nair KS, Harrington AT, Willcocks RJ, Zilke KL, Rooney WD, Walter GA, Vandenborne K. Magnetic Resonance Imaging Studies in Duchenne Muscular Dystrophy: Linking Findings to the Physical Therapy Clinic. Phys Ther 2020; 100:2035-2048. [PMID: 32737968 PMCID: PMC7596892 DOI: 10.1093/ptj/pzaa140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 12/31/2022]
Abstract
Duchenne muscular dystrophy (DMD) is a muscle degenerative disorder that manifests in early childhood and results in progressive muscle weakness. Physical therapists have long been an important component of the multidisciplinary team caring for people with DMD, providing expertise in areas of disease assessment, contracture management, assistive device prescription, and exercise prescription. Over the last decade, magnetic resonance imaging of muscles in people with DMD has led to an improved understanding of the muscle pathology underlying the clinical manifestations of DMD. Findings from magnetic resonance imaging (MRI) studies in DMD, paired with the clinical expertise of physical therapists, can help guide research that leads to improved physical therapist care for this unique patient population. The 2 main goals of this perspective article are to (1) summarize muscle pathology and disease progression findings from qualitative and quantitative muscle MRI studies in DMD and (2) link MRI findings of muscle pathology to the clinical manifestations observed by physical therapists with discussion of any potential implications of MRI findings on physical therapy management.
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Affiliation(s)
| | | | | | - Kavya S Nair
- Department of Physical Therapy, University of Florida
| | - Ann T Harrington
- Center for Rehabilitation, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania
| | | | - Kirsten L Zilke
- Oregon Health & Science University, Shriners Hospitals for Children, Portland, Oregon
| | - William D Rooney
- Advanced Imaging Research Center, Oregon Health & Science University
| | - Glenn A Walter
- Department of Physiology and Functional Genomics, University of Florida
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18
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Maggi L, Moscatelli M, Frangiamore R, Mazzi F, Verri M, De Luca A, Pasanisi MB, Baranello G, Tramacere I, Chiapparini L, Bruzzone MG, Mantegazza R, Aquino D. Quantitative Muscle MRI Protocol as Possible Biomarker in Becker Muscular Dystrophy. Clin Neuroradiol 2020; 31:257-266. [PMID: 31974637 DOI: 10.1007/s00062-019-00875-0] [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: 08/02/2019] [Accepted: 12/30/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Aim of this study is to compare Quantitative Magnetic Resonance Imaging (qMRI) measures between Becker Muscular Dystrophy (BMD) and Healthy Subjects (HS) and to correlate these parameters with clinical scores. METHODS Ten BMD patients (mean age ±standard deviation: 38.7 ± 15.0 years) and ten age-matched HS, were investigated through magnetic resonance imaging (MRI) at thigh and calf levels, including: 1) a standard axial T1-weighted sequence; 2) a volumetric T2-weighted sequence; 3) a multiecho spin-echo sequence; 4) a 2-point Dixon sequence; 5) a Diffusion Tensor Imaging (DTI) sequence. RESULTS Mean Fat Fraction (FF), T2-relaxation time and Fractional Anisotropy (FA) DTI at thigh and calf levels were significantly higher in BMD patients than in HS (p-values < 0.01). FF at thigh and calf levels significantly correlated with North Star Ambulatory Assessment (NSAA) score (p-values < 0.01) and6 Minutes Walking Test (6MWT) (p-values < 0.01), whereas only calf muscle FF was significantly associated with time to get up from floor (p-value = 0.01). T2 significantly correlated with NSAA score (p-value < 0.01), 6MWT (p-value = 0.02) and time to get up from floor (p-value < 0.01) only at calf level. Among DTI values, only FA in thigh and calf muscles significantly correlated with NSAA score, 6MWT and 10-m walk (all p-values < 0.05); only FA in calf muscles significantly correlated with time to get up from floor (p = 0.01). CONCLUSIONS Muscle FF, T2-relaxometry and DTI, seem to be a promising biomarker to assess BMD disease severity, although further studies are needed to evaluate changes over the time.
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Affiliation(s)
- Lorenzo Maggi
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. .,Neurology IV-Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Via Celoria 11, 20133, Milan, Italy.
| | - Marco Moscatelli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rita Frangiamore
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Federica Mazzi
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mattia Verri
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alberto De Luca
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria Barbara Pasanisi
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Baranello
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luisa Chiapparini
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Renato Mantegazza
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Domenico Aquino
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Shenvi SD, Taber DJ, Hardie AD, Botstein JO, McGillicuddy JW. Assessment of magnetic resonance imaging derived fat fraction as a sensitive and reliable predictor of myosteatosis in liver transplant recipients. HPB (Oxford) 2020; 22:102-108. [PMID: 31405777 DOI: 10.1016/j.hpb.2019.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/01/2019] [Accepted: 06/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Measures of skeletal muscle abnormalities are rapidly emerging as independent predictors of outcomes after liver transplantation (LT). We describe a simple, novel assessment of myosteatosis acquired prior to liver transplantation using Magnetic Resonance Imaging (MRI) derived fat fraction. METHODS A retrospective longitudinal cohort study included clinical and biochemical data from patients who underwent liver transplantation at our institution between Feb 2008 and Aug 2014. Patients transplanted for a diagnosis of hepatocellular carcinoma were excluded from the study. The fat fraction of erector spinae muscles was estimated using MRI at the level where muscle volume was highest, with myosteatosis defined at a cut-off value of 0.8. RESULTS 180 patients were included. At baseline, those with myosteatosis were, on average, older, more likely to be female, and more likely to receive a multi-organ transplant (p < 0.05). Patients with pre-transplant myosteatosis, as delineated by MRI derived fat fraction, also had increased length of hospital stay. CONCLUSION This preliminary study suggests myosteatosis, as measured by fat fraction on MRI prior to LT, may be associated with increased graft loss and mortality after transplant.
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Affiliation(s)
- Sunil D Shenvi
- Department of HPB Surgery and Multiorgan Transplantation, Ruby Hall Clinic, Pune, India.
| | - David J Taber
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew D Hardie
- Department of Radiology & Radiological Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jonathan O Botstein
- Department of Radiology & Radiological Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - John W McGillicuddy
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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20
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Klickovic U, Zampedri L, Sinclair CDJ, Wastling SJ, Trimmel K, Howard RS, Malaspina A, Sharma N, Sidle K, Emira A, Shah S, Yousry TA, Hanna MG, Greensmith L, Morrow JM, Thornton JS, Fratta P. Skeletal muscle MRI differentiates SBMA and ALS and correlates with disease severity. Neurology 2019; 93:e895-e907. [PMID: 31391248 PMCID: PMC6745729 DOI: 10.1212/wnl.0000000000008009] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/05/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the use of muscle MRI for the differential diagnosis and as a disease progression biomarker for 2 major forms of motor neuron disorders: spinal bulbar muscular atrophy (SBMA) and amyotrophic lateral sclerosis (ALS). METHODS We applied quantitative 3-point Dixon and semiquantitative T1-weighted and short tau inversion recovery (STIR) imaging to bulbar and lower limb muscles and performed clinical and functional assessments in ALS (n = 21) and SBMA (n = 21), alongside healthy controls (n = 16). Acquired images were analyzed for the presence of fat infiltration or edema as well as specific patterns of muscle involvement. Quantitative MRI measurements were correlated with clinical measures of disease severity in ALS and SBMA. RESULTS Quantitative imaging revealed significant fat infiltration in bulbar (p < 0.001) and limb muscles in SBMA compared to controls (thigh: p < 0.001; calf: p = 0.001), identifying a characteristic pattern of muscle involvement. In ALS, semiquantitative STIR imaging detected marked hyperintensities in lower limb muscles, distinguishing ALS from SBMA and controls. Finally, MRI measurements correlated significantly with clinical scales of disease severity in both ALS and SBMA. CONCLUSIONS Our findings show that muscle MRI differentiates between SBMA and ALS and correlates with disease severity, supporting its use as a diagnostic tool and biomarker for disease progression. This highlights the clinical utility of muscle MRI in motor neuron disorders and contributes to establish objective outcome measures, which is crucial for the development of new drugs.
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Affiliation(s)
- Uros Klickovic
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Luca Zampedri
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Christopher D J Sinclair
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Stephen J Wastling
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Karin Trimmel
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Robin S Howard
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Andrea Malaspina
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Nikhil Sharma
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Katie Sidle
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Ahmed Emira
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Sachit Shah
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Tarek A Yousry
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Michael G Hanna
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Linda Greensmith
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Jasper M Morrow
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - John S Thornton
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria.
| | - Pietro Fratta
- From the Neuroradiological Academic Unit (C.D.J.S., S.J.W., A.E., S.S., T.A.Y., J.S.T.), and MRC Centre for Neuromuscular Diseases (U.K., L.Z., K.T., R.S.H., N.S., K.S., M.G.H., L.G., J.M.M., P.F.), UCL Queen Square Institute of Neurology, University College London; Blizard Institute (A.M.), Queen Mary University of London, UK; and Department of Radiology (U.K.), University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria.
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21
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Barnard AM, Lott DJ, Batra A, Triplett WT, Forbes SC, Riehl SL, Willcocks RJ, Smith BK, Vandenborne K, Walter GA. Imaging respiratory muscle quality and function in Duchenne muscular dystrophy. J Neurol 2019; 266:2752-2763. [PMID: 31350642 DOI: 10.1007/s00415-019-09481-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Duchenne muscular dystrophy (DMD) is characterized by damage to muscles including the muscles involved in respiration. Dystrophic muscles become weak and infiltrated with fatty tissue, resulting in progressive respiratory impairment. The objective of this study was to assess respiratory muscle quality and function in DMD using magnetic resonance imaging and to determine the relationship to clinical respiratory function. METHODS Individuals with DMD (n = 36) and unaffected controls (n = 12) participated in this cross sectional magnetic resonance imaging study. Participants underwent dynamic imaging of the thorax to assess diaphragm and chest wall mobility and chemical shift-encoded imaging of the chest and abdomen to determine fatty infiltration of the accessory respiratory muscles. Additionally, clinical pulmonary function measures were obtained. RESULTS Thoracic cavity area was decreased in individuals with DMD compared to controls during tidal and maximal breathing. Individuals with DMD had reduced chest wall movement in the anterior-posterior direction during maximal inspirations and expirations, but diaphragm descent during maximal inspirations (normalized to height) was only decreased in a subset of individuals with maximal inspiratory pressures less than 60% predicted. Muscle fat fraction was elevated in all three expiratory muscles assessed (p < 0.001), and the degree of fatty infiltration correlated with percent predicted maximal expiratory pressures (r = - 0.70, p < 0.001). The intercostal muscles demonstrated minimal visible fatty infiltration; however, this analysis was qualitative and resolution limited. INTERPRETATION This magnetic resonance imaging investigation of diaphragm movement, chest wall movement, and accessory respiratory muscle fatty infiltration provides new insights into the relationship between disease progression and clinical respiratory function.
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Affiliation(s)
- Alison M Barnard
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA.,Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, USA
| | - Donovan J Lott
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Abhinandan Batra
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - William T Triplett
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Sean C Forbes
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Samuel L Riehl
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | | | - Barbara K Smith
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Krista Vandenborne
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Glenn A Walter
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, USA.
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22
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Farrow M, Grainger AJ, Tan AL, Buch MH, Emery P, Ridgway JP, Feiweier T, Tanner SF, Biglands J. Normal values and test-retest variability of stimulated-echo diffusion tensor imaging and fat fraction measurements in the muscle. Br J Radiol 2019; 92:20190143. [PMID: 31298948 DOI: 10.1259/bjr.20190143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess the test-retest variability of both diffusion parameters and fat fraction (FF) estimates in normal muscle, and to assess differences in normal values between muscles in the thigh. METHODS 29 healthy volunteers (mean age 37 years, range 20-60 years, 17/29 males) completed the study. Magnetic resonance images of the mid-thigh were acquired using a stimulated echo acquisition mode-echoplanar imaging (STEAM-EPI) imaging sequence, to assess diffusion, and 2-point Dixon imaging, to assess FF. Imaging was repeated in 19 participants after a 30 min interval in order to assess test-retest variability of the measurements. RESULTS Intraclass correlation coefficients (ICCs) for test-retest variability were 0.99 [95% confidence interval, (CI): 0.98, 1] for FF, 0.94 (95% CI: 0.84, 0.97) for mean diffusivity and 0.89 (95% CI: 0.74, 0.96) for fractional anisotropy (FA). FF was higher in the hamstrings than the quadriceps by a mean difference of 1.81% (95% CI:1.63, 2.00)%, p < 0.001. Mean diffusivity was significantly lower in the hamstrings than the quadriceps (0.26 (0.13, 0.39) x10-3 mm2s-1, p < 0.001) whereas fractional anisotropy was significantly higher in the hamstrings relative to the quadriceps with a mean difference of 0.063 (0.05, 0.07), p < 0.001. CONCLUSIONS This study has shown excellent test-retest, variability in MR-based FF and diffusion measurements and demonstrated significant differences in these measures between hamstrings and quadriceps in the healthy thigh. ADVANCES IN KNOWLEDGE Test-retest variability is excellent for STEAM-EPI diffusion and 2-point Dixon-based FF measurements in the healthy muscle. Inter- and intraobserver variability were excellent for region of interest placement for STEAM-EPI diffusion and 2-point Dixon-based FF measurements in the healthy muscle. There are significant differences in FF and diffusion measurements between the hamstrings and quadriceps in the normal muscle.
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Affiliation(s)
- Matthew Farrow
- 1Leeds institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, United Kingdom.,2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Andrew J Grainger
- 1Leeds institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, United Kingdom.,2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Ai Lyn Tan
- 1Leeds institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, United Kingdom.,2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Maya H Buch
- 1Leeds institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, United Kingdom.,2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Paul Emery
- 1Leeds institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, United Kingdom.,2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - John P Ridgway
- 2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,3Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Steven F Tanner
- 2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,3Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - John Biglands
- 2NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,3Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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Abstract
OBJECTIVE. For many years, MRI of the musculoskeletal system has relied mostly on conventional sequences with qualitative analysis. More recently, using quantitative MRI applications to complement qualitative imaging has gained increasing interest in the MRI community, providing more detailed physiologic or anatomic information. CONCLUSION. In this article, we review the current state of quantitative MRI, technical and software advances, and the most relevant clinical and research musculoskeletal applications of quantitative MRI.
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Alizai H, Chang G, Regatte RR. MR Imaging of the Musculoskeletal System Using Ultrahigh Field (7T) MR Imaging. PET Clin 2019; 13:551-565. [PMID: 30219187 DOI: 10.1016/j.cpet.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
MR imaging is an indispensable instrument for the diagnosis of musculoskeletal diseases. In vivo MR imaging at 7T offers many advantages, including increased signal-to-noise ratio, higher spatial resolution, improved spectral resolution for spectroscopy, improved sensitivity for X-nucleus imaging, and decreased image acquisition times. There are also however technical challenges of imaging at a higher field strength compared with 1.5 and 3T MR imaging systems. We discuss the many potential opportunities as well as the challenges presented by 7T MR imaging systems and highlight recent developments in in vivo research imaging of musculoskeletal applications in general and cartilage, skeletal muscle, and bone in particular.
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Affiliation(s)
- Hamza Alizai
- Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY 10016, USA.
| | - Gregory Chang
- Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY 10016, USA
| | - Ravinder R Regatte
- Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY 10016, USA
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25
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Fortin M, Wilk N, Dobrescu O, Martel P, Santaguida C, Weber MH. Relationship between cervical muscle morphology evaluated by MRI, cervical muscle strength and functional outcomes in patients with degenerative cervical myelopathy. Musculoskelet Sci Pract 2018; 38:1-7. [PMID: 30059855 DOI: 10.1016/j.msksp.2018.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/11/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cervical muscle alterations have been reported in patients with chronic neck pain, but the assessment of muscle morphology and strength has been overlooked in patients with degenerative cervical myelopathy (DCM). OBJECTIVES This study aimed to investigate the relationship between cervical muscle degenerative changes observed on MRI, muscle strength and symptoms severity in patients diagnosed with DCM. DESIGN Observational study. METHODS Cervical muscle measurements of total cross-sectional area (CSA), functional CSA (fat free area, FCSA) and ratio of FCSA/CSA (e.g. fatty infiltration) were obtained from T2-weighted axial MR images from C2-C3 to C6-C7 in 20 patients. Muscle strength was assessed manually using a microFET2 dynamometer. The association between cervical muscle morphology parameters, muscle strength, symptoms severity and functional status was investigated. RESULTS Greater mean CSA and FCSA was associated with greater overall muscle strength. The mean FCSA explained 37%, 76%, 39%, 20% and 65% of the total variance in flexion, extension, right-side bending, left-side bending and overall muscle strength, respectively. The mean ratio of FCSA/CSA was not significantly associated with cervical muscle strength in any direction. However, greater FCSA/CSA ratio (e.g. less fatty infiltration) was associated with lower disability score (p = 0.02, R2 = 0.20). CONCLUSIONS Cervical muscle lean muscle mass was positively associated with cervical muscle strength in patients with DCM. Moreover, greater fatty infiltration in the cervical extensor muscles was associated with lower functional score. Such findings suggest that clinicians should pay greater attention to cervical muscle morphology and function in patients with DCM.
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Affiliation(s)
- Maryse Fortin
- McGill University Health Centre, Montreal General Hospital Site, Department of Orthopedic Surgery, Montreal, Quebec, Canada; PERFORM Centre, Concordia University, Montreal, Quebec, Canada.
| | - Nikola Wilk
- McGill University, Faculty of Medicine, Montreal, Quebec, Canada
| | | | - Philippe Martel
- McGill University Health Centre, Montreal General Hospital Site, Department of Orthopedic Surgery, Montreal, Quebec, Canada
| | - Carlo Santaguida
- McGill University, Faculty of Medicine, Department of Neurology and Neurosurgery, Montreal, Quebec, Canada
| | - Michael H Weber
- McGill University Health Centre, Montreal General Hospital Site, Department of Orthopedic Surgery, Montreal, Quebec, Canada
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26
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Kälin PS, Crawford RJ, Marcon M, Manoliu A, Bouaicha S, Fischer MA, Ulbrich EJ. Shoulder muscle volume and fat content in healthy adult volunteers: quantification with DIXON MRI to determine the influence of demographics and handedness. Skeletal Radiol 2018; 47:1393-1402. [PMID: 29687149 DOI: 10.1007/s00256-018-2945-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 03/05/2018] [Accepted: 04/02/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to provide mean values for fat-fraction and volume for full-length bilateral rotator cuff and deltoid muscles in asymptomatic adults selected on the basis of their good musculoskeletal and systemic health, and to understand the influence of gender, age, and arm dominance. MATERIALS AND METHODS Seventy-six volunteers aged 20 to 60 years who were screened for normal BMI and high general health were included in the study. MRI was performed at 3 Tesla using three-point DIXON sequences. Volume and fat-signal fraction of the rotator cuff muscles and the deltoid muscle were determined with semi-automated segmentation of entire muscle lengths. Differences according to age, gender, and handedness per muscle were evaluated. RESULTS Fat-signal fractions were comparable between genders (mean ± 2 SD, 95% CI, women 7.0 ± 3.0; 6.8-7.2%, men 6.8 ± 2.7; 6.7-7.0%) but did not show convincing changes with age. Higher shoulder muscle volume and lower fat-signal fraction in the dominant arm were shown for teres minor and deltoid (p < 0.01) with similar trends shown for the other rotator cuff muscles. CONCLUSIONS Bilateral fat-signal fractions and volumes based on entire length shoulder muscles in asymptomatic 20-60 year old adults may provide reference for clinicians. Differences shown according to arm dominance should be considered and may rationalize the need for bilateral imaging in determining appropriate management.
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Affiliation(s)
- Pascal S Kälin
- Department of Radiology, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
| | - Rebecca J Crawford
- Centre for Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland.,Faculty of Health Professions, Curtin University, Perth, Australia
| | - Magda Marcon
- Department of Radiology, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Andrei Manoliu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Samy Bouaicha
- Department of Orthopedics, University Hospital Balgrist and University of Zurich, Zurich, Switzerland
| | | | - Erika J Ulbrich
- Department of Radiology, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
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Bray TJP, Chouhan MD, Punwani S, Bainbridge A, Hall-Craggs MA. Fat fraction mapping using magnetic resonance imaging: insight into pathophysiology. Br J Radiol 2018; 91:20170344. [PMID: 28936896 PMCID: PMC6223159 DOI: 10.1259/bjr.20170344] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/18/2017] [Accepted: 09/06/2017] [Indexed: 02/06/2023] Open
Abstract
Adipose cells have traditionally been viewed as a simple, passive energy storage depot for triglycerides. However, in recent years it has become clear that adipose cells are highly physiologically active and have a multitude of endocrine, metabolic, haematological and immune functions. Changes in the number or size of adipose cells may be directly implicated in disease (e.g. in the metabolic syndrome), but may also be linked to other pathological processes such as inflammation, malignant infiltration or infarction. MRI is ideally suited to the quantification of fat, since most of the acquired signal comes from water and fat protons. Fat fraction (FF, the proportion of the acquired signal derived from fat protons) has, therefore, emerged as an objective, image-based biomarker of disease. Methods for FF quantification are becoming increasingly available in both research and clinical settings, but these methods vary depending on the scanner, manufacturer, imaging sequence and reconstruction software being used. Careful selection of the imaging method-and correct interpretation-can improve the accuracy of FF measurements, minimize potential confounding factors and maximize clinical utility. Here, we review methods for fat quantification and their strengths and weaknesses, before considering how they can be tailored to specific applications, particularly in the gastrointestinal and musculoskeletal systems. FF quantification is becoming established as a clinical and research tool, and understanding the underlying principles will be helpful to both imaging scientists and clinicians.
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Affiliation(s)
- Timothy JP Bray
- Centre for
Medical Imaging, University College London,University College London,
London, UK
| | - Manil D Chouhan
- Centre for
Medical Imaging, University College London,University College London,
London, UK
| | - Shonit Punwani
- Centre for
Medical Imaging, University College London,University College London,
London, UK
| | - Alan Bainbridge
- Department
of Medical Physics, University College London
Hospitals,University
College London Hospitals, London,
UK
| | - Margaret A Hall-Craggs
- Centre for
Medical Imaging, University College London,University College London,
London, UK
- Department
of Medical Physics, University College London
Hospitals,University
College London Hospitals, London,
UK
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28
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Barnard AM, Willcocks RJ, Finanger EL, Daniels MJ, Triplett WT, Rooney WD, Lott DJ, Forbes SC, Wang DJ, Senesac CR, Harrington AT, Finkel RS, Russman BS, Byrne BJ, Tennekoon GI, Walter GA, Sweeney HL, Vandenborne K. Skeletal muscle magnetic resonance biomarkers correlate with function and sentinel events in Duchenne muscular dystrophy. PLoS One 2018; 13:e0194283. [PMID: 29554116 PMCID: PMC5858773 DOI: 10.1371/journal.pone.0194283] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/28/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To provide evidence for quantitative magnetic resonance (qMR) biomarkers in Duchenne muscular dystrophy by investigating the relationship between qMR measures of lower extremity muscle pathology and functional endpoints in a large ambulatory cohort using a multicenter study design. METHODS MR spectroscopy and quantitative imaging were implemented to measure intramuscular fat fraction and the transverse magnetization relaxation time constant (T2) in lower extremity muscles of 136 participants with Duchenne muscular dystrophy. Measures were collected at 554 visits over 48 months at one of three imaging sites. Fat fraction was measured in the soleus and vastus lateralis using MR spectroscopy, while T2 was assessed using MRI in eight lower extremity muscles. Ambulatory function was measured using the 10m walk/run, climb four stairs, supine to stand, and six minute walk tests. RESULTS Significant correlations were found between all qMR and functional measures. Vastus lateralis qMR measures correlated most strongly to functional endpoints (|ρ| = 0.68-0.78), although measures in other rapidly progressing muscles including the biceps femoris (|ρ| = 0.63-0.73) and peroneals (|ρ| = 0.59-0.72) also showed strong correlations. Quantitative MR biomarkers were excellent indicators of loss of functional ability and correlated with qualitative measures of function. A VL FF of 0.40 was an approximate lower threshold of muscle pathology associated with loss of ambulation. DISCUSSION Lower extremity qMR biomarkers have a robust relationship to clinically meaningful measures of ambulatory function in Duchenne muscular dystrophy. These results provide strong supporting evidence for qMR biomarkers and set the stage for their potential use as surrogate outcomes in clinical trials.
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Affiliation(s)
- Alison M. Barnard
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
| | - Rebecca J. Willcocks
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
| | - Erika L. Finanger
- Departments of Pediatrics and Neurology, Oregon Health & Science University, Portland, OR, United States of America
| | - Michael J. Daniels
- Department of Statistics, University of Florida, Gainesville, FL, United States of America
| | - William T. Triplett
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
| | - William D. Rooney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, United States of America
| | - Donovan J. Lott
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
| | - Sean C. Forbes
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
| | - Dah-Jyuu Wang
- Department of Radiology, Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Claudia R. Senesac
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
| | - Ann T. Harrington
- The Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | | | - Barry S. Russman
- Departments of Pediatrics and Neurology, Oregon Health & Science University, Portland, OR, United States of America
| | - Barry J. Byrne
- Department of Pediatrics and Molecular Genetics and Microbiology, Powell Gene Therapy Center, University of Florida, Gainesville, FL, United States of America
| | - Gihan I. Tennekoon
- The Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Glenn A. Walter
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, United States of America
| | - H. Lee Sweeney
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, United States of America
| | - Krista Vandenborne
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States of America
- * E-mail:
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29
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Diffusion Tensor Imaging of Dystrophic Skeletal Muscle. Clin Neuroradiol 2018; 29:231-242. [DOI: 10.1007/s00062-018-0667-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/12/2018] [Indexed: 11/26/2022]
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30
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A data-oriented self-calibration and robust chemical-shift encoding by using clusterization (OSCAR): Theory, optimization and clinical validation in neuromuscular disorders. Magn Reson Imaging 2017; 45:84-96. [PMID: 28982632 DOI: 10.1016/j.mri.2017.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 12/15/2022]
Abstract
Multi-echo Chemical Shift-Encoded (CSE) methods for Fat-Water quantification are growing in clinical use due to their ability to estimate and correct some confounding effects. State of the art CSE water/fat separation approaches rely on a multi-peak fat spectrum with peak frequencies and relative amplitudes kept constant over the entire MRI dataset. However, the latter approximation introduces a systematic error in fat percentage quantification in patients where the differences in lipid chemical composition are significant (such as for neuromuscular disorders) because of the spatial dependence of the peak amplitudes. The present work aims to overcome this limitation by taking advantage of an unsupervised clusterization-based approach offering a reliable criterion to carry out a data-driven segmentation of the input MRI dataset into multiple regions. Results established that the presented algorithm is able to identify at least 4 different partitions from MRI dataset under which to perform independent self-calibration routines and was found robust in NMD imaging studies (as evaluated on a cohort of 24 subjects) against latest CSE techniques with either calibrated or non-calibrated approaches. Particularly, the PDFF of the thigh was more reproducible for the quantitative estimation of pathological muscular fat infiltrations, which may be promising to evaluate disease progression in clinical practice.
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31
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Association between paraspinal muscle morphology, clinical symptoms and functional status in patients with lumbar spinal stenosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2543-2551. [PMID: 28748488 DOI: 10.1007/s00586-017-5228-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/13/2017] [Accepted: 07/18/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Lumbar spinal stenosis (LSS) is a disabling condition associated with narrowing of the spinal canal or vertebral foramina. Paraspinal muscle atrophy and fatty infiltration have been reported in patients with chronic LBP and disc herniation. However, very few imaging studies have examined paraspinal muscle morphology and composition in patients with LSS. The purpose of this study was to investigate the association of paraspinal muscle size, composition and asymmetry with functional status in patients with LSS. METHODS Thirty-six patients diagnosed with LSS at L4-L5 with neurogenic claudication were included. Paraspinal muscle measurements were obtained from axial T2-weighted MR images, bilaterally, at the level of the superior and inferior vertebral endplates of L5. Muscle measurements of interest included: total cross-sectional area (CSA), functional CSA (FCSA), the ratio of FCSA to CSA (FCSA/CSA) as an indicator of muscle composition, and relative % asymmetry in muscle CSA. The association between muscle parameters and other patient characteristics with function as indicated from Oswestry Disability Index (ODI) scores and pain interference status was investigated. RESULTS Greater multifidus muscle fatty infiltration (e.g., lower FCSA/CSA) and lower psoas relative CSA were associated with lower function (higher ODI and pain interference scores) in univariable and multivariable analyses. There was no association between the different muscle parameters and stenosis severity or back or leg pain duration or severity. CONCLUSIONS Our findings suggest an association of multifidus muscle fatty infiltration and psoas muscle size with functional status in patients diagnosed with LSS. Future prospective studies are needed to evaluate whether such muscle parameters are associated with prognosis and functional recovery following surgical treatment.
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32
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Fortin M, Omidyeganeh M, Battié MC, Ahmad O, Rivaz H. Evaluation of an automated thresholding algorithm for the quantification of paraspinal muscle composition from MRI images. Biomed Eng Online 2017; 16:61. [PMID: 28532491 PMCID: PMC5441067 DOI: 10.1186/s12938-017-0350-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/13/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The imaging assessment of paraspinal muscle morphology and fatty infiltration has gained considerable attention in the past decades, with reports suggesting an association between muscle degenerative changes and low back pain (LBP). To date, qualitative and quantitative approaches have been used to assess paraspinal muscle composition. Though highly reliable, manual thresholding techniques are time consuming and not always feasible in a clinical setting. The tedious and rater-dependent nature of such manual thresholding techniques provides the impetus for the development of automated or semi-automated segmentation methods. The purpose of the present study was to develop and evaluate an automated thresholding algorithm for the assessment of paraspinal muscle composition. The reliability and validity of the muscle measurements using the new automated thresholding algorithm were investigated through repeated measurements and comparison with measurements from an established, highly reliable manual thresholding technique. METHODS Magnetic resonance images of 30 patients with LBP were randomly selected cohort of patients participating in a project on commonly diagnosed lumbar pathologies in patients attending spine surgeon clinics. A series of T2-weighted MR images were used to train the algorithm; preprocessing techniques including adaptive histogram equalization method image adjustment scheme were used to enhance the quality and contrast of the images. All muscle measurements were repeated twice using a manual thresholding technique and the novel automated thresholding algorithm, from axial T2-weigthed images, at least 5 days apart. The rater was blinded to all earlier measurements. Inter-method agreement and intra-rater reliability for each measurement method were assessed. The study did not received external funding and the authors have no disclosures. RESULTS There was excellent agreement between the two methods with inter-method reliability coefficients (intraclass correlation coefficients) varying from 0.79 to 0.99. Bland and Altman plots further confirmed the agreement between the two methods. Intra-rater reliability and standard error of measurements were comparable between methods, with reliability coefficient varying between 0.95 and 0.99 for the manual thresholding and 0.97-0.99 for the automated algorithm. CONCLUSION The proposed automated thresholding algorithm to assess paraspinal muscle size and composition measurements was highly reliable, with excellent agreement with the reference manual thresholding method.
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Affiliation(s)
- Maryse Fortin
- PERFORM Centre, Concordia University, 7200 Sherbrooke W, Montreal, QC, H4B 1R6, Canada.,Department of Electrical Engineering, Engineering, Computer Science and Visual Arts Integrated Complex, Concordia University, 1515 Ste-Catherine W. Street, Montreal, QC, H3G 2W1, Canada
| | - Mona Omidyeganeh
- PERFORM Centre, Concordia University, 7200 Sherbrooke W, Montreal, QC, H4B 1R6, Canada.,Department of Electrical Engineering, Engineering, Computer Science and Visual Arts Integrated Complex, Concordia University, 1515 Ste-Catherine W. Street, Montreal, QC, H3G 2W1, Canada
| | - Michele Crites Battié
- Common Spinal Disorders Research Group, Faculty of Rehabilitation Medicine University of Alberta, 8205-114 Street, Edmonton, AB, T6G 2G4, Canada
| | - Omair Ahmad
- Department of Electrical Engineering, Engineering, Computer Science and Visual Arts Integrated Complex, Concordia University, 1515 Ste-Catherine W. Street, Montreal, QC, H3G 2W1, Canada
| | - Hassan Rivaz
- PERFORM Centre, Concordia University, 7200 Sherbrooke W, Montreal, QC, H4B 1R6, Canada. .,Department of Electrical Engineering, Engineering, Computer Science and Visual Arts Integrated Complex, Concordia University, 1515 Ste-Catherine W. Street, Montreal, QC, H3G 2W1, Canada.
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33
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Bonati U, Holiga Š, Hellbach N, Risterucci C, Bergauer T, Tang W, Hafner P, Thoeni A, Bieri O, Gerlach I, Marquet A, Khwaja O, Sambataro F, Bertolino A, Dukart J, Fischmann A, Fischer D, Czech C. Longitudinal characterization of biomarkers for spinal muscular atrophy. Ann Clin Transl Neurol 2017; 4:292-304. [PMID: 28491897 PMCID: PMC5420809 DOI: 10.1002/acn3.406] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/05/2017] [Indexed: 12/27/2022] Open
Abstract
Objective Recent advances in understanding Spinal Muscular Atrophy (SMA) etiopathogenesis prompted development of potent intervention strategies and raised need for sensitive outcome measures capable of assessing disease progression and response to treatment. Several biomarkers have been proposed; nevertheless, no general consensus has been reached on the most feasible ones. We observed a wide range of measures over 1 year to assess their ability to monitor the disease status and progression. Methods 18 SMA patients and 19 healthy volunteers (HV) were followed in this 52‐weeks observational study. Quantitative‐MRI (qMRI) of both thighs and clinical evaluation of motor function was performed at baseline, 6, 9 and 12 months follow‐up. Blood samples were taken in patients for molecular characterization at screening, 9 and 12 month follow‐up. Progression, responsiveness and reliability of collected indices were quantified. Correlation analysis was performed to test for potential associations. Results QMRI indices, clinical scales and molecular measures showed high to excellent reliability. Significant differences were found between qMRI of SMA patients and HV. Significant associations were revealed between multiple qMRI measures and functional clinical scales. None of the qMRI, clinical, or molecular measures was able to detect significant disease progression over 1 year. Interpretation We probed a variety of quantitative measures for SMA in a slowly‐progressing disease population over 1 year. The presented measures demonstrated potential to provide a closer link to underlying disease biology as compared to conventional functional scales. The proposed biomarker framework can guide implementation of more sensitive endpoints in future clinical trials and prove their utility in search for novel disease‐modifying therapies.
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Affiliation(s)
- Ulrike Bonati
- Division of Neuropediatrics University of Basel Children's Hospital Spitalstrasse 334056 Basel Switzerland.,Department of Neurology University of Basel Hospital Petersgraben 44031 Basel Switzerland
| | - Štefan Holiga
- Roche Pharma and Early Development Neuroscience, Ophthalmology and Rare Diseases Roche Innovation Center Basel F. Hoffmann-La Roche Ltd Grenzacherstrasse 1244070 Basel Switzerland.,Max Planck Institute for Human Cognitive and Brain Sciences Stephan str. 1A04103 Leipzig Germany
| | - Nicole Hellbach
- Roche Pharma and Early Development Neuroscience, Ophthalmology and Rare Diseases Roche Innovation Center Basel F. Hoffmann-La Roche Ltd Grenzacherstrasse 1244070 Basel Switzerland
| | - Céline Risterucci
- Roche Pharma and Early Development Neuroscience, Ophthalmology and Rare Diseases Roche Innovation Center Basel F. Hoffmann-La Roche Ltd Grenzacherstrasse 1244070 Basel Switzerland
| | - Tobias Bergauer
- Roche Pharma and Early Development Neuroscience, Ophthalmology and Rare Diseases Roche Innovation Center Basel F. Hoffmann-La Roche Ltd Grenzacherstrasse 1244070 Basel Switzerland
| | - Wakana Tang
- Roche Molecular Diagnostics Research Genomics & Oncology Roche Molecular Systems Inc.4300 Hacienda Dr Pleasanton 94588 California USA
| | - Patricia Hafner
- Division of Neuropediatrics University of Basel Children's Hospital Spitalstrasse 334056 Basel Switzerland.,Department of Neurology University of Basel Hospital Petersgraben 44031 Basel Switzerland.,University Clinics of Internal Medicine Kantonsspital Baselland Bruderholz 4101 Switzerland
| | - Alain Thoeni
- MIAC AG c/o University of Basel Hospital Mittlere-Strasse 834031 Basel Switzerland.,Department of Radiology University of Basel Hospital Petersgraben 44031 Basel Switzerland
| | - Oliver Bieri
- Department of Radiology University of Basel Hospital Petersgraben 44031 Basel Switzerland
| | - Irene Gerlach
- Roche Pharma and Early Development Neuroscience, Ophthalmology and Rare Diseases Roche Innovation Center Basel F. Hoffmann-La Roche Ltd Grenzacherstrasse 1244070 Basel Switzerland
| | - Anne Marquet
- Roche Pharma and Early Development Neuroscience, Ophthalmology and Rare Diseases Roche Innovation Center Basel F. Hoffmann-La Roche Ltd Grenzacherstrasse 1244070 Basel Switzerland
| | - Omar Khwaja
- Roche Pharma and Early Development Neuroscience, Ophthalmology and Rare Diseases Roche Innovation Center Basel F. Hoffmann-La Roche Ltd Grenzacherstrasse 1244070 Basel Switzerland
| | - Fabio Sambataro
- Roche Pharma and Early Development Neuroscience, Ophthalmology and Rare Diseases Roche Innovation Center Basel F. Hoffmann-La Roche Ltd Grenzacherstrasse 1244070 Basel Switzerland
| | - Alessandro Bertolino
- Roche Pharma and Early Development Neuroscience, Ophthalmology and Rare Diseases Roche Innovation Center Basel F. Hoffmann-La Roche Ltd Grenzacherstrasse 1244070 Basel Switzerland
| | - Juergen Dukart
- Roche Pharma and Early Development Neuroscience, Ophthalmology and Rare Diseases Roche Innovation Center Basel F. Hoffmann-La Roche Ltd Grenzacherstrasse 1244070 Basel Switzerland
| | - Arne Fischmann
- Department of Radiology University of Basel Hospital Petersgraben 44031 Basel Switzerland.,Hirslanden Klinik St. Anna St. Anna-Strasse 326006 Luzern Switzerland
| | - Dirk Fischer
- Division of Neuropediatrics University of Basel Children's Hospital Spitalstrasse 334056 Basel Switzerland.,Department of Neurology University of Basel Hospital Petersgraben 44031 Basel Switzerland
| | - Christian Czech
- Roche Pharma and Early Development Neuroscience, Ophthalmology and Rare Diseases Roche Innovation Center Basel F. Hoffmann-La Roche Ltd Grenzacherstrasse 1244070 Basel Switzerland
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Pichiecchio A, Rossi M, Cinnante C, Colafati GS, Icco R, Parini R, Menni F, Furlan F, Burlina A, Sacchini M, Donati MA, Fecarotta S, Casa RD, Deodato F, Taurisano R, Rocco M. Muscle MRI of classic infantile pompe patients: Fatty substitution and edema‐like changes. Muscle Nerve 2017; 55:841-848. [DOI: 10.1002/mus.25417] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 07/18/2016] [Accepted: 09/23/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Anna Pichiecchio
- Neuroradiology DepartmentC. Mondino National Neurological InstituteVia Mondino2 ‐ 27100Pavia Italy
| | - Marta Rossi
- Child Neuropsychiatry UnitDepartment of Brain and Behavioral Sciences, University of PaviaPavia Italy
| | - Claudia Cinnante
- Unit of NeuroradiologyDepartment of Neuroscience, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of MilanMilan Italy
| | | | - Roberto Icco
- Neurology UnitDepartment of Brain and Behavioral Sciences, University of PaviaPavia Italy
| | - Rossella Parini
- Unit of Rare Metabolic Diseases, San Gerardo HospitalMonza Italy
| | - Francesca Menni
- Pediatric Highly Intensive Care UnitDepartment of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilano Italy
| | - Francesca Furlan
- Unit of Metabolic DiseasesAzienda Ospedaliera UniversitariaPadua Italy
| | - Alberto Burlina
- Unit of Metabolic DiseasesAzienda Ospedaliera UniversitariaPadua Italy
| | - Michele Sacchini
- Metabolic and Neuromuscular UnitAOU Meyer HospitalFlorence Italy
| | | | - Simona Fecarotta
- Department of Translational Medicine‐Section of PediatricsFederico II UniversityNaples Italy
| | - Roberto Della Casa
- Department of Translational Medicine‐Section of PediatricsFederico II UniversityNaples Italy
| | | | | | - Maja Rocco
- Unit of Rare DiseasesDepartment of Pediatrics, Giannina Gaslini InstituteGenoa Italy
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Manually defining regions of interest when quantifying paravertebral muscles fatty infiltration from axial magnetic resonance imaging: a proposed method for the lumbar spine with anatomical cross-reference. BMC Musculoskelet Disord 2017; 18:25. [PMID: 28103921 PMCID: PMC5247810 DOI: 10.1186/s12891-016-1378-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/22/2016] [Indexed: 12/21/2022] Open
Abstract
Background There is increasing interest in paravertebral muscle composition as a potential prognostic and diagnostic element in lumbar spine health. As a consequence, it is becoming popular to use magnetic resonance imaging (MRI) to examine muscle volume and fatty infiltration in lumbar paravertebral muscles to assess both age-related change and their clinical relevance in low back pain (LBP). A variety of imaging methods exist for both measuring key variables (fat, muscle) and for defining regions of interest, making pooled comparisons between studies difficult and rendering post-production analysis of MRIs confusing. We therefore propose and define a method as an option for use as a standardized MRI procedure for measuring lumbar paravertebral muscle composition, and to stimulate discussion towards establishing consensus for the analysis of skeletal muscle composition amongst clinician researchers. Method In this descriptive methodological study we explain our method by providing an examination of regional lumbar morphology, followed by a detailed description of the proposed technique. Identification of paravertebral muscles and vertebral anatomy includes axial E12 sheet-plastinates from cadaveric material, combined with a series of axial MRIs that encompass sequencing commonly used for investigations of muscle quality (fat-water DIXON, T1-, and T2-weighted) to illustrate regional morphology; these images are shown for L1 and L4 levels to highlight differences in regional morphology. The method for defining regions of interest (ROI) for multifidus (MF), and erector spinae (ES) is then described. Results Our method for defining ROIs for lumbar paravertebral muscles on axial MRIs is outlined and discussed in relation to existing literature. The method provides a foundation for standardising the quantification of muscle quality that particularly centres on examining fatty infiltration and composition. We provide recommendations relating to imaging parameters that should additionally inform a priori decisions when planning studies examining lumbar muscle tissues with MRI. Conclusions We intend this method to provide a platform towards developing and delivering meaningful comparisons between MRI data on lumbar paravertebral muscle quality.
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36
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Duijnisveld BJ, Henseler JF, Reijnierse M, Fiocco M, Kan HE, Nelissen RGHH. Quantitative Dixon MRI sequences to relate muscle atrophy and fatty degeneration with range of motion and muscle force in brachial plexus injury. Magn Reson Imaging 2016; 36:98-104. [PMID: 27989913 DOI: 10.1016/j.mri.2016.10.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 10/14/2016] [Accepted: 10/26/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Assessment of muscle atrophy and fatty degeneration in brachial plexus injury (BPI) could yield valuable insight into pathophysiology and could be used to predict clinical outcome. The objective of this study was to quantify and relate fat percentage and cross-sectional area (CSA) of the biceps to range of motion and muscle force of traumatic brachial plexus injury (BPI) patients. METHODS T1-weighted TSE sequence and three-point Dixon images of the affected and non-affected biceps brachii were acquired on a 3 Tesla magnetic resonance scanner to determine the fat percentage, total and contractile CSA of 20 adult BPI patients. Regions of interest were drawn by two independent investigators to determine the inter-observer reliability. Paired Students' t-test and multivariate analysis were used to relate fat percentage, total and contractile CSA to active flexion and biceps muscle force. RESULTS The mean fat percentage 12±5.1% of affected biceps was higher than 6±1.0% of the non-affected biceps (p<0.001). The mean contractile CSA 8.1±5.1cm2 of the affected biceps was lower than 19.4±4.9cm2 of the non-affected biceps (p<0.001). The inter-observer reliability was excellent (ICC 0.82 to 0.96). The contractile CSA contributed most to the reduction in active flexion and muscle force. CONCLUSION Quantitative measurement of fat percentage, total and contractile CSA using three-point Dixon sequences provides an excellent reliability and relates with active flexion and muscle force in BPI.
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Affiliation(s)
- Bouke J Duijnisveld
- Department of Orthopaedics, Leiden University Medical Center, The Netherlands.
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, The Netherlands
| | - Marta Fiocco
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, The Netherlands; Mathematica institute Leiden University, Leiden University Medical Center, The Netherlands
| | - Hermien E Kan
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, The Netherlands
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37
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Siracusano G, La Corte A, Milazzo C, Anastasi GP, Finocchio G, Gaeta M. On the R 2⁎ relaxometry in complex multi-peak multi-Echo chemical shift-based water-fat quantification: Applications to the neuromuscular diseases. Magn Reson Imaging 2016; 35:4-14. [PMID: 27569370 DOI: 10.1016/j.mri.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/03/2016] [Accepted: 08/20/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Investigation of the feasibility of the R2⁎ mapping techniques by using latest theoretical models corrected for confounding factors and optimized for signal to noise ratio. THEORY AND METHODS The improvement of the performance of state of the art magnetic resonance imaging (MRI) relaxometry algorithms is challenging because of a non-negligible bias and still unresolved numerical instabilities. Here, R2⁎ mapping reconstructions, including complex fitting with multi-spectral fat-correction by using single-decay and double-decay formulation, are deeply studied in order to investigate and identify optimal configuration parameters and minimize the occurrence of numerical artifacts. The effects of echo number, echo spacing, and fat/water relaxation model type are evaluated through both simulated and in-vivo data. We also explore the stability and feasibility of the fat/water relaxation model by analyzing the impact of high percentage of fat infiltrations and local transverse relaxation differences among biological species. RESULTS The main limits of the MRI relaxometry are the presence of bias and the occurrence of artifacts, which significantly affect its accuracy. Chemical-shift complex R2⁎-correct single-decay reconstructions exhibit a large bias in presence of a significant difference in the relaxation rates of fat and water and with fat concentration larger than 30%. We find that for fat-dominated tissues or in patients affected by extensive iron deposition, MRI reconstructions accounting for multi-exponential relaxation time provide accurate R2⁎ measurements and are less prone to numerical artifacts. CONCLUSIONS Complex fitting and fat-correction with multi-exponential decay formulation outperforms the conventional single-decay approximation in various diagnostic scenarios. Although it still lacks of numerical stability, which requires model enhancement and support from spectroscopy, it offers promising perspectives for the development of relaxometry as a reliable tool to improve tissue characterization and monitoring of neuromuscular disorders.
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Affiliation(s)
- Giulio Siracusano
- Department of Mathematical and Computer Sciences, Physical Sciences and Earth Sciences, University of Messina, V.le F. D'alcontres, 31, 98166, Messina, Italy; Department of Computer Engineering and Telecommunications, University of Catania, Viale Andrea Doria 6, 95125, Catania, Italy.
| | - Aurelio La Corte
- Department of Computer Engineering and Telecommunications, University of Catania, Viale Andrea Doria 6, 95125, Catania, Italy
| | - Carmelo Milazzo
- Department of Biomedical sciences, Dental and of Morphological and Functional images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Giuseppe Pio Anastasi
- Department of Biomedical sciences, Dental and of Morphological and Functional images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Giovanni Finocchio
- Department of Mathematical and Computer Sciences, Physical Sciences and Earth Sciences, University of Messina, V.le F. D'alcontres, 31, 98166, Messina, Italy; Istituto Nazionale di Geofisica e Vulcanologia (INGV), Via Vigna Murata 605, 00143, Roma, Italy
| | - Michele Gaeta
- Department of Biomedical sciences, Dental and of Morphological and Functional images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
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Valentin S, Yeates TD, Licka T, Elliott J. In vivo MRI features of spinal muscles in the ovine model. J Orthop Translat 2016; 6:1-9. [PMID: 29392107 PMCID: PMC5790160 DOI: 10.1016/j.jot.2015.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Muscle fatty infiltration (MFI) has been identified in patients with spinal pain using magnetic resonance imaging (MRI). Even though sheep are a commonly used animal model for the human spine, comparative sheep MFI data from MRI is not available. Determining MFI in sheep spinal muscles using acquisition protocols commonly used in man will identify the applicability of this approach in future sheep model studies, such that the effects of spinal interventions on muscle can be assessed prior to their use in a human (clinical) population. Objective To quantify ovine lumbar spine MFI using three-dimensional two-point Dixon and T1-weighted sequences. Methods T1-weighted and Dixon lumbar spine axial sequences were collected in 14 healthy Austrian mountain sheep using a 1.5-T MRI. At each vertebrae, the region of interest of psoas major and minor (PS), multifidus (M), and longissimus (L) were identified. To determine MFI from the T1-weighted images, the mean pixel intensity (MPI) was calculated as a percentage of subcutaneous or intermuscular fat. For the Dixon images, fat sequence MPI was calculated as a percentage of the summed fat and water sequence MPIs. Spinal degeneration was graded and correlated to MFI. Dixon MFI was compared to T1-weighted MFI obtained from subcutaneous and intermuscular fat. Results For every muscle, T1-weighted MFI calculated using subcutaneous fat scored significantly lower than Dixon MFI and T1-weighted MFI calculated using intermuscular fat (p < 0.001). There were no significant MFI differences between T1-weighted images calculated using intermuscular fat and Dixon images for M and L (p > 0.05), although significant differences were found for PS. Conclusion In sheep, Dixon sequences provide an acceptable comparison to T1-weighted sequences for lumbar extensor MFI based on intermuscular fat. However, compared to the human literature, ovine lumbar musculature contains greater MFI, making interspecies comparisons more complex.
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Affiliation(s)
- Stephanie Valentin
- Movement Science Group Vienna, Equine Clinic, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Tobey DeMott Yeates
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Theresia Licka
- Movement Science Group Vienna, Equine Clinic, University of Veterinary Medicine Vienna, Vienna, Austria.,Large Animal Hospital, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Roslin, Scotland, UK
| | - James Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
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Mhuiris ÁN, Volken T, Elliott JM, Hoggarth M, Samartzis D, Crawford RJ. Reliability of quantifying the spatial distribution of fatty infiltration in lumbar paravertebral muscles using a new segmentation method for T1-weighted MRI. BMC Musculoskelet Disord 2016; 17:234. [PMID: 27230072 PMCID: PMC4882844 DOI: 10.1186/s12891-016-1090-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/19/2016] [Indexed: 12/05/2022] Open
Abstract
Background To our knowledge, there are no methods allowing for quantification of the spatial distribution of lumbar paravertebral muscle fatty infiltration (FI) in the transverse plane. There is an increasing emphasis on muscle tissues as modifiable factors in lumbar spine health. Population datasets based on conventional T1-weighted (T1-W) magnetic resonance imaging (MRI) represent a valuable resource for examining all spinal tissues, and methods with reliability are needed. The aim of our study was to determine the reliability of a novel method quantifying lumbar paravertebral muscle fat content based on conventional T1-W MRI. Methods Axial 3-Tesla T1W MRIs from ten adult subjects (3W, 7M; mean age 52.8 ± SD 7.2 years) were randomly selected from the large prospective cross-sectional Hong Kong Population-based Disc Degeneration Cohort study examining lumbar spine degeneration. The selected sample included subjects with mixed imaging-determined disc degeneration and low back pain history. Two raters with MRI lumbar paravertebral muscle analysis experience (R1 > 250 h and R2 > 1000 h) repeat-measured the image-set a week apart. Multifidus and erector spinae (spinalis, longissimus and iliocostalis) were manually outlined together on a single-slice from the inferior vertebral end-plates of L1 to L5 using a semi-automated, quartile-defining (Q1-4 (medial to lateral) and Qmean) MatLab-based programme. Bland-Altman plots and intra-class correlation coefficients (ICC) with 95 % confidence intervals (CI) describe intra- and inter-rater reliability according to lumbar level, quartile, and side, and combined level and quartile. Results There was good intra- (ICC = 0.88; CI: 0.87–0.90) and inter-rater agreement (ICC = 0.82; CI: 0.80–0.84). Intra-rater values for Qmean (ICC; CI) were higher at L5 (0.89; 0.79–0.94) than L1 (0.61; 0.37–0.78). Higher intra-rater values for L1-5 were shown at Q1 (0.93; 0.91–0.95) than Q3 (0.83; 0.78–0.87) or Q4 (0.81; 0.76–0.85), and on the right (0.91; 0.90–0.93) than left (0.85; 0.83–0.88). Similar observations were made for inter-rater values in terms of lumbar level and quartile, with no differences between sides shown. Conclusions In our study of ten cases we demonstrate a reliable method to quantify the spatial distribution of fat content in lumbar paravertebral muscles based on T1W MRI. Understanding the geography of fat content in these muscles may offer additional insight in determining and improving spinal health. The clinical relevance and application of this method require testing across various populations to build on the early feasibility established in this study.
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Affiliation(s)
- Áine Ni Mhuiris
- Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, Postfach, CH-8401, Winterthur, Switzerland
| | - Thomas Volken
- Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, Postfach, CH-8401, Winterthur, Switzerland
| | - James M Elliott
- Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, Postfach, CH-8401, Winterthur, Switzerland.,Feinberg School of Medicine, Northwestern University, Chicago, USA.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Mark Hoggarth
- Feinberg School of Medicine, Northwestern University, Chicago, USA.,McCormick School of Engineering, Northwestern University, Evanston, USA
| | - Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfalum, Hong Kong, SAR China
| | - Rebecca J Crawford
- Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, Postfach, CH-8401, Winterthur, Switzerland. .,Faculty of Health Professions, Curtin University, Perth, Australia.
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Crawford RJ, Filli L, Elliott JM, Nanz D, Fischer MA, Marcon M, Ulbrich EJ. Age- and Level-Dependence of Fatty Infiltration in Lumbar Paravertebral Muscles of Healthy Volunteers. AJNR Am J Neuroradiol 2016; 37:742-8. [PMID: 26635285 DOI: 10.3174/ajnr.a4596] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/11/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Normative age-related decline in paravertebral muscle quality is important for reference to disease and risk identification in patients. We aimed to establish age- and vertebral level-dependence of paravertebral (multifidus and erector spinae) muscle volume and fat content in healthy adult volunteers. MATERIALS AND METHODS In this prospective study multifidus and erector spinae fat signal fraction and volume at lumbar levels L1-L5 were measured in 80 healthy volunteers (10 women and men per decade, 20-62 years of age) by 2-point Dixon 3T MR imaging. ANOVA with post hoc Bonferroni correction compared fat signal fraction and volume among subgroups. Pearson and Spearman analysis were used for correlations (P < .05). RESULTS Fat signal fraction was higher in women (17.8% ± 10.7%) than men (14.7% ± 7.8%; P < .001) and increased with age. Multifidus and erector spinae volume was lower in women (565.4 ± 83.8 cm(3)) than in men (811.6 ± 98.9 cm(3); P < .001) and was age-independent. No differences in fat signal fraction were shown between the right and left paravertebral muscles or among the L1, L2, and L3 lumbar levels. The fat signal fraction was highest at L5 (women, 31.9% ± 9.3%; men, 25.7% ± 8.0%; P < .001). The fat signal fraction at L4 correlated best with total lumbar fat signal fraction (women, r = 0.95; men, r = 0.92, P < .001). Total fat signal fraction was higher in the multifidus compared with erector spinae muscles at L1-L4 for both sexes (P < .001). CONCLUSIONS Lumbar paravertebral muscle fat content increases with aging, independent of volume, in healthy volunteers 20-62 years of age. Women, low lumbar levels, and the multifidus muscle are most affected. Further study examining younger and older subjects and the functional impact of fatty infiltrated paravertebral muscles are warranted.
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Affiliation(s)
- R J Crawford
- From the Centre for Health Sciences (R.J.C., J.M.E.), Zurich University of Applied Sciences, Winterthur, Switzerland Faculty of Health Professions (R.J.C.), Curtin University, Perth, Australia
| | - L Filli
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland
| | - J M Elliott
- From the Centre for Health Sciences (R.J.C., J.M.E.), Zurich University of Applied Sciences, Winterthur, Switzerland Feinberg School of Medicine (J.M.E.), Northwestern University, Chicago, Illinois School of Health and Rehabilitation Sciences (J.M.E.), University of Queensland, Brisbane, Australia
| | - D Nanz
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland
| | - M A Fischer
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland
| | - M Marcon
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland Institute of Diagnostic Radiology (M.M.), University Hospital Santa Maria della Misericordia, Udine, Italy
| | - E J Ulbrich
- Institute of Diagnostic and Interventional Radiology (L.F., D.N., M.A.F., M.M., E.J.U.), University Hospital and University of Zurich, Zurich, Switzerland
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Damon BM, Li K, Bryant ND. Magnetic resonance imaging of skeletal muscle disease. HANDBOOK OF CLINICAL NEUROLOGY 2016; 136:827-42. [PMID: 27430444 DOI: 10.1016/b978-0-444-53486-6.00041-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Neuromuscular diseases often exhibit a temporally varying, spatially heterogeneous, and multifaceted pathology. The goals of this chapter are to describe and evaluate the use of quantitative magnetic resonance imaging (MRI) methods to characterize muscle pathology. The following criteria are used for this evaluation: objective measurement of continuously distributed variables; clear and well-understood relationship to the pathology of interest; sensitivity to improvement or worsening of clinical status; and the measurement properties of accuracy and precision. Two major classes of MRI methods meet all of these criteria: (1) MRI methods for measuring muscle contractile volume or cross-sectional area by combining structural MRI and quantitative fat-water MRI; and (2) an MRI method for characterizing the edema caused by inflammation, the measurement of the transverse relaxation time constant (T2). These methods are evaluated with respect to the four criteria listed above and examples from neuromuscular disorders are provided. Finally, these methods are summarized and synthesized and recommendations for additional quantitative MRI developments are made.
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Affiliation(s)
- Bruce M Damon
- Vanderbilt University Institute of Imaging Science and the Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA; Departments of Biomedical Engineering and Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA.
| | - Ke Li
- Vanderbilt University Institute of Imaging Science and the Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
| | - Nathan D Bryant
- Vanderbilt University Institute of Imaging Science and the Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
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Agten CA, Rosskopf AB, Gerber C, Pfirrmann CWA. Quantification of early fatty infiltration of the rotator cuff muscles: comparison of multi-echo Dixon with single-voxel MR spectroscopy. Eur Radiol 2015; 26:3719-27. [PMID: 26679183 DOI: 10.1007/s00330-015-4144-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/08/2015] [Accepted: 11/30/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate quantification of early fatty infiltration in supraspinatus muscles with magnetic resonance (MR) imaging using a T2*-corrected multi-echo 3D-gradient-echo Dixon-based sequence (multi-echo Dixon) and compare it to proton-MR-spectroscopy. METHODS Sixty subjects (mean age 46 years, 41 men) with good supraspinatus muscle quality on 1.5 T MR imaging were included. Fat percentage (FP) in the supraspinatus muscle was quantified using a multi-echo Dixon compared to single-voxel MR spectroscopy as reference standard. In 18 subjects the multi-echo Dixon was repeated to assess test-retest reliability. Measurements based on multi-echo Dixon were performed by two independent readers by placing regions-of-interest (ROIs) in the supraspinatus muscle corresponding to the MR-spectroscopy voxel. Intraclass and concordance correlation coefficients (ICC/CCC) were used for statistical analysis. RESULTS Test-retest reliability was substantial for reader 1 (ICC = 0.757) and almost perfect for reader 2 (ICC = 0.873). Inter-reader reliability for multi-echo Dixon was almost perfect (ICC = 0.893, P < .0005). Mean FP in all 60 subjects with multi-echo Dixon was 3.5 ± 1.6 for reader 1, 3.7 ± 1.8 for reader 2, and 2.8 ± 1.4 with MR spectroscopy. Correlation between multi-echo Dixon and MR spectroscopy was moderate (CCC = 0.641). CONCLUSION The multi-echo Dixon sequence is a reliable method and comparable to MR-spectroscopy for quantification of low levels of fatty infiltration in the supraspinatus muscle. KEY POINTS • Multi-echo Dixon for low fat quantification in muscles is reliable. • Multi-echo Dixon low fat quantification is comparable to single-voxel MR spectroscopy • Multi-echo Dixon detects substantial differences in fatty infiltration within Goutallier 0-1.
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Affiliation(s)
- Christoph A Agten
- Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zurich, Switzerland. .,Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Andrea B Rosskopf
- Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christian Gerber
- Orthopaedic Surgery, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christian W A Pfirrmann
- Radiology, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Morrow JM, Sinclair CDJ, Fischmann A, Machado PM, Reilly MM, Yousry TA, Thornton JS, Hanna MG. MRI biomarker assessment of neuromuscular disease progression: a prospective observational cohort study. Lancet Neurol 2015; 15:65-77. [PMID: 26549782 PMCID: PMC4672173 DOI: 10.1016/s1474-4422(15)00242-2] [Citation(s) in RCA: 236] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 08/10/2015] [Accepted: 09/04/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND A substantial impediment to progress in trials of new therapies in neuromuscular disorders is the absence of responsive outcome measures that correlate with patient functional deficits and are sensitive to early disease processes. Irrespective of the primary molecular defect, neuromuscular disorder pathological processes include disturbance of intramuscular water distribution followed by intramuscular fat accumulation, both quantifiable by MRI. In pathologically distinct neuromuscular disorders, we aimed to determine the comparative responsiveness of MRI outcome measures over 1 year, the validity of MRI outcome measures by cross-sectional correlation against functionally relevant clinical measures, and the sensitivity of specific MRI indices to early muscle water changes before intramuscular fat accumulation beyond the healthy control range. METHODS We did a prospective observational cohort study of patients with either Charcot-Marie-Tooth disease 1A or inclusion body myositis who were attending the inherited neuropathy or muscle clinics at the Medical Research Council (MRC) Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK. Genetic confirmation of the chromosome 17p11.2 duplication was required for Charcot-Marie-Tooth disease 1A, and classification as pathologically or clinically definite by MRC criteria was required for inclusion body myositis. Exclusion criteria were concomitant diseases and safety-related MRI contraindications. Healthy age-matched and sex-matched controls were also recruited. Assessments were done at baseline and 1 year. The MRI outcomes-fat fraction, transverse relaxation time (T2), and magnetisation transfer ratio (MTR)-were analysed during the 12-month follow-up, by measuring correlation with functionally relevant clinical measures, and for T2 and MTR, sensitivity in muscles with fat fraction less than the 95th percentile of the control group. FINDINGS Between Jan 19, 2010, and July 7, 2011, we recruited 20 patients with Charcot-Marie-Tooth disease 1A, 20 patients with inclusion body myositis, and 29 healthy controls (allocated to one or both of the 20-participant matched-control subgroups). Whole muscle fat fraction increased significantly during the 12-month follow-up at calf level (mean absolute change 1.2%, 95% CI 0.5-1.9, p=0.002) but not thigh level (0.2%, -0.2 to 0.6, p=0.38) in patients with Charcot-Marie-Tooth disease 1A, and at calf level (2.6%, 1.3-4.0, p=0.002) and thigh level (3.3%, 1.8-4.9, p=0.0007) in patients with inclusion body myositis. Fat fraction correlated with the lower limb components of the inclusion body myositis functional rating score (ρ=-0.64, p=0.002) and the Charcot-Marie-Tooth examination score (ρ=0.63, p=0.003). Longitudinal T2 and MTR changed consistently with fat fraction but more variably. In muscles with a fat fraction lower than the control group 95th percentile, T2 was increased in patients compared with controls (regression coefficients: inclusion body myositis thigh 4.0 ms [SE 0.5], calf 3.5 ms [0.6]; Charcot-Marie-Tooth 1A thigh 1.0 ms [0.3], calf 2.0 ms [0.3]) and MTR reduced compared with controls (inclusion body myositis thigh -1.5 percentage units [pu; 0.2], calf -1.1 pu [0.2]; Charcot-Marie-Tooth 1A thigh -0.3 pu [0.1], calf -0.7 pu [0.1]). INTERPRETATION MRI outcome measures can monitor intramuscular fat accumulation with high responsiveness, show validity by correlation with conventional functional measures, and detect muscle water changes preceding marked intramuscular fat accumulation. Confirmation of our results in further cohorts with these and other muscle-wasting disorders would suggest that MRI biomarkers might prove valuable in experimental trials. FUNDING Medical Research Council UK.
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Affiliation(s)
- Jasper M Morrow
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Christopher D J Sinclair
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK; Neuroradiological Academic Unit, UCL Institute of Neurology, London, UK
| | - Arne Fischmann
- Neuroradiological Academic Unit, UCL Institute of Neurology, London, UK; Department of Radiology, University of Basel Hospital, Basel, Switzerland
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Mary M Reilly
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Tarek A Yousry
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK; Neuroradiological Academic Unit, UCL Institute of Neurology, London, UK; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK.
| | - John S Thornton
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK; Neuroradiological Academic Unit, UCL Institute of Neurology, London, UK; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Michael G Hanna
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
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Filli L, Ulbrich EJ, Guggenberger R, Boss A, Fischer MA, Del Grande F, Maurer B, Andreisek G. Effect of Gd-DOTA on fat quantification in skeletal muscle using two-point Dixon technique - preliminary data. Eur J Radiol 2015; 85:131-135. [PMID: 26724657 DOI: 10.1016/j.ejrad.2015.11.007] [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] [Received: 03/02/2015] [Revised: 10/25/2015] [Accepted: 11/02/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess differences in fat signal fraction (FSF) in skeletal muscle as determined by two-point Dixon technique at 3T before and after application of intravenous gadoterate meglumide (Gd-DOTA). MATERIALS AND METHODS Eight patients (mean age, 50.8 years; range, 41-72 years) underwent clinical whole-body MRI at 3T for myopathic symptoms. Two-point Dixon technique based T1-weighted turbo spin-echo images were acquired before and after the administration of intravenous Gd-DOTA. On both image sets, the FSF was calculated in the gluteus medius, gluteus maximus, and quadriceps muscles bilaterally. Pre- and post-contrast FSF values were compared by linear regression, Bland-Altman plot as well as paired Student t-tests with Bonferroni correction. RESULTS The mean pre- and post-contrast FSF of included muscles were 28.7%±14.9% and 27.8%±15.1%, respectively. Linear regression indicated almost equivalent FSF estimation between pre- and post-contrast measurements (sum of squared residuals R(2), 0.92±0.04; slope, 0.97; X-intercept, -0.05; Y-intercept, +0.05). The Bland-Altman plot revealed a minimal systematical bias of the post-contrast FSF measurements of -0.87%. Paired Student t-tests did not reveal significant differences (overall p-value, 0.168). CONCLUSION Gd-DOTA does not significantly influence FSF quantification in skeletal muscle based on the two-point Dixon technique at 3T.
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Affiliation(s)
- Lukas Filli
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland.
| | - Erika J Ulbrich
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Roman Guggenberger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Andreas Boss
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Michael A Fischer
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Britta Maurer
- Division of Rheumatology, University Hospital Zurich, University of Zurich, Switzerland
| | - Gustav Andreisek
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
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Picaud J, Collewet G, Idier J. Quantification of mass fat fraction in fish using water-fat separation MRI. Magn Reson Imaging 2015; 34:44-50. [PMID: 26481904 DOI: 10.1016/j.mri.2015.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 08/14/2015] [Accepted: 10/12/2015] [Indexed: 12/18/2022]
Abstract
Selection of fish with appropriate fat content and anatomic distribution is searched in fish industry. This necessitates fast and accurate measurements of mass fat fraction maps on a large number of fish. The objective of this work is to assess the relevance of MRI water-fat separation for this purpose. For the separation of the water and fat images we rely on a single T2(⁎) and a multiple peak fat spectrum model, the parameters of which are estimated using the "Varpro" method. The difference of proton density between fat and water and the lack of the signal from the macromolecules are taken into account to convert the obtained proton density fat fraction into mass fat fraction. We used 0.23T NMR to validate the method on 30 salmon steaks. The fat fraction values were in the range of 5% to 25%. Very good accordance was found between 1.5T MRI and NMR although MRI slightly overestimated the mass fat fraction. The R(2) of the linear regression was equal to 0.96 (P<10(-5)), the slope to 1.12 (CI.95=0.03). These results demonstrate that a good accuracy can be achieved. We also show that high throughput can be achieved since the measurements do not depend on the position and we conclude that, for example, it is feasible to quantify the mass fat fraction in fish steaks within about one minute per sample.
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Affiliation(s)
- Julien Picaud
- IRSTEA,17 avenue de Cucillé, CS 64427, 35044, Rennes Cedex, France; IRCCyN, CNRS, BP 92101 - 1 rue de la Noë - 44321 Nantes Cedex 3, France
| | | | - Jérôme Idier
- IRCCyN, CNRS, BP 92101 - 1 rue de la Noë - 44321 Nantes Cedex 3, France
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Quantitative Skeletal Muscle MRI: Part 2, MR Spectroscopy and T2 Relaxation Time Mapping-Comparison Between Boys With Duchenne Muscular Dystrophy and Healthy Boys. AJR Am J Roentgenol 2015. [PMID: 26204310 DOI: 10.2214/ajr.14.13755] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The purpose of this study is to validate the use of MR spectroscopy (MRS) in measuring muscular fat and to compare it with T2 maps in differentiating boys with Duchenne muscular dystrophy (DMD) from healthy boys. SUBJECTS AND METHODS Forty-two boys with DMD and 31 healthy boys were evaluated with MRI with (1)H-MRS and T2 maps. Grading of muscle fat and edema on conventional images, calculation of fat fractions ([fat / fat] + water) on MRS, and calculation of T2 fat values on T2 maps of the gluteus maximus and vastus lateralis muscles were performed. Group comparisons were made. The 95% reference interval (RI) of fat fraction for the control group was applied and compared with T2 map results. RESULTS Minimal fat on T1-weighted images was seen in 90.3% (gluteus maximus) and 71.0% (vastus lateralis) of healthy boys, versus 33.3% (gluteus maximus) and 52.4% (vastus lateralis) of boys with DMD. Muscle edema was seen in none of the healthy boys versus 52.4% (gluteus maximus) and 57.1% (vastus lateralis) of the boys with DMD. Fat fractions were higher in the DMD group (52.7%, gluteus maximus; 27.3%, vastus lateralis) than in the control group (12.8%, gluteus maximus; 13.7%, vastus lateralis) (p < 0.001). The 95% RI for gluteus maximus (38.7%) resulted in 61.9% sensitivity and 100% specificity for differentiating boys with DMD from healthy boys, whereas the value for vastus lateralis (17.8%) resulted in 76.2% sensitivity and 100% specificity; both had lower accuracy than did T2 maps (100% sensitivity and specificity). There was a positive correlation between T2 fat values and fat fractions (p < 0.0001). CONCLUSION In differentiation of the two groups, T2 maps were more accurate than MRS. Fat fractions can underestimate the actual amount of fat because of coexisting muscle edema in DMD.
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Yoo YH, Kim HS, Lee YH, Yoon CS, Paek MY, Yoo H, Kannengiesser S, Chung TS, Song HT, Suh JS, Kim S. Comparison of Multi-Echo Dixon Methods with Volume Interpolated Breath-Hold Gradient Echo Magnetic Resonance Imaging in Fat-Signal Fraction Quantification of Paravertebral Muscle. Korean J Radiol 2015; 16:1086-95. [PMID: 26357503 PMCID: PMC4559780 DOI: 10.3348/kjr.2015.16.5.1086] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/19/2015] [Indexed: 11/15/2022] Open
Abstract
Objective To assess whether multi-echo Dixon magnetic resonance (MR) imaging with simultaneous T2* estimation and correction yields more accurate fat-signal fraction (FF) measurement of the lumbar paravertebral muscles, in comparison with non-T2*-corrected two-echo Dixon or T2*-corrected three-echo Dixon, using the FF measurements from single-voxel MR spectroscopy as the reference standard. Materials and Methods Sixty patients with low back pain underwent MR imaging with a 1.5T scanner. FF mapping images automatically obtained using T2*-corrected Dixon technique with two (non-T2*-corrected), three, and six echoes, were compared with images from single-voxel MR spectroscopy at the paravertebral muscles on levels L4 through L5. FFs were measured directly by two radiologists, who independently drew the region of interest on the mapping images from the three sequences. Results A total of 117 spectroscopic measurements were performed either bilaterally (57 of 60 subjects) or unilaterally (3 of 60 subjects). The mean spectroscopic FF was 14.3 ± 11.7% (range, 1.9-63.7%). Interobserver agreement was excellent between the two radiologists. Lin's concordance correlation between the spectroscopic findings and all the imaging-based FFs were statistically significant (p < 0.001). FFs obtained from the T2*-corrected six-echo Dixon sequences showed a significantly better concordance with the spectroscopic data, with its concordance correlation coefficient being 0.99 and 0.98 (p < 0.001), as compared with two- or three-echo methods. Conclusion T2*-corrected six-echo Dixon sequence would be a better option than two- or three-echo methods for noninvasive quantification of lumbar muscle fat quantification.
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Affiliation(s)
- Yeon Hwa Yoo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Hak-Sun Kim
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Young Han Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Choon-Sik Yoon
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | | | - Hanna Yoo
- Biostatistics Collaboration Lab, Yonsei University College of Medicine, Seoul 03722, Korea
| | | | - Tae-Sub Chung
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Ho-Taek Song
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jin-Suck Suh
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
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Valentin S, Licka TF, Elliott J. MRI-determined lumbar muscle morphometry in man and sheep: potential biomechanical implications for ovine model to human spine translation. J Anat 2015. [PMID: 26200090 DOI: 10.1111/joa.12354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The sheep is a commonly used animal model for human lumbar spine surgery, but only in vitro investigations comparing the human and ovine spine exist. Spinal musculature has previously not been compared between man and sheep. This additional knowledge could further indicate to what extent these species are biomechanically similar. Therefore, the purpose of the study was to investigate spinal muscle morphometric properties using magnetic resonance imaging (MRI) in different age groups of healthy human participants and sheep in vivo. Healthy human participants (n = 24) and sheep (n = 17) of different age groups underwent T1-weighted MRI of the lumbar spine. Regions of interest of the muscles erector spinae (ES), multifidus (M) and psoas (PS) were identified. The ratio of flexor to extensor volume, ratio of M to ES volume, and muscle fat relative to an area of intermuscular fat were calculated. Sheep M to ES ratio was significantly smaller than in the human participants (sheep 0.16 ± 0.02; human 0.37 ± 0.05; P < 0.001), although flexor to extensor ratio was not significantly different between species (human 0.39 ± 0.08; sheep 0.43 ± 0.05; P = 0.06). Age did not influence any muscle ratio outcome. Sheep had significantly greater extensor muscle fat compared with the human participants (M left human 40.64%, sheep 53.81%; M right human 39.17%, sheep 51.33%; ES left human 40.86%, sheep 51.29%; ES right human 35.93%, sheep 44.38%; all median values; all P < 0.001), although PS did not show any significant between-species differences (PS left human 36.89%, sheep 33.67%; PS right human 32.78%, sheep 30.09%; P < 0.05). The apparent differences in the size and shape of sheep and human lumbar spine muscles may indicate dissimilar biomechanical and functional demands, which is an important consideration when translating to human surgical models.
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Affiliation(s)
- Stephanie Valentin
- Equine Clinic, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Theresia F Licka
- Equine Clinic, University of Veterinary Medicine Vienna, Vienna, Austria.,Royal (Dick) School of Veterinary Studies, Large Animal Hospital, University of Edinburgh, Roslin, UK
| | - James Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
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Zheng Y, Li W, Du J, Jin S, Li S, Zhao Y, Xu C, Wang Z, Lv H, Zhang W, Xiao J, Yuan Y. The trefoil with single fruit sign in muscle magnetic resonance imaging is highly specific for dystrophinopathies. Eur J Radiol 2015; 84:1992-8. [PMID: 26119801 DOI: 10.1016/j.ejrad.2015.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/11/2015] [Accepted: 06/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the diagnostic value of the trefoil (three leaflets formed by relative sparing of the sartorius, gracilis, and adductor longus) with single fruit sign (relative sparing of the semitendinosus) in the evaluation of thigh muscle magnetic resonance imaging (MRI) for dystrophinopathies. METHODS Five examiners blinded to any clinical data analyzed muscle MRI scans from 166 patients with dystrophinopathies (124 cases confirmed genetically and 42 cases confirmed by immunohistochemistry) and from 244 control patients, all treated in our hospital from 2011 to 2014. The controls were patients with other neuromuscular disorders and with dystrophinopathies excluded by genetic testing and/or muscle biopsy. Examiners assessed the presence or absence of the trefoil with single fruit sign approximately at the middle thigh cross-section. Results were analyzed for diagnostic accuracy and inter-examiner agreement. RESULTS Sensitivity of the trefoil with single fruit sign for all patients with dystrophinopathies was 41.6% (95% confidence interval (CI) of 34.0-49.5). However, specificity was 99.2% (95% CI 97.1-99.9). The positive predictive value (PPV) was 97.2% and negative predictive value (NPV) was 71.4%. Inter-examiner agreement was substantial (Kappa=0.66). The 69 dystrophinopathy patients whose MRIs exhibited the sign were significantly older than the 97 dystrophinopathy patients whose MRIs did not (Z=-3.970, P<0.001). CONCLUSIONS The trefoil with single fruit sign is a potential imaging marker for diagnosis of dystrophinopathies.
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Affiliation(s)
- Yiming Zheng
- Department of Neurology, Peking University First Hospital, China
| | - Wenzhu Li
- Department of Neurology, Peking University First Hospital, China
| | - Jing Du
- Department of Radiology, Peking University First Hospital, China
| | - Suqin Jin
- Department of Neurology, Peking University First Hospital, China
| | - Shanglin Li
- Department of Neurology, Peking University First Hospital, China
| | - Yawen Zhao
- Department of Neurology, Peking University First Hospital, China
| | - Chunxiao Xu
- Department of Neurology, Peking University First Hospital, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, China
| | - He Lv
- Department of Neurology, Peking University First Hospital, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, China
| | - Jiangxi Xiao
- Department of Radiology, Peking University First Hospital, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, China.
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The Rapid and Progressive Degeneration of the Cervical Multifidus in Whiplash: An MRI Study of Fatty Infiltration. Spine (Phila Pa 1976) 2015; 40:E694-700. [PMID: 25785961 PMCID: PMC4466088 DOI: 10.1097/brs.0000000000000891] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Single-center prospective longitudinal study. OBJECTIVE To study the (1) temporal development of muscle fatty infiltrates (MFI) in the cervical multifidi after whiplash, (2) differences in multifidi MFI between those who recover or report milder pain-related disability and those who report moderate/severe symptoms at 3 months, and (3) predictive value of multifidi MFI outcomes. SUMMARY OF BACKGROUND DATA The temporal development of MFI on conventional magnetic resonance image has been shown to be associated with specific aspects of pain and psychological factors. The replication of such findings has yet to be explored longitudinally. METHODS Thirty-six subjects with whiplash injury were enrolled at less than 1 week postinjury and classified at 3 months using percentage scores on the Neck Disability Index as recovered/mild (0%-28%) or severe (≥30%). A fat/water magnetic resonance imaging measure, patient self-report of pain-related disability, and post-traumatic stress disorder were collected at less than 1 week, 2 weeks, and 3 months postinjury. The effects of time and group (per Neck Disability Index) and the interaction of time by group on MFI were determined. Receiver operating characteristic curve analysis was used to determine a cut-point for MFI at 2 weeks to predict outcome at 3 months. RESULTS There was no difference in MFI across groups at enrolment. MFI values were significantly higher in the severe group than those in the recovered/mild group at 2 weeks and 3 months. The receiver operating characteristic curve analysis indicated that MFI levels of 20.5% or above resulted in a sensitivity of 87.5% and a specificity of 92.9% for predicting outcome at 3 months. CONCLUSION Consistent with previous evidence, muscle degeneration occurs soon after injury but only in those patients with poor functional recovery. This study provides further evidence that (1) multifidi MFI occur in tandem with known predictive risk factors (older age, pain-related disability, and post-traumatic stress disorder) and (2) routine imaging protocols may need to be reconsidered in the vast majority of patients after whiplash. LEVEL OF EVIDENCE 3.
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