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Liang W, Liu Y, Zhao Y, Chen Y, Yin Y, Zhai L, Li Z, Gong Z, Zhang J, Zhang M. Quantitative MRI Analysis of Brachial Plexus and Limb-Girdle Muscles in Upper Extremity Onset Amyotrophic Lateral Sclerosis. J Magn Reson Imaging 2024; 60:291-301. [PMID: 37767949 DOI: 10.1002/jmri.29027] [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: 07/20/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Recent evidence highlights the potential of axonal degeneration as a biomarker for amyotrophic lateral sclerosis (ALS) detection. However, the diagnostic potential of peripheral nerve axon changes in ALS remains unclear. PURPOSE To evaluate the diagnostic performance of quantitative MRI of the brachial plexus and limb-girdle muscles (LGMs) in patients with upper extremity onset of ALS. STUDY TYPE Retrospective. POPULATION 47 patients with upper extremity onset of ALS and 20 healthy volunteers. FIELD STRENGTH/SEQUENCE 3-T, three-dimensional sampling perfection with application-optimized contrasts using different flip angle evolutions with short-tau inversion recovery sequences, T2-weighted turbo spin-echo Dixon sequence. ASSESSMENT The cross-sectional area (CSA) and nerve-muscle T2 signal intensity ratio (nT2) of the bilateral brachial plexus as well as the CSA and fat fraction (FF) of the bilateral LGMs were assessed by two radiologists. Disease severity and clinical stage of ALS patients were assessed by two neurologists. STATISTICAL TESTS Student's t-test, Wilcoxon rank-sum test, binary logistic regression, interclass correlation coefficient, receiver operating characteristic analysis, and correlation analysis were performed for MRI quantitative metrics and clinical variables. Significance level: P < 0.05. RESULTS In the affected limbs of patients with ALS, the CSA of the brachial plexus roots, trunks, and cords and the nT2 values of the brachial plexus trunks were significantly smaller than in the healthy controls. In the LGMs, the affected limbs of ALS showed significantly smaller CSA and higher FF than controls. The model containing parameters such as brachial plexus trunk CSA, subscapularis CSA, infraspinatus CSA, and subscapularis FF had excellent diagnostic efficacy for ALS. Additionally, increased subscapularis FF and supraspinatus FF were correlated with disease severity, and subscapularis CSA was negatively correlated with the clinical stage. DATA CONCLUSION Brachial plexus thinning, LGM atrophy, and fatty infiltration might serve as MRI-derived biomarkers for ALS with upper extremity onset. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Weiqiang Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yali Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yangyang Yin
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Linhan Zhai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zehui Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenxiang Gong
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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El Khalfi R, Maupoint E, Chiavassa-Gandois H, Goumarre C, Filliole A, Lapègue F, Fabry V, Acket B, Laforet A, Sans N, Cintas P, Faruch-Bilfeld M. Assessment of whole-body muscle MRI for the early diagnosis of Amyotrophic Lateral Sclerosis. Eur J Radiol 2024; 176:111481. [PMID: 38703513 DOI: 10.1016/j.ejrad.2024.111481] [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: 12/14/2023] [Revised: 03/01/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES To evaluate muscle signal abnormalities on whole-body muscle MRI with T2 and diffusion-weighted imaging in early ALS stages. METHODS 101 muscles were analyzed in newly diagnosed ALS patients and healthy controls on a whole-body MRI protocol including four-point T2-Dixon imaging and diffusion-weighted imaging (b0 and b800). Sensitivity and inter-observer agreement were assessed. RESULTS 15 patients (mean age, 64 +/- 12 [SD], 9 men) who met the Awaji-Shima criteria for definite, probable or possible ALS and 9 healthy controls were assessed (mean age, 53 +/- 13 [SD], 2 men). 61 % of the muscles assessed in ALS patients (62/101) showed signal hyperintensities on T2-weighted imaging, mainly in the upper and lower extremities (legs, hands and feet). ALS patients had a significantly higher number of involved muscles compared to healthy controls (p = 0,006). Diffusion-weighted imaging allowed for the detection of additional involvement in 22 muscles, thus improving the sensitivity of whole-body MRI from 60 % (using T2-weighted imaging only) up to 80 % (with the combination of T2-weighted and diffusion-weighted imaging). CONCLUSIONS ALS patients exhibited significant muscle signal abnormalities on T2-weighted and diffusion-weighted imaging in early disease stages. Whole-body MRI could be used for pre-EMG mapping of muscle involvement in order to choose suitable targets, thus improving early diagnosis.
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Affiliation(s)
- Rokia El Khalfi
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France.
| | - Estelle Maupoint
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Hélène Chiavassa-Gandois
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Céline Goumarre
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Antoine Filliole
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Franck Lapègue
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Vincent Fabry
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Blandine Acket
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Anne Laforet
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Nicolas Sans
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Pascal Cintas
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Marie Faruch-Bilfeld
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France.
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Shin-Yi Lin C, Howells J, Rutkove S, Nandedkar S, Neuwirth C, Noto YI, Shahrizaila N, Whittaker RG, Bostock H, Burke D, Tankisi H. Neurophysiological and imaging biomarkers of lower motor neuron dysfunction in motor neuron diseases/amyotrophic lateral sclerosis: IFCN handbook chapter. Clin Neurophysiol 2024; 162:91-120. [PMID: 38603949 DOI: 10.1016/j.clinph.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/07/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024]
Abstract
This chapter discusses comprehensive neurophysiological biomarkers utilised in motor neuron disease (MND) and, in particular, its commonest form, amyotrophic lateral sclerosis (ALS). These encompass the conventional techniques including nerve conduction studies (NCS), needle and high-density surface electromyography (EMG) and H-reflex studies as well as novel techniques. In the last two decades, new methods of assessing the loss of motor units in a muscle have been developed, that are more convenient than earlier methods of motor unit number estimation (MUNE),and may use either electrical stimulation (e.g. MScanFit MUNE) or voluntary activation (MUNIX). Electrical impedance myography (EIM) is another novel approach for the evaluation that relies upon the application and measurement of high-frequency, low-intensity electrical current. Nerve excitability techniques (NET) also provide insights into the function of an axon and reflect the changes in resting membrane potential, ion channel dysfunction and the structural integrity of the axon and myelin sheath. Furthermore, imaging ultrasound techniques as well as magnetic resonance imaging are capable of detecting the constituents of morphological changes in the nerve and muscle. The chapter provides a critical description of the ability of each technique to provide neurophysiological insight into the complex pathophysiology of MND/ALS. However, it is important to recognise the strengths and limitations of each approach in order to clarify utility. These neurophysiological biomarkers have demonstrated reliability, specificity and provide additional information to validate and assess lower motor neuron dysfunction. Their use has expanded the knowledge about MND/ALS and enhanced our understanding of the relationship between motor units, axons, reflexes and other neural circuits in relation to clinical features of patients with MND/ALS at different stages of the disease. Taken together, the ultimate goal is to aid early diagnosis, distinguish potential disease mimics, monitor and stage disease progression, quantify response to treatment and develop potential therapeutic interventions.
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Affiliation(s)
- Cindy Shin-Yi Lin
- Faculty of Medicine and Health, Central Clinical School, Brain and Mind Centre, University of Sydney, Sydney 2006, Australia.
| | - James Howells
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Seward Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sanjeev Nandedkar
- Natus Medical Inc, Middleton, Wisconsin, USA and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christoph Neuwirth
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital, St. Gallen, Switzerland
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Roger G Whittaker
- Newcastle University Translational and Clinical Research Institute (NUTCRI), Newcastle University., Newcastle Upon Tyne, United Kingdom
| | - Hugh Bostock
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, WC1N 3BG, London, United Kingdom
| | - David Burke
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Tzeplaeff L, Jürs AV, Wohnrade C, Demleitner AF. Unraveling the Heterogeneity of ALS-A Call to Redefine Patient Stratification for Better Outcomes in Clinical Trials. Cells 2024; 13:452. [PMID: 38474416 PMCID: PMC10930688 DOI: 10.3390/cells13050452] [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: 01/31/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Despite tremendous efforts in basic research and a growing number of clinical trials aiming to find effective treatments, amyotrophic lateral sclerosis (ALS) remains an incurable disease. One possible reason for the lack of effective causative treatment options is that ALS may not be a single disease entity but rather may represent a clinical syndrome, with diverse genetic and molecular causes, histopathological alterations, and subsequent clinical presentations contributing to its complexity and variability among individuals. Defining a way to subcluster ALS patients is becoming a central endeavor in the field. Identifying specific clusters and applying them in clinical trials could enable the development of more effective treatments. This review aims to summarize the available data on heterogeneity in ALS with regard to various aspects, e.g., clinical, genetic, and molecular.
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Affiliation(s)
- Laura Tzeplaeff
- Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, 81675 München, Germany
| | - Alexandra V. Jürs
- Translational Neurodegeneration Section “Albrecht Kossel”, Department of Neurology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Camilla Wohnrade
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany;
| | - Antonia F. Demleitner
- Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, 81675 München, Germany
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5
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Perera T, Bencsik C, Pfeffer G, Mobach T. New SOD1 Mutation Causing Rapid Amyotrophic Lateral Sclerosis with Nerve Root Enhancement. Can J Neurol Sci 2023; 50:932-934. [PMID: 36321541 DOI: 10.1017/cjn.2022.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tefani Perera
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Caralyn Bencsik
- Department of Critical Care Medicine, Calgary, Alberta, Canada
| | - Gerald Pfeffer
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Theodore Mobach
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Zhang X, Wang C, Zheng D, Xiao H, Zhong Q. Magnetic resonance imaging evaluation of masticatory muscle changes in patients with primary trigeminal neuralgia before microvascular decompression. Medicine (Baltimore) 2022; 101:e31010. [PMID: 36254090 PMCID: PMC9575714 DOI: 10.1097/md.0000000000031010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Primary trigeminal neuralgia (PTN) is characterized by chronic neuropathic pain. There are few studies exploring masticatory muscle changes in patients with PTN. This study evaluated the changes in the masticatory muscles using magnetic resonance imaging (MRI) and the predictive factors of masticatory muscle changes in patients with PTN. The radiologic outcomes of 52 patients with PTN and 58 healthy adults were evaluated. The temporalis, lateral pterygoid, medial pterygoid, and masseter muscles were assessed using MRI. Atrophy and edema of the masticatory muscles were noted. Multivariate analyses were conducted to identify factors associated with masticatory muscle atrophy. Among the PTN group, the right side (61.5%) and mandibular branch (53.9%) were the most affected. Muscle atrophy of the temporalis (P < .001), medial pterygoid (P = .016), lateral pterygoid (P = .031), and masseter (P = .001) were significantly higher in the PTN group than in the control group. Lateral pterygoid edema was significantly higher in the PTN group (P < .001). However, no significant difference was found in the temporalis and masseter edema between the two groups. Logistic regression analysis demonstrated that neurovascular conflict (NVC) significantly predicted mastication muscle atrophy (P = .037). Patients with PTN had higher rates of masticatory muscle atrophy and edema. The assessment of NVC may be a preoperative imaging biomarker to predict atrophy in PTN.
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Affiliation(s)
- Xiaojuan Zhang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Radiology, 900th Hospital Logistic Support Forces of PLA, Fuzhou, China
| | - Chuandong Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Dan Zheng
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Radiology, 900th Hospital Logistic Support Forces of PLA, Fuzhou, China
| | - Hui Xiao
- Department of Radiology, 900th Hospital Logistic Support Forces of PLA, Fuzhou, China
- * Correspondence: Qun Zhong and Hui Xiao, Fuzong Clinical Medical College of Fujian Medical University and Department of Radiology, 900th Hospital Logistic Support Forces of PLA, Fuzhou 350001, China (e-mail: , )
| | - Qun Zhong
- Department of Radiology, 900th Hospital Logistic Support Forces of PLA, Fuzhou, China
- * Correspondence: Qun Zhong and Hui Xiao, Fuzong Clinical Medical College of Fujian Medical University and Department of Radiology, 900th Hospital Logistic Support Forces of PLA, Fuzhou 350001, China (e-mail: , )
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Cauda Equina Atrophy in Amyotrophic Lateral Sclerosis on Routine Lumbar Magnetic Resonance Imaging. J Comput Assist Tomogr 2022; 46:991-996. [PMID: 35759769 DOI: 10.1097/rct.0000000000001349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the cross-sectional area of the cauda equina in amyotrophic lateral sclerosis (ALS) on routine lumbar magnetic resonance imaging and investigate the diagnostic accuracy in comparison with age- and sex-matched non-ALS controls. METHODS This retrospective study included 15 ALS patients and 15 age- and sex-matched non-ALS controls. Two independent neuroradiologists measured and compared the total cross-sectional area of the cauda equina of ALS patients and the non-ALS controls at the level of the L3 and L4 using axial T2-weighted images. The cutoff value, sensitivity, specificity, and area under the curve were measured. The interobserver reproducibility of the 2 independently obtained measurements was evaluated. RESULTS The total cross-sectional area of the cauda equina in the ALS group was significantly smaller than that in the non-ALS group (L3: median, 66.73 vs 90.19 mm2, P < 0.001; L4: median, 52.9 vs 67.63 mm2, P < 0.001). The cutoff values at L3 and L4 were 76.95 and 61.04 mm2 with a sensitivity and specificity of 1 and 0.87 and 0.8 and 0.87, respectively. The area under the curve at L3 and L4 were high at 0.96 and 0.94, respectively. The interobserver reproducibility was 0.88 at L3 and 0.89 at L4. CONCLUSIONS The ALS patients showed significant atrophy of the cauda equina compared with non-ALS patients.
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Martínez-Payá J, Ríos-Díaz J, del Baño-Aledo M, Hervás D, Tembl-Ferrairó J, Sevilla-Mantecón T, Vázquez-Costa J. The cross-sectional area of the median nerve: An independent prognostic biomarker in amyotrophic lateral sclerosis. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Chu X, Du K, Tang Y, Zhao X, Yu M, Zheng Y, Deng J, Lv H, Zhang W, Wang Z, Yuan Y, Meng L. Skeletal Muscle Involvement Pattern of Hereditary Transthyretin Amyloidosis: A Study Based on Muscle MRI. Front Neurol 2022; 13:851190. [PMID: 35592471 PMCID: PMC9112281 DOI: 10.3389/fneur.2022.851190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/28/2022] [Indexed: 12/03/2022] Open
Abstract
Objects This study was intended to explore the characteristics of muscle magnetic resonance imaging (MRI) of patients with hereditary transthyretin amyloidosis (ATTRv amyloidosis) prospectively. Methods The clinical data of 20 patients with ATTRv amyloidosis at our hospital between July 2020 and August 2021 were analyzed. MRI of lower limbs including calf muscles was performed in all these 20 patients and MRI of thigh muscles was performed in 16 of them. Results The mean age of the 20 patients with ATTRv amyloidosis was 44.2 years (ranging from 26 to 60) whose mean duration of weakness was 23.3 ± 23.0 (ranging from 0 to 84) months. All the patients presented with polyneuropathy, and 18 of them with weakness in their lower limbs. Muscle involvement was selective in these patients with ATTRv amyloidosis. The posterior group of muscles was heavily fatty, and the soleus muscle was the most heavily involved. The proportion of fatty infiltration scores at the calf level was higher than at the thigh level with paired comparison for most patients. Three of these patients had more severely fatty infiltration of muscles at the thigh level. The fatty infiltration of posterior compartments at the calf level was highly consistent with neuropathy impairment scores of lower limbs (weakness), the strength of ankle plantar flexion muscles, and the amplitude of the compound muscle action potential of the tibial nerve. Conclusions It was found that the pattern of muscle fatty infiltration was consistent with a distal-to-proximal gradient on the whole and that proximal involvements in MRI of lower limbs in some patients could also be observed. Selective fatty infiltration of muscles of posterior compartments and fatty infiltration of the soleus muscle might be typical of ATTRv amyloidosis.
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Affiliation(s)
- Xujun Chu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Kang Du
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yuwei Tang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Xutong Zhao
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Meng Yu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yiming Zheng
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Jianwen Deng
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - He Lv
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
- Yun Yuan
| | - Lingchao Meng
- Department of Neurology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
- *Correspondence: Lingchao Meng
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Paoletti M, Diamanti L, Muzic SI, Ballante E, Solazzo F, Foppoli L, Deligianni X, Santini F, Figini S, Bergsland N, Pichiecchio A. Longitudinal Quantitative MRI Evaluation of Muscle Involvement in Amyotrophic Lateral Sclerosis. Front Neurol 2021; 12:749736. [PMID: 34899571 PMCID: PMC8651545 DOI: 10.3389/fneur.2021.749736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/11/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Biomarkers of disease progression and outcome measures are still lacking for patients with amyotrophic lateral sclerosis (ALS). Muscle MRI can be a promising candidate to track longitudinal changes and to predict response to the therapy in clinical trials. Objective: Our aim is to apply quantitative muscle MRI in the evaluation of disease progression, focusing on thigh and leg muscles of patients with ALS, and to explore the correlation between radiological and clinical scores. Methods: We enrolled newly diagnosed patients with ALS, longitudinally scored using the ALS Functional Rating Scale-Revised (ALSFRS-R), who underwent a 3T muscle MRI protocol including a 6-point Dixon gradient-echo sequence and multi-echo turbo spin echo (TSE) T2-weighted sequence for quantification of fat fraction (FF), cross-sectional area (CSA), and water T2 (wT2). A total of 12 muscles of the thigh and six muscles of the leg were assessed by the manual drawing of 18 regions of interest (ROIs), for each side. A group of 11 age-matched healthy controls (HCs) was enrolled for comparison. Results: 15 patients (M/F 8/7; mean age 62.2 years old, range 29-79) diagnosed with possible (n = 2), probable (n = 12), or definite (n = 1) ALS were enrolled. Eleven patients presented spinal onset, whereas four of them had initial bulbar involvement. All patients performed MRI at T0, nine of them at T1, and seven of them at T2. At baseline, wT2 was significantly elevated in ALS subjects compared to HCs for several muscles of the thigh and mainly for leg muscles. By contrast, FF was elevated in few muscles, and mainly at the level of the thigh. The applied mixed effects model showed that FF increased significantly in the leg muscles over time (mainly in the triceps surae) and that wT2 decreased significantly in line with worsening in the leg subscore of ALSFRS-R, mainly at the leg level and in the anterior and medial compartment of the thigh. Conclusions: Quantitative MRI represents a non-invasive tool that is able to outline the trajectory of pathogenic modifications at the muscle level in ALS. In particular, wT2 was found to be increased early in the clinical history of ALS and also tended to decrease over time, also showing a positive correlation with leg subscore of ALSFRS-R.
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Affiliation(s)
- Matteo Paoletti
- Neuroradiology Department, Advanced Imaging and Radiomics Center, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Luca Diamanti
- Neuro-Oncology Unit, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Shaun I Muzic
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Department of Radiology, Fondazione Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Policlinico San Matteo, Medical School University of Pavia, Pavia, Italy
| | - Elena Ballante
- Department of Mathematics, University of Pavia, Pavia, Italy.,BioData Science Center, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Francesca Solazzo
- Neuroradiology Department, Advanced Imaging and Radiomics Center, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Lia Foppoli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Xeni Deligianni
- Radiology/Division of Radiological Physics, University Hospital of Basel, Basel, Switzerland.,Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Francesco Santini
- Radiology/Division of Radiological Physics, University Hospital of Basel, Basel, Switzerland.,Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Silvia Figini
- Department of Political and Social Sciences, University of Pavia, Pavia, Italy
| | - Niels Bergsland
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States.,IRCCS Fondazione Don Carlo Gnocchi Organizzazione non lucrativa di utilità sociale (ONLUS), Milan, Italy
| | - Anna Pichiecchio
- Neuroradiology Department, Advanced Imaging and Radiomics Center, Istituto di Ricovero e Cura di Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Evans MC, Wade C, Hohenschurz-Schmidt D, Lally P, Ugwudike A, Shah K, Bangerter N, Sharp DJ, Rice ASC. Magnetic Resonance Imaging as a Biomarker in Diabetic and HIV-Associated Peripheral Neuropathy: A Systematic Review-Based Narrative. Front Neurosci 2021; 15:727311. [PMID: 34621152 PMCID: PMC8490874 DOI: 10.3389/fnins.2021.727311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/17/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Peripheral neuropathy can be caused by diabetes mellitus and HIV infection, and often leaves patients with treatment-resistant neuropathic pain. To better treat this condition, we need greater understanding of the pathogenesis, as well as objective biomarkers to predict treatment response. Magnetic resonance imaging (MRI) has a firm place as a biomarker for diseases of the central nervous system (CNS), but until recently has had little role for disease of the peripheral nervous system. Objectives: To review the current state-of-the-art of peripheral nerve MRI in diabetic and HIV symmetrical polyneuropathy. We used systematic literature search methods to identify all studies currently published, using this as a basis for a narrative review to discuss major findings in the literature. We also assessed risk of bias, as well as technical aspects of MRI and statistical analysis. Methods: Protocol was pre-registered on NIHR PROSPERO database. MEDLINE, Web of Science and EMBASE databases were searched from 1946 to 15th August 2020 for all studies investigating either diabetic or HIV neuropathy and MRI, focusing exclusively on studies investigating symmetrical polyneuropathy. The NIH quality assessment tool for observational and cross-sectional cohort studies was used for risk of bias assessment. Results: The search resulted in 18 papers eligible for review, 18 for diabetic neuropathy and 0 for HIV neuropathy. Risk of bias assessment demonstrated that studies generally lacked explicit sample size justifications, and some may be underpowered. Whilst most studies made efforts to balance groups for confounding variables (age, gender, BMI, disease duration), there was lack of consistency between studies. Overall, the literature provides convincing evidence that DPN is associated with larger nerve cross sectional area, T2-weighted hyperintense and hypointense lesions, evidence of nerve oedema on Dixon imaging, decreased fractional anisotropy and increased apparent diffusion coefficient compared with controls. Analysis to date is largely restricted to the sciatic nerve or its branches. Conclusions: There is emerging evidence that various structural MR metrics may be useful as biomarkers in diabetic polyneuropathy, and areas for future direction are discussed. Expanding this technique to other forms of peripheral neuropathy, including HIV neuropathy, would be of value. Systematic Review Registration: (identifier: CRD 42020167322) https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167322.
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Affiliation(s)
- Matthew C. Evans
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Brain Sciences, Care Research and Technology Centre, UK Dementia Research Institute, London, United Kingdom
| | - Charles Wade
- Department of Brain Sciences, Care Research and Technology Centre, UK Dementia Research Institute, London, United Kingdom
| | - David Hohenschurz-Schmidt
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Pete Lally
- Department of Brain Sciences, Care Research and Technology Centre, UK Dementia Research Institute, London, United Kingdom
- Royal School of Mines, Imperial College London, London, United Kingdom
| | - Albert Ugwudike
- Royal School of Mines, Imperial College London, London, United Kingdom
| | - Kamal Shah
- Royal School of Mines, Imperial College London, London, United Kingdom
| | - Neal Bangerter
- Royal School of Mines, Imperial College London, London, United Kingdom
| | - David J. Sharp
- Department of Brain Sciences, Care Research and Technology Centre, UK Dementia Research Institute, London, United Kingdom
| | - Andrew S. C. Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
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Kriss A, Jenkins T. Muscle MRI in motor neuron diseases: a systematic review. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:161-175. [PMID: 34151652 DOI: 10.1080/21678421.2021.1936062] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: To summarize applications of muscle magnetic resonance imaging (MRI) in cross-sectional assessment and longitudinal monitoring of motor neuron diseases and evaluate associations with clinical assessment techniques.Methods: PubMed and Scopus were searched for research published up to May 2021 relating to muscle MRI in motor neuron diseases, according to predefined inclusion and exclusion criteria. Studies were systematically appraised for bias and data were extracted for discussion.Results: Twenty-eight papers met inclusion criteria. The studies assessed muscle T1- and T2-weighted signal, diffusion, muscle volume, and fat infiltration, employing quantitative, qualitative, and semi-quantitative approaches. Various regions of interest were considered; changes in thigh and calf muscles were most frequently reported. Preliminary evidence of concordance between clinical and radiological findings and utility as an objective longitudinal biomarker is emerging.Conclusion: Muscle MRI appears a promising objective, versatile, and practical biomarker to assess motor neuron diseases.
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Affiliation(s)
| | - Thomas Jenkins
- Sheffield Institute for Translational Neuroscience, University of Sheffield, UK
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13
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Lucchini M, Bortolani S, Monforte M, Papacci M, Ricci E, Mirabella M, Tasca G. Long-term Follow-up and Muscle Imaging Findings in Brachio-Cervical Inflammatory Myopathy. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/4/e1016. [PMID: 34011678 PMCID: PMC8192058 DOI: 10.1212/nxi.0000000000001016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/17/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report on a cohort of patients diagnosed with brachio-cervical inflammatory myopathy (BCIM), with specific focus on muscle MRI and follow-up data. METHODS Clinical, histopathologic, serologic, and pre- and post-treatment MRI findings of patients diagnosed with BCIM were retrospectively evaluated. RESULTS Six patients, all females with a mean age at onset of 53 years (range 37-62 years), were identified. Mean diagnostic delay was 17 months, and mean follow-up was 35 months. Most common clinical features encompassed predominant involvement of neck and proximal upper limb muscles, followed by distal upper limb, facial, and bulbar muscle weakness with different severity. Lower limb involvement was rare, although present in severe cases. Muscle biopsies showed a heterogeneous degree of perivascular and endomysial inflammatory changes. Myositis-specific antibodies were absent in all patients, whereas all resulted positive for antinuclear antibodies; half of the patients had anti-acetylcholine receptor antibodies without evidence of muscle fatigability. MRI showed disproportionate involvement of upper girdle and neck muscles compared with lower limbs, with frequent hyperintensities on short-tau inversion recovery sequences. Partial clinical and radiologic improvement with steroid and immunosuppressant therapy was obtained in most patients, especially in proximal upper limb muscles, whereas neck weakness persisted. CONCLUSION BCIM is an inflammatory myopathy with a peculiar clinical and radiologic presentation and a relatively broad spectrum of severity. Long-term follow-up data suggest that appropriate and early treatment can prevent chronic muscle function impairment. MRI characterization can be helpful in reducing diagnostic and treatment delay with positive consequence on clinical outcome.
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Affiliation(s)
- Matteo Lucchini
- From the UOC di Neurologia (M.L., S.B., M. Monforte., E.R., M. Mirabella, G.T.), Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; and Università Cattolica del Sacro Cuore (M.L., M.P., E.R., M. Mirabella), Rome, Italy.
| | - Sara Bortolani
- From the UOC di Neurologia (M.L., S.B., M. Monforte., E.R., M. Mirabella, G.T.), Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; and Università Cattolica del Sacro Cuore (M.L., M.P., E.R., M. Mirabella), Rome, Italy
| | - Mauro Monforte
- From the UOC di Neurologia (M.L., S.B., M. Monforte., E.R., M. Mirabella, G.T.), Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; and Università Cattolica del Sacro Cuore (M.L., M.P., E.R., M. Mirabella), Rome, Italy
| | - Manuela Papacci
- From the UOC di Neurologia (M.L., S.B., M. Monforte., E.R., M. Mirabella, G.T.), Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; and Università Cattolica del Sacro Cuore (M.L., M.P., E.R., M. Mirabella), Rome, Italy
| | - Enzo Ricci
- From the UOC di Neurologia (M.L., S.B., M. Monforte., E.R., M. Mirabella, G.T.), Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; and Università Cattolica del Sacro Cuore (M.L., M.P., E.R., M. Mirabella), Rome, Italy
| | - Massimiliano Mirabella
- From the UOC di Neurologia (M.L., S.B., M. Monforte., E.R., M. Mirabella, G.T.), Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; and Università Cattolica del Sacro Cuore (M.L., M.P., E.R., M. Mirabella), Rome, Italy
| | - Giorgio Tasca
- From the UOC di Neurologia (M.L., S.B., M. Monforte., E.R., M. Mirabella, G.T.), Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; and Università Cattolica del Sacro Cuore (M.L., M.P., E.R., M. Mirabella), Rome, Italy
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Schreiber S, Vielhaber S, Schreiber F, Cartwright MS. Peripheral nerve imaging in amyotrophic lateral sclerosis. Clin Neurophysiol 2020; 131:2315-2326. [DOI: 10.1016/j.clinph.2020.03.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/20/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
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15
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Dörner M, Schreiber F, Stephanik H, Tempelmann C, Winter N, Stahl JH, Wittlinger J, Willikens S, Kramer M, Heinze HJ, Vielhaber S, Schelle T, Grimm A, Schreiber S. Peripheral Nerve Imaging Aids in the Diagnosis of Immune-Mediated Neuropathies-A Case Series. Diagnostics (Basel) 2020; 10:E535. [PMID: 32751486 PMCID: PMC7459443 DOI: 10.3390/diagnostics10080535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diagnosis of immune-mediated neuropathies and their differentiation from amyotrophic lateral sclerosis (ALS) can be challenging, especially at early disease stages. Accurate diagnosis is, however, important due to the different prognosis and available treatment options. We present one patient with a left-sided dorsal flexor paresis and initial suspicion of ALS and another with multifocal sensory deficits. In both, peripheral nerve imaging was the key for diagnosis. METHODS We performed high-resolution nerve ultrasound (HRUS) and 7T or 3T magnetic resonance neurography (MRN). RESULTS In both patients, HRUS revealed mild to severe, segmental or inhomogeneous, nerve enlargement at multiple sites, as well as an area increase of isolated fascicles. MRN depicted T2 hyperintense nerves with additional contrast-enhancement. DISCUSSION Peripheral nerve imaging was compatible with the respective diagnosis of an immune-mediated neuropathy, i.e., multifocal motor neuropathy (MMN) in patient 1 and multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) in patient 2. Peripheral nerve imaging, especially HRUS, should play an important role in the diagnostic work-up for immune-mediated neuropathies and their differentiation from ALS.
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Affiliation(s)
- Marc Dörner
- Center for Neurology, Tuebingen University Hospital and Hertie-Institute for Clinical Brain Research, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (N.W.); (J.-H.S.); (J.W.); (S.W.); (M.K.); (A.G.)
| | - Frank Schreiber
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (H.S.); (C.T.); (H.-J.H.); (S.V.); (S.S.)
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
| | - Heike Stephanik
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (H.S.); (C.T.); (H.-J.H.); (S.V.); (S.S.)
| | - Claus Tempelmann
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (H.S.); (C.T.); (H.-J.H.); (S.V.); (S.S.)
| | - Natalie Winter
- Center for Neurology, Tuebingen University Hospital and Hertie-Institute for Clinical Brain Research, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (N.W.); (J.-H.S.); (J.W.); (S.W.); (M.K.); (A.G.)
| | - Jan-Hendrik Stahl
- Center for Neurology, Tuebingen University Hospital and Hertie-Institute for Clinical Brain Research, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (N.W.); (J.-H.S.); (J.W.); (S.W.); (M.K.); (A.G.)
| | - Julia Wittlinger
- Center for Neurology, Tuebingen University Hospital and Hertie-Institute for Clinical Brain Research, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (N.W.); (J.-H.S.); (J.W.); (S.W.); (M.K.); (A.G.)
| | - Sophia Willikens
- Center for Neurology, Tuebingen University Hospital and Hertie-Institute for Clinical Brain Research, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (N.W.); (J.-H.S.); (J.W.); (S.W.); (M.K.); (A.G.)
| | - Magdalena Kramer
- Center for Neurology, Tuebingen University Hospital and Hertie-Institute for Clinical Brain Research, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (N.W.); (J.-H.S.); (J.W.); (S.W.); (M.K.); (A.G.)
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (H.S.); (C.T.); (H.-J.H.); (S.V.); (S.S.)
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
- Center for Behavioural Brain Sciences (CBBS), 39120 Magdeburg, Germany
- Leibniz Institue for Neurobiology (LIN), 39120 Magdeburg, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (H.S.); (C.T.); (H.-J.H.); (S.V.); (S.S.)
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
- Center for Behavioural Brain Sciences (CBBS), 39120 Magdeburg, Germany
| | - Thomas Schelle
- Department of Neurology, Städtisches Klinikum Dessau, 06847 Dessau, Germany;
| | - Alexander Grimm
- Center for Neurology, Tuebingen University Hospital and Hertie-Institute for Clinical Brain Research, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (N.W.); (J.-H.S.); (J.W.); (S.W.); (M.K.); (A.G.)
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (H.S.); (C.T.); (H.-J.H.); (S.V.); (S.S.)
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
- Center for Behavioural Brain Sciences (CBBS), 39120 Magdeburg, Germany
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16
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Mazal AT, Faramarzalian A, Samet JD, Gill K, Cheng J, Chhabra A. MR neurography of the brachial plexus in adult and pediatric age groups: evolution, recent advances, and future directions. Expert Rev Med Devices 2020; 17:111-122. [PMID: 31964194 DOI: 10.1080/17434440.2020.1719830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: MR neurography (MRN) of the brachial plexus has emerged in recent years as a safe and accurate modality for the identification of brachial plexopathies in pediatric and adult populations. While clinical differentiation of brachial plexopathy from cervical spine-related radiculopathy or nerve injury has long relied upon nonspecific physical exam and electrodiagnostic testing modalities, MRN now permits detailed interrogation of peripheral nerve anatomy and pathology, as well as assessment of surrounding soft tissues and musculature, thereby facilitating accurate diagnosis. The reader will learn about the current state of brachial plexus MRN, including recent advances and future directions, and gain knowledge about the adult and pediatric brachial plexopathies that can be characterized using these techniques.Areas Covered: The review details recent developments in brachial plexus MRN, including increasing availability of 3.0-T MR scanners at both private and academic diagnostic imaging centers, as well as the advent of multiple new vascular and fat signal suppression techniques. A literature search of PubMed and SCOPUS was used as the principal source of information gathered for this review.Expert Opinion: Refinement of fat-suppression, 3D techniques and diffusion MR imaging modalities has improved the accuracy of MRN, rendering it as a useful adjunct to clinical findings during the evaluation of suspected brachial plexus lesions.
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Affiliation(s)
- Alexander T Mazal
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ali Faramarzalian
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jonathan D Samet
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin Gill
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jonathan Cheng
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA.,Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
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17
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Protean Manifestations and Diagnostic Challenges Including Discordance Between Electrodiagnostic-Radiologic Studies in Neurolymphomatosis. Neurologist 2020; 25:4-9. [DOI: 10.1097/nrl.0000000000000245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Corazza G, Le Corroller T, Grapperon AM, Salort-Campana E, Verschueren A, Attarian S, Delmont E. Comparison of MRI and motor evoked potential with triple stimulation technique for the detection of brachial plexus abnormalities in multifocal motor neuropathy. Muscle Nerve 2019; 61:325-329. [PMID: 31792993 DOI: 10.1002/mus.26773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Conduction blocks (CB) are the diagnostic hallmark of multifocal motor neuropathy (MMN). Conventional nerve conduction studies cannot detect CB above Erb's point. Our purpose was to compare the performance of the motor evoked potential with triple stimulation technique (MEP-TST) and MRI in the detection of abnormalities of the brachial plexus. METHODS Examinations were performed on 26 patients with MMN (11 definite, 6 probable, 9 possible), of whom 7 had no CB. RESULTS MEP-TST detected proximal CB in 19/26 patients. Plexus MRI showed T2 hyperintensity in 18/26 patients, with nerve enlargement in 14/18. A combination of both techniques increased the detection rate of brachial plexus abnormalities to 96% of patients (25/26). CONCLUSIONS MEP-TST and MRI have high sensitivities for detecting brachial plexus abnormalities. A combination of the two techniques increases the detection rate of supportive criteria for the diagnosis of MMN.
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Affiliation(s)
- Giovanni Corazza
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | - Thomas Le Corroller
- Department of Radiology, Institute for Locomotion, Hôpital Sainte-Marguerite, Marseille, France
| | - Aude-Marie Grapperon
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | | | - Annie Verschueren
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | - Shahram Attarian
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France
| | - Emilien Delmont
- Referral Centre for Neuromuscular Diseases and ALS, Hôpital La Timone, Marseille, France.,Aix-Marseille University, Timone Neuroscience Institute, UMR CNRS 7289, Marseille, France
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19
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Jenkins TM, Alix JJP, Fingret J, Esmail T, Hoggard N, Baster K, McDermott CJ, Wilkinson ID, Shaw PJ. Longitudinal multi-modal muscle-based biomarker assessment in motor neuron disease. J Neurol 2019; 267:244-256. [PMID: 31624953 PMCID: PMC6954906 DOI: 10.1007/s00415-019-09580-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 12/29/2022]
Abstract
Background Clinical phenotypic heterogeneity represents a major barrier to trials in motor neuron disease (MND) and objective surrogate outcome measures are required, especially for slowly progressive patients. We assessed responsiveness of clinical, electrophysiological and radiological muscle-based assessments to detect MND-related progression. Materials and methods A prospective, longitudinal cohort study of 29 MND patients and 22 healthy controls was performed. Clinical measures, electrophysiological motor unit number index/size (MUNIX/MUSIX) and relative T2- and diffusion-weighted whole-body muscle magnetic resonance (MR) were assessed three times over 12 months. Multi-variable regression models assessed between-group differences, clinico-electrophysiological associations, and longitudinal changes. Standardized response means (SRMs) assessed sensitivity to change over 12 months. Results MND patients exhibited 18% higher whole-body mean muscle relative T2-signal than controls (95% CI 7–29%, p < 0.01), maximal in leg muscles (left tibialis anterior 71% (95% CI 33–122%, p < 0.01). Clinical and electrophysiological associations were evident. By 12 months, 16 patients had died or could not continue. In the remainder, relative T2-signal increased over 12 months by 14–29% in right tibialis anterior, right quadriceps, bilateral hamstrings and gastrocnemius/soleus (p < 0.01), independent of onset-site, and paralleled progressive weakness and electrophysiological loss of motor units. Highest clinical, electrophysiological and radiological SRMs were found for revised ALS-functional rating scale scores (1.22), tibialis anterior MUNIX (1.59), and relative T2-weighted leg muscle MR (right hamstrings: 0.98), respectively. Diffusion MR detected minimal changes. Conclusion MUNIX and relative T2-weighted MR represent objective surrogate markers of progressive denervation in MND. Radiological changes were maximal in leg muscles, irrespective of clinical onset-site. Electronic supplementary material The online version of this article (10.1007/s00415-019-09580-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas M Jenkins
- Sheffield Institute for Translational Neuroscience, University of Sheffield, 385a Glossop Road, Sheffield, S10 2HQ, UK. .,Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - James J P Alix
- Sheffield Institute for Translational Neuroscience, University of Sheffield, 385a Glossop Road, Sheffield, S10 2HQ, UK.,Departments of Neurophysiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jacob Fingret
- Sheffield Institute for Translational Neuroscience, University of Sheffield, 385a Glossop Road, Sheffield, S10 2HQ, UK
| | - Taniya Esmail
- Sheffield Institute for Translational Neuroscience, University of Sheffield, 385a Glossop Road, Sheffield, S10 2HQ, UK
| | - Nigel Hoggard
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Kathleen Baster
- Statistics Services Unit, School of Mathematics and Statistics, University of Sheffield, Sheffield, UK
| | - Christopher J McDermott
- Sheffield Institute for Translational Neuroscience, University of Sheffield, 385a Glossop Road, Sheffield, S10 2HQ, UK.,Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Iain D Wilkinson
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, 385a Glossop Road, Sheffield, S10 2HQ, UK.,Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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20
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Gentile F, Scarlino S, Falzone YM, Lunetta C, Tremolizzo L, Quattrini A, Riva N. The Peripheral Nervous System in Amyotrophic Lateral Sclerosis: Opportunities for Translational Research. Front Neurosci 2019; 13:601. [PMID: 31293369 PMCID: PMC6603245 DOI: 10.3389/fnins.2019.00601] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/27/2019] [Indexed: 12/11/2022] Open
Abstract
Although amyotrophic lateral sclerosis (ALS) has been considered as a disorder of the motor neuron (MN) cell body, recent evidences show the non-cell-autonomous pathogenic nature of the disease. Axonal degeneration, loss of peripheral axons and destruction of nerve terminals are early events in the disease pathogenic cascade, anticipating MN degeneration, and the onset of clinical symptoms. Therefore, although ALS and peripheral axonal neuropathies should be differentiated in clinical practice, they also share damage to common molecular pathways, including axonal transport, RNA metabolism and proteostasis. Thus, an extensive evaluation of the molecular events occurring in the peripheral nervous system (PNS) could be fundamental to understand the pathogenic mechanisms of ALS, favoring the discovery of potential disease biomarkers, and new therapeutic targets.
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Affiliation(s)
- Francesco Gentile
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology – San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Scarlino
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology – San Raffaele Scientific Institute, Milan, Italy
| | - Yuri Matteo Falzone
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology – San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Lucio Tremolizzo
- Neurology Unit, ALS Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Angelo Quattrini
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology – San Raffaele Scientific Institute, Milan, Italy
| | - Nilo Riva
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology – San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
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21
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Kronlage M, Knop KC, Schwarz D, Godel T, Heiland S, Bendszus M, Bäumer P. Amyotrophic Lateral Sclerosis versus Multifocal Motor Neuropathy: Utility of MR Neurography. Radiology 2019; 292:149-156. [PMID: 31063079 DOI: 10.1148/radiol.2019182538] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Differential diagnosis between amyotrophic lateral sclerosis (ALS) and multifocal motor neuropathy (MMN) relies on clinical examination and electrophysiological criteria. Peripheral nerve imaging might assist this differential diagnosis. Purpose To assess diagnostic accuracy of MR neurography in the differential diagnosis of ALS and MMN. Materials and Methods This prospective study was conducted between December 2015 and April 2017. Study participants with ALS or MMN underwent MR neurography of the lumbosacral plexus, midthigh, proximal calf, and midupper arm of the clinically more affected side using high-resolution T2-weighted sequences. Matched healthy study participants who underwent MR neurography served as a control group. Two blinded readers independently rated fascicular lesions and muscle denervation signs on a five-point scale and made an image-only diagnosis, which was compared with the clinical diagnosis to assess diagnostic accuracy (reported for ALS vs non-ALS and MMN vs non-MMN). The Kruskal-Wallis test was used to compare readers' scoring results. Results Twenty-two participants with ALS (12 men and 10 women; mean age ± standard deviation, 62.3 years ± 9.0), eight participants with MMN (seven men and one woman; mean age, 57.6 years ± 18.6), and 15 healthy participants (seven men and eight women; mean age, 59.1 years ± 10.9) were enrolled in this study. Nerves of participants with ALS either appeared normal or showed T2-weighted hyperintensities without fascicular enlargement (reader 1, 22 of 22 participants; reader 2, 21 of 22 participants). In contrast, nerves in MMN were characterized by fascicular swellings (reader 1, six of eight participants; reader 2, seven of eight participants). Muscle denervation signs were more prominent in ALS than in MMN. Inter-rater reliability for blinded diagnosis was κ of 0.82. By consensus, the sensitivity to diagnose ALS (vs MMN and healthy control participants) was 19 of 22 (86% [95% confidence interval {CI}: 67%, 95%]). The corresponding specificity was 23 of 23 (100% [95% CI: 86%, 100%]). The sensitivity to diagnose MMN (vs ALS and healthy control participants) was seven of eight (88% [95% CI: 53%, 99%]). The corresponding specificity was 37 of 37 (100% [95% CI: 91%, 100%]). Conclusion MR neurography is an accurate method for assisting in the differential diagnosis of amyotrophic lateral sclerosis and multifocal motor neuropathy. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Andreisek in this issue.
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Affiliation(s)
- Moritz Kronlage
- From the Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (M.K., D.S., T.G., S.H., M.B., P.B.); Neurologie Neuer Wall, Hamburg, Germany (K.C.K.); Department of Radiology, German Cancer Research Center, Heidelberg, Germany (P.B.); and dia.log, Altoetting Center for Radiology, Altoetting, Germany (P.B.)
| | - Karl Christian Knop
- From the Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (M.K., D.S., T.G., S.H., M.B., P.B.); Neurologie Neuer Wall, Hamburg, Germany (K.C.K.); Department of Radiology, German Cancer Research Center, Heidelberg, Germany (P.B.); and dia.log, Altoetting Center for Radiology, Altoetting, Germany (P.B.)
| | - Daniel Schwarz
- From the Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (M.K., D.S., T.G., S.H., M.B., P.B.); Neurologie Neuer Wall, Hamburg, Germany (K.C.K.); Department of Radiology, German Cancer Research Center, Heidelberg, Germany (P.B.); and dia.log, Altoetting Center for Radiology, Altoetting, Germany (P.B.)
| | - Tim Godel
- From the Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (M.K., D.S., T.G., S.H., M.B., P.B.); Neurologie Neuer Wall, Hamburg, Germany (K.C.K.); Department of Radiology, German Cancer Research Center, Heidelberg, Germany (P.B.); and dia.log, Altoetting Center for Radiology, Altoetting, Germany (P.B.)
| | - Sabine Heiland
- From the Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (M.K., D.S., T.G., S.H., M.B., P.B.); Neurologie Neuer Wall, Hamburg, Germany (K.C.K.); Department of Radiology, German Cancer Research Center, Heidelberg, Germany (P.B.); and dia.log, Altoetting Center for Radiology, Altoetting, Germany (P.B.)
| | - Martin Bendszus
- From the Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (M.K., D.S., T.G., S.H., M.B., P.B.); Neurologie Neuer Wall, Hamburg, Germany (K.C.K.); Department of Radiology, German Cancer Research Center, Heidelberg, Germany (P.B.); and dia.log, Altoetting Center for Radiology, Altoetting, Germany (P.B.)
| | - Philipp Bäumer
- From the Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany (M.K., D.S., T.G., S.H., M.B., P.B.); Neurologie Neuer Wall, Hamburg, Germany (K.C.K.); Department of Radiology, German Cancer Research Center, Heidelberg, Germany (P.B.); and dia.log, Altoetting Center for Radiology, Altoetting, Germany (P.B.)
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22
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Verber NS, Shepheard SR, Sassani M, McDonough HE, Moore SA, Alix JJP, Wilkinson ID, Jenkins TM, Shaw PJ. Biomarkers in Motor Neuron Disease: A State of the Art Review. Front Neurol 2019; 10:291. [PMID: 31001186 PMCID: PMC6456669 DOI: 10.3389/fneur.2019.00291] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/06/2019] [Indexed: 12/17/2022] Open
Abstract
Motor neuron disease can be viewed as an umbrella term describing a heterogeneous group of conditions, all of which are relentlessly progressive and ultimately fatal. The average life expectancy is 2 years, but with a broad range of months to decades. Biomarker research deepens disease understanding through exploration of pathophysiological mechanisms which, in turn, highlights targets for novel therapies. It also allows differentiation of the disease population into sub-groups, which serves two general purposes: (a) provides clinicians with information to better guide their patients in terms of disease progression, and (b) guides clinical trial design so that an intervention may be shown to be effective if population variation is controlled for. Biomarkers also have the potential to provide monitoring during clinical trials to ensure target engagement. This review highlights biomarkers that have emerged from the fields of systemic measurements including biochemistry (blood, cerebrospinal fluid, and urine analysis); imaging and electrophysiology, and gives examples of how a combinatorial approach may yield the best results. We emphasize the importance of systematic sample collection and analysis, and the need to correlate biomarker findings with detailed phenotype and genotype data.
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Affiliation(s)
- Nick S Verber
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Stephanie R Shepheard
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Matilde Sassani
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Harry E McDonough
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Sophie A Moore
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - James J P Alix
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Iain D Wilkinson
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Tom M Jenkins
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Pamela J Shaw
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
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23
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A pilot study assessing T1-weighted muscle MRI in amyotrophic lateral sclerosis (ALS). Skeletal Radiol 2019; 48:569-575. [PMID: 30225607 DOI: 10.1007/s00256-018-3073-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 09/02/2018] [Accepted: 09/09/2018] [Indexed: 02/02/2023]
Abstract
The authors set out to study the role of T1-weighted muscle MRI in the diagnostic phase of ALS, comparing images from ten patients and nine age-matched healthy controls (HCs). All subjects underwent MRI of 68 muscles in the hands, paraspinal regions and lower limbs; the images were semi-quantitatively scored. Atrophy was more frequent in muscles of ALS patients than HCs (p < 0.0001); fatty infiltration was particularly marked in iliopsoas (p = 0.046), anterior (p = 0.020) and posterior (p = 0.047) calf muscles in patients. A trend towards agreement was found between MRI and clinic-EMG data for the first dorsal interosseous, paraspinal, and tibial anterior muscles. Muscle T1-weighted MRI can distinguish ALS patients from HCs for specific regions (i.e., legs). MRI abnormalities could be found in pauci-symptomatic spinal muscles in bulbar-onset patients. Muscle MRI may be a useful diagnostic tool in ALS, in particular for muscles difficult to investigate using clinical-EMG methods.
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24
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Kirk SE, Tracey TJ, Steyn FJ, Ngo ST. Biomarkers of Metabolism in Amyotrophic Lateral Sclerosis. Front Neurol 2019; 10:191. [PMID: 30936848 PMCID: PMC6431787 DOI: 10.3389/fneur.2019.00191] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/14/2019] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by the deterioration of motor neurons. However, this complex disease extends beyond the boundaries of the central nervous system, with metabolic alterations being observed at the systemic and cellular level. While the number of studies that assess the role and impact of metabolic perturbations in ALS is rapidly increasing, the use of metabolism biomarkers in ALS remains largely underinvestigated. In this review, we discuss current and potential metabolism biomarkers in the context of ALS. Of those for which data does exist, there is limited insight provided by individual markers, with specificity for disease, and lack of reproducibility and efficacy in informing prognosis being the largest drawbacks. However, given the array of metabolic markers available, the potential exists for a panel of metabolism biomarkers, which may complement other current biomarkers (including neurophysiology, imaging, as well as CSF, blood and urine markers) to overturn these limitations and give rise to new diagnostic and prognostic indicators.
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Affiliation(s)
- Siobhan E Kirk
- The Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD, Australia
| | - Timothy J Tracey
- The Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD, Australia
| | - Frederik J Steyn
- The Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD, Australia.,Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Shyuan T Ngo
- The Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD, Australia.,Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.,Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
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25
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The changing landscape of motor neuron disease imaging: the transition from descriptive studies to precision clinical tools. Curr Opin Neurol 2019; 31:431-438. [PMID: 29750730 DOI: 10.1097/wco.0000000000000569] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Neuroimaging in motor neuron disease (MND) has traditionally been seen as an academic tool with limited direct relevance to individualized patient care. This has changed radically in recent years as computational imaging has emerged as a viable clinical tool with true biomarker potential. This transition is not only fuelled by technological advances but also by important conceptual developments. RECENT FINDINGS The natural history of MND is now evaluated by presymptomatic, postmortem and multi-timepoint longitudinal imaging studies. The anatomical spectrum of MND imaging has also been expanded from an overwhelmingly cerebral focus to innovative spinal and muscle applications. In contrast to the group-comparisons of previous studies, machine-learning and deep-learning approaches are increasingly utilized to model real-life diagnostic dilemmas and aid prognostic classification. The focus from evaluating focal structural changes has shifted to the appraisal of network integrity by connectivity-based approaches. The armamentarium of MND imaging has also been complemented by novel PET-ligands, spinal toolboxes and the availability of magnetoencephalography and high-field magnetic resonance (MR) imaging platforms. SUMMARY In addition to the technological and conceptual advances, collaborative multicentre research efforts have also gained considerable momentum. This opinion-piece reviews emerging trends in MND imaging and their implications to clinical care and drug development.
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26
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Zubair AS, Mustafa R, Amrami KK, Crum BA. Case of Early Amyotrophic Lateral Sclerosis With Prominent Magnetic Resonance Imaging Plexus Abnormalities. J Clin Neuromuscul Dis 2018; 20:41-44. [PMID: 30124559 DOI: 10.1097/cnd.0000000000000206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Amyotrophic lateral sclerosis is a neurodegenerative disorder, which is characterized by progressive upper and lower motor neuron signs and symptoms, resulting in progressive muscle weakness. There are very rare reports of magnetic resonance imaging (MRI) abnormalities within the nerve roots or plexus reported in amyotrophic lateral sclerosis. Here, we report a patient who presented with progressive left arm weakness and was found to have bilateral MRI plexus abnormalities. This report illustrates that MRI plexus abnormalities can be seen in amyotrophic lateral sclerosis, possibly before symptoms, and may have clinical value in the diagnostic process.
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Affiliation(s)
| | - Rafid Mustafa
- Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Kimberly K Amrami
- Division of Musculoskeletal Radiology, Departments of Radiology and Neurologic Surgery, Mayo Clinic College of Medicine & Science, Rochester, MN
| | - Brian A Crum
- Department of Neurology, Mayo Clinic College of Medicine & Science, Rochester, MN
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27
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Klupp E, Cervantes B, Sollmann N, Treibel F, Weidlich D, Baum T, Rummeny EJ, Zimmer C, Kirschke JS, Karampinos DC. Improved Brachial Plexus Visualization Using an Adiabatic iMSDE-Prepared STIR 3D TSE. Clin Neuroradiol 2018; 29:631-638. [DOI: 10.1007/s00062-018-0706-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/03/2018] [Indexed: 12/12/2022]
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28
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Jenkins TM, Alix JJP, David C, Pearson E, Rao DG, Hoggard N, O'Brien E, Baster K, Bradburn M, Bigley J, McDermott CJ, Wilkinson ID, Shaw PJ. Imaging muscle as a potential biomarker of denervation in motor neuron disease. J Neurol Neurosurg Psychiatry 2018; 89:248-255. [PMID: 29089397 PMCID: PMC5869448 DOI: 10.1136/jnnp-2017-316744] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/05/2017] [Accepted: 10/09/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess clinical, electrophysiological and whole-body muscle MRI measurements of progression in patients with motor neuron disease (MND), as tools for future clinical trials, and to probe pathophysiological mechanisms in vivo. METHODS A prospective, longitudinal, observational, clinicoelectrophysiological and radiological cohort study was performed. Twenty-nine patients with MND and 22 age-matched and gender-matched healthy controls were assessed with clinical measures, electrophysiological motor unit number index (MUNIX) and T2-weighted whole-body muscle MRI, at first clinical presentation and 4 months later. Between-group differences and associations were assessed using age-adjusted and gender-adjusted multivariable regression models. Within-subject longitudinal changes were assessed using paired t-tests. Patterns of disease spread were modelled using mixed-effects multivariable regression, assessing associations between muscle relative T2 signal and anatomical adjacency to site of clinical onset. RESULTS Patients with MND had 30% higher relative T2 muscle signal than controls at baseline (all regions mean, 95% CI 15% to 45%, p<0.001). Higher T2 signal was associated with greater overall disability (coefficient -0.009, 95% CI -0.017 to -0.001, p=0.023) and with clinical weakness and lower MUNIX in multiple individual muscles. Relative T2 signal in bilateral tibialis anterior increased over 4 months in patients with MND (right: 10.2%, 95% CI 2.0% to 18.4%, p=0.017; left: 14.1%, 95% CI 3.4% to 24.9%, p=0.013). Anatomically, contiguous disease spread on MRI was not apparent in this model. CONCLUSIONS Whole-body muscle MRI offers a new approach to objective assessment of denervation over short timescales in MND and enables investigation of patterns of disease spread in vivo. Muscles inaccessible to conventional clinical and electrophysiological assessment may be investigated using this methodology.
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Affiliation(s)
- Thomas M Jenkins
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK.,Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - James J P Alix
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK.,Department of Neurophysiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Charlotte David
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Eilish Pearson
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - D Ganesh Rao
- Department of Neurophysiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nigel Hoggard
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Eoghan O'Brien
- Statistical Services Unit, School of Mathematics and Statistics, University of Sheffield, Sheffield, UK
| | - Kathleen Baster
- Statistical Services Unit, School of Mathematics and Statistics, University of Sheffield, Sheffield, UK
| | - Michael Bradburn
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Julia Bigley
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Christopher J McDermott
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK.,Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Iain D Wilkinson
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK.,Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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29
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Monforte M, Primiano G, Silvestri G, Mirabella M, Luigetti M, Cuccagna C, Ricci E, Servidei S, Tasca G. Sporadic late-onset nemaline myopathy: clinical, pathology and imaging findings in a single center cohort. J Neurol 2018; 265:542-551. [PMID: 29356967 DOI: 10.1007/s00415-018-8741-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 12/12/2022]
Abstract
Sporadic late-onset nemaline myopathy (SLONM) is a rare acquired myopathy characterized by rapid-onset proximal weakness in late adulthood, and the presence of nemaline bodies on muscle biopsy. In recent years, several therapeutic interventions, including immunomodulating agents and autologous stem cell transplantation, have shown variable degrees of efficacy in different patients, but no consensus has been reached to allow an effective tailoring of treatments in this severe disease. We performed a retrospective evaluation of clinical, pathological, laboratory, muscle MRI, and follow-up data of SLONM patients diagnosed in the period 2010-2015 in our neuromuscular center. Six patients (three males and three females) were identified. Average time elapsed from the onset of symptoms to referral to the neuromuscular specialist was 23.7 months. Monoclonal gammopathy was detectable in five patients. Nemaline bodies were detected in all the patients, and their abundance correlated with clinical severity. Signs of cardiac involvement were present in all the patients to different extents. Muscle MRI showed a preferential involvement of neck extensors, paraspinal, gluteal, hamstring and soleus muscles. All patients were treated with prednisone and repeated courses of intravenous immunoglobulins, and a favorable outcome was reached in five patients. Our experience confirms that SLONM is clinically characterized by subacute proximal and axial muscle weakness. Time to referral was relatively long and should be reduced with increasing awareness of the disease. Muscle MRI could be of help as a diagnostic tool to identify this potentially treatable myopathy. Cardiac evaluation should be warranted in all SLONM patients to detect subclinical heart involvement.
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Affiliation(s)
- Mauro Monforte
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Guido Primiano
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
| | - Gabriella Silvestri
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
| | - Massimiliano Mirabella
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
| | - Marco Luigetti
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
| | - Cristina Cuccagna
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
| | - Enzo Ricci
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
| | - Serenella Servidei
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
| | - Giorgio Tasca
- Istituto di Neurologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli", Largo A. Gemelli 8, 00168, Rome, Italy
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30
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Wang X, Harrison C, Mariappan YK, Gopalakrishnan K, Chhabra A, Lenkinski RE, Madhuranthakam AJ. MR Neurography of Brachial Plexus at 3.0 T with Robust Fat and Blood Suppression. Radiology 2017; 283:538-546. [DOI: 10.1148/radiol.2016152842] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Xinzeng Wang
- From the Department of Radiology (X.W., C.E.H., A.C., R.E.L., A.J.M.) and Advanced Imaging Research Center (A.C., R.E.L., A.J.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75019-9061; and Philips Healthcare, Philips Innovation Campus, Bangalore, India (Y.K.M., K.G.)
| | - Crystal Harrison
- From the Department of Radiology (X.W., C.E.H., A.C., R.E.L., A.J.M.) and Advanced Imaging Research Center (A.C., R.E.L., A.J.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75019-9061; and Philips Healthcare, Philips Innovation Campus, Bangalore, India (Y.K.M., K.G.)
| | - Yogesh K. Mariappan
- From the Department of Radiology (X.W., C.E.H., A.C., R.E.L., A.J.M.) and Advanced Imaging Research Center (A.C., R.E.L., A.J.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75019-9061; and Philips Healthcare, Philips Innovation Campus, Bangalore, India (Y.K.M., K.G.)
| | - Karthik Gopalakrishnan
- From the Department of Radiology (X.W., C.E.H., A.C., R.E.L., A.J.M.) and Advanced Imaging Research Center (A.C., R.E.L., A.J.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75019-9061; and Philips Healthcare, Philips Innovation Campus, Bangalore, India (Y.K.M., K.G.)
| | - Avneesh Chhabra
- From the Department of Radiology (X.W., C.E.H., A.C., R.E.L., A.J.M.) and Advanced Imaging Research Center (A.C., R.E.L., A.J.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75019-9061; and Philips Healthcare, Philips Innovation Campus, Bangalore, India (Y.K.M., K.G.)
| | - Robert E. Lenkinski
- From the Department of Radiology (X.W., C.E.H., A.C., R.E.L., A.J.M.) and Advanced Imaging Research Center (A.C., R.E.L., A.J.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75019-9061; and Philips Healthcare, Philips Innovation Campus, Bangalore, India (Y.K.M., K.G.)
| | - Ananth J. Madhuranthakam
- From the Department of Radiology (X.W., C.E.H., A.C., R.E.L., A.J.M.) and Advanced Imaging Research Center (A.C., R.E.L., A.J.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75019-9061; and Philips Healthcare, Philips Innovation Campus, Bangalore, India (Y.K.M., K.G.)
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31
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Simon NG, Lagopoulos J, Paling S, Pfluger C, Park SB, Howells J, Gallagher T, Kliot M, Henderson RD, Vucic S, Kiernan MC. Peripheral nerve diffusion tensor imaging as a measure of disease progression in ALS. J Neurol 2017; 264:882-890. [PMID: 28265751 DOI: 10.1007/s00415-017-8443-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 12/12/2022]
Abstract
Clinical trial design in amyotrophic lateral sclerosis (ALS) remains hampered by a lack of reliable and sensitive biomarkers of disease progression. The present study evaluated peripheral nerve diffusion tensor imaging (DTI) as a surrogate marker of axonal degeneration in ALS. Longitudinal studies were undertaken in 21 ALS patients studied at 0 and 3 months, and 19 patients at 0, 3 and 6 months, with results compared to 13 age-matched controls. Imaging metrics were correlated across a range of functional assessments including amyotrophic lateral sclerosis functional rating scale revised (ALSFRS-R), lower limb muscle strength (Medical Research Council sum score, MRCSS-LL), compound muscle action potential amplitudes and motor unit number estimation (MUNE). Fractional anisotropy was reduced at baseline in ALS patients in the tibial (p < 0.05), and peroneal nerve (p < 0.05). Fractional anisotropy and axial diffusivity declined in the tibial nerve between baselines, 3- and 6-month scans (p < 0.01). From a functional perspective, ALSFRS-R correlated with fractional anisotropy values from tibial (R = 0.75, p < 0.001) and peroneal nerves (R = 0.52, p = 0.001). Similarly, peroneal nerve MUNE values correlated with fractional anisotropy values from the tibial (R = 0.48, p = 0.002) and peroneal nerve (R = 0.39, p = 0.01). There were correlations between the change in ALSFRS-R and tibial nerve axial diffusivity (R = 0.38, p = 0.02) and the change in MRCSS-LL and peroneal nerve fractional anisotropy (R = 0.44, p = 0.009). In conclusion, this study has demonstrated that some peripheral nerve DTI metrics are sensitive to axonal degeneration in ALS. Further, that DTI metrics correlated with measures of functional disability, strength and neurophysiological measures of lower motor neuron loss.
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Affiliation(s)
- Neil G Simon
- St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia.
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience-Thomson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Sita Paling
- Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Casey Pfluger
- Centre for Clinical Research, School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Susanna B Park
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - James Howells
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Thomas Gallagher
- Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Michel Kliot
- Department of Neurosurgery, Stanford Neurosience Health Center, Palo Alto, CA, USA
| | - Robert D Henderson
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Steve Vucic
- Westmead Clinical School, C24 Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
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