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Topaloglu M, Sarikaya D, Peker A, Senturk YE, Terlemez R, Cetin BU, Oge AE, Ketenci A. Differentiation of Post-Polio Syndrome from Prior Poliomyelitis Sequela by Assessing Paraspinal Muscle Involvement in Magnetic Resonance Imaging. J Clin Med 2024; 13:4828. [PMID: 39200970 PMCID: PMC11355844 DOI: 10.3390/jcm13164828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 08/10/2024] [Accepted: 08/12/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Post-polio syndrome (PPS) affects former polio patients, manifesting decades after initial infection with progressive symptoms like pain, fatigue, and muscle weakness. Diagnosis relies on the clinical criteria and exclusion of other probable causes. The purpose of this study is to determine the scope and new diagnostic value of magnetic resonance imaging (MRI) in identifying muscle involvement in PPS and distinguishing it from prior poliomyelitis (PPM). Methods: This study was approved by the Koç University Ethics Committee with Approval No. 2023.409.IRB2.090. Electronic medical archives from two academic institutions were searched for records tagged with ICD code B-91 for poliomyelitis sequalae. The resulting search query of 291 records was manually sorted for PPS and PPM, medical history, clinical examination findings, and lumbar MR images down to 32 patients. Two independent radiologists evaluated the paraspinal musculature in the MRIs using the Mercuri scale. Inter-rater agreement, comparison of the paraspinal musculatures between groups, and their relationship to leg involvement were assessed with the resulting data. Results: Inter-rater agreement was found to be almost perfect across all muscles, except for the multifidus muscle. When clinical examination findings were included for these muscles, quadratus lumborum (QL) degradation was found in both right-side (p = 0.017) and left-side (p = 0.002) leg involvement. Conclusions: QL muscle deterioration may serve as a diagnostic marker for PPS, potentially guiding lumbar pain treatment through rehabilitation.
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Affiliation(s)
- Mahir Topaloglu
- Department of Physical Medicine and Rehabilitation, Koç University School of Medicine, 34450 Istanbul, Turkey; (D.S.); (A.K.)
| | - Deniz Sarikaya
- Department of Physical Medicine and Rehabilitation, Koç University School of Medicine, 34450 Istanbul, Turkey; (D.S.); (A.K.)
| | - Ahmet Peker
- Department of Radiology, Koç University School of Medicine, 34450 Istanbul, Turkey; (A.P.); (Y.E.S.)
| | - Yunus Emre Senturk
- Department of Radiology, Koç University School of Medicine, 34450 Istanbul, Turkey; (A.P.); (Y.E.S.)
| | - Rana Terlemez
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Faculty of Medicine, Istanbul University, 34098 Istanbul, Turkey; (R.T.); (B.U.C.)
| | - Burak Ugur Cetin
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Faculty of Medicine, Istanbul University, 34098 Istanbul, Turkey; (R.T.); (B.U.C.)
| | - Ali Emre Oge
- Department of Neurology, Koç University School of Medicine, 34450 Istanbul, Turkey;
| | - Aysegul Ketenci
- Department of Physical Medicine and Rehabilitation, Koç University School of Medicine, 34450 Istanbul, Turkey; (D.S.); (A.K.)
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Krkoska P, Kokosova V, Dostal M, Vlazna D, Kerkovsky M, Straka M, Gerstberger R, Matulova K, Ovesna P, Adamova B. Assessment of lumbar paraspinal muscle morphology using mDixon Quant magnetic resonance imaging (MRI): a cross-sectional study in healthy subjects. Quant Imaging Med Surg 2024; 14:6015-6035. [PMID: 39144006 PMCID: PMC11320528 DOI: 10.21037/qims-23-1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/13/2024] [Indexed: 08/16/2024]
Abstract
Background Lumbar paraspinal muscles (LPM) are a part of the deep spinal stabilisation system and play an important role in stabilising the lumbar spine and trunk. Inadequate function of these muscles is thought to be an essential aetiological factor in low back pain, and several neuromuscular diseases are characterised by dysfunction of LPM. The main aims of our study were to develop a methodology for LPM assessment using advanced magnetic resonance imaging (MRI) methods, including a manual segmentation process, to confirm the measurement reliability, to evaluate the LPM morphological parameters [fat fraction (FF), total muscle volume (TMV) and functional muscle volume (FMV)] in a healthy population, to study the influence of physiological factors on muscle morphology, and to build equations to predict LPM morphological parameters in a healthy population. Methods This prospective cross-sectional observational comparative single-centre study was conducted at the University Hospital in Brno, enrolling healthy volunteers from April 2021 to March 2023. MRI of the lumbar spine and LPM (erector spinae muscle and multifidus muscle) were performed using a 6-point Dixon gradient echo sequence. The segmentation of the LPM and the control muscle (psoas muscle) was done manually to obtain FF and TMV in a range from Th12/L1 to L5/S1. Intra-rater and inter-rater reliability were evaluated. Linear regression models were constructed to assess the effect of physiological factors on muscle FF, TMV and FMV. Results We enrolled 90 healthy volunteers (median age 38 years, 45 men). The creation of segmentation masks and the assessment of FF and TMV proved reliable (Dice coefficient 84% to 99%, intraclass correlation coefficient ≥0.97). The univariable models showed that FF of LPM was influenced the most by age (39.6% to 44.8% of variability, P<0.001); TMV and FMV by subject weight (34.9% to 67.6% of variability, P<0.001) and sex (24.7% to 64.1% of variability, P<0.001). Multivariable linear regression models for FF of LPM included age, body mass index and sex, with R-squared values ranging from 45.4% to 51.1%. Models for volumes of LPM included weight, age and sex, with R-squared values ranged from 37.4% to 76.8%. Equations were developed to calculate predicted FF, TMV and FMV for each muscle. Conclusions A reliable methodology has been developed to assess the morphological parameters (biomarkers) of the LPM. The morphological parameters of the LPM are significantly influenced by physiological factors. Equations were constructed to calculate the predicted FF, TMV and FMV of individual muscles in relation to anthropometric parameters, age, and sex. This study, which presented LPM assessment methodology and predicted values of LPM morphological parameters in a healthy population, could improve our understanding of diseases involving LPM (low back pain and some neuromuscular diseases).
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Affiliation(s)
- Peter Krkoska
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Viktoria Kokosova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Marek Dostal
- Department of Biophysics, Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czechia
| | - Daniela Vlazna
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Rehabilitation, University Hospital Brno, Brno, Czechia
| | - Milos Kerkovsky
- Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czechia
| | - Matej Straka
- Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czechia
| | - Radim Gerstberger
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czechia
| | | | - Petra Ovesna
- Institute of Biostatistics and Analyses Ltd., Brno, Czechia
| | - Blanka Adamova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
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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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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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