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McDonald C, Camino E, Escandon R, Finkel RS, Fischer R, Flanigan K, Furlong P, Juhasz R, Martin AS, Villa C, Sweeney HL. Draft Guidance for Industry Duchenne Muscular Dystrophy, Becker Muscular Dystrophy, and Related Dystrophinopathies - Developing Potential Treatments for the Entire Spectrum of Disease. J Neuromuscul Dis 2024; 11:499-523. [PMID: 38363616 DOI: 10.3233/jnd-230219] [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] [Indexed: 02/17/2024]
Abstract
Background Duchenne muscular dystrophy (DMD) and related dystrophinopathies are neuromuscular conditions with great unmet medical needs that require the development of effective medical treatments. Objective To aid sponsors in clinical development of drugs and therapeutic biological products for treating DMD across the disease spectrum by integrating advancements, patient registries, natural history studies, and more into a comprehensive guidance. Methods This guidance emerged from collaboration between the FDA, the Duchenne community, and industry stakeholders. It entailed a structured approach, involving multiple committees and boards. From its inception in 2014, the guidance underwent revisions incorporating insights from gene therapy studies, cardiac function research, and innovative clinical trial designs. Results The guidance provides a deeper understanding of DMD and its variants, focusing on patient engagement, diagnostic criteria, natural history, biomarkers, and clinical trials. It underscores patient-focused drug development, the significance of dystrophin as a biomarker, and the pivotal role of magnetic resonance imaging in assessing disease progression. Additionally, the guidance addresses cardiomyopathy's prominence in DMD and the burgeoning field of gene therapy. Conclusions The updated guidance offers a comprehensive understanding of DMD, emphasizing patient-centric approaches, innovative trial designs, and the importance of biomarkers. The focus on cardiomyopathy and gene therapy signifies the evolving realm of DMD research. It acts as a crucial roadmap for sponsors, potentially leading to improved treatments for DMD.
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Affiliation(s)
| | - Eric Camino
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Rafael Escandon
- DGBI Consulting, LLC, Bainbridge Island, Washington, DC, USA
| | | | - Ryan Fischer
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Kevin Flanigan
- Center for Experimental Neurotherapeutics, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pat Furlong
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Rose Juhasz
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Ann S Martin
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Chet Villa
- Trinity Health Michigan, Grand Rapids, MI, USA
| | - H Lee Sweeney
- Cincinnati Children's Hospital Medical Center within the UC Department of Pediatrics, Cincinnati, OH, USA
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Fu X, Wang Z, Wang L, Lv G, Cheng Y, Wang B, Zhang Z, Jin X, Kang Y, Zhou Y, Wu Q. Increased diaphragm echodensity correlates with postoperative pulmonary complications in patients after major abdominal surgery: a prospective observational study. BMC Pulm Med 2022; 22:400. [PMCID: PMC9636692 DOI: 10.1186/s12890-022-02194-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background Associated with increased morbidity and mortality, postoperative pulmonary complications (PPCs) often occur after major abdominal surgery. Diaphragmatic dysfunction is suggested to play an important role in the development of PPCs and diaphragm echodensity can be used as an indicator of diaphragm function. This study aimed to determine whether diaphragm echodensity could predict the occurrence of PPCs in patients after major abdominal surgery. Methods Diaphragm ultrasound images of patients after major abdominal surgery were collected during spontaneous breathing trials. Echodensity was quantified based on the right-skewed distribution of grayscale values (50th percentile, ED50; 85th percentile, ED85; mean, EDmean). Intra- and inter-analyzer measurement reproducibility was determined. Outcomes including occurrence of PPCs, reintubation rate, duration of ventilation, and length of ICU stay were recorded. Results Diaphragm echodensity was measured serially in 117 patients. Patients who developed PPCs exhibited a higher ED50 (35.00 vs. 26.00, p < 0.001), higher ED85 (64.00 vs. 55.00, p < 0.001) and higher EDmean (39.32 vs. 33.98, p < 0.001). In ROC curve analysis, the area under the curve of ED50 for predicting PPCs was 0.611. The optimal ED50 cutoff value for predicting the occurrence of PPCs was 36. According to this optimal ED50 cutoff value, patients were further divided into a high-risk group (ED50 > 36, n = 35) and low-risk group (ED50 ≤ 36, n = 82). Compared with the low-risk group, the high-risk group had a higher incidence of PPCs (unadjusted p = 0.003; multivariate-adjusted p < 0.001). Conclusion Diaphragm echodensity can be feasibly and reproducibly measured in mechanically ventilated patients. The increase in diaphragm echodensity during spontaneous breathing trials was related to an increased risk of PPCs in patients after major abdominal surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02194-6.
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Affiliation(s)
- Xin Fu
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen Wang
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Luping Wang
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Guangxuan Lv
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yisong Cheng
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wang
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongwei Zhang
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaodong Jin
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Kang
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yongfang Zhou
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Wu
- grid.13291.380000 0001 0807 1581Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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Goryachev I, Tresansky AP, Ely GT, Chrzanowski SM, Nagy JA, Rutkove SB, Anthony BW. Comparison of Quantitative Ultrasound Methods to Classify Dystrophic and Obese Models of Skeletal Muscle. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1918-1932. [PMID: 35811236 DOI: 10.1016/j.ultrasmedbio.2022.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
In this study, we compared multiple quantitative ultrasound metrics for the purpose of differentiating muscle in 20 healthy, 10 dystrophic and 10 obese mice. High-frequency ultrasound scans were acquired on dystrophic (D2-mdx), obese (db/db) and control mouse hindlimbs. A total of 248 image features were extracted from each scan, using brightness-mode statistics, Canny edge detection metrics, Haralick features, envelope statistics and radiofrequency statistics. Naïve Bayes and other classifiers were trained on single and pairs of features. The a parameter from the Homodyned K distribution at 40 MHz achieved the best univariate classification (accuracy = 85.3%). Maximum classification accuracy of 97.7% was achieved using a logistic regression classifier on the feature pair of a2 (K distribution) at 30 MHz and brightness-mode variance at 40MHz. Dystrophic and obese mice have muscle with distinct acoustic properties and can be classified to a high level of accuracy using a combination of multiple features.
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Affiliation(s)
- Ivan Goryachev
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Anne Pigula Tresansky
- Harvard-MIT Program in Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Gregory Tsiang Ely
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Stephen M Chrzanowski
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Janice A Nagy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian W Anthony
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
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Yu HK, Liu X, Pan M, Chen JW, Liu C, Wu Y, Li ZB, Wang HY. Performance of Passive Muscle Stiffness in Diagnosis and Assessment of Disease Progression in Duchenne Muscular Dystrophy. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:414-421. [PMID: 34893358 DOI: 10.1016/j.ultrasmedbio.2021.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/07/2021] [Accepted: 09/02/2021] [Indexed: 06/14/2023]
Abstract
The aim of this study was to evaluate the performance of passive muscle stiffness in diagnosing and assessing disease progression in Duchenne muscular dystrophy (DMD). Boys with DMD and age-matched controls were recruited. Shear wave elastography (SWE) videos were collected by performing dynamic stretching of the gastrocnemius medius (GM). At ankle angles from plantar flexion (PF) 30° to dorsiflexion (DF) 20°, the shear modulus of the GM was measured for each 10° of ankle movement. Shear modulus at each ankle angle was compared between the DMD and control group. Correlation between passive muscle stiffness and motor function grading was also analyzed. A total of 26 patients with DMD and 20 healthy boys were enrolled. At multiple stretch levels, passive muscle stiffness of the GM was significantly higher in patients with DMD than in those in the control group (all p values <0.05). The shear modulus of GM at an ankle angle of DF 10° had the largest area under the receiver operating characteristic curve in differentiating DMD patients from normal subjects (AUC = 0.902, 95% confidence interval: 0.814-0.990). Motor function grading was a significant determinant of passive muscle stiffness at an ankle angle of DF 10° (B = 21.409, t = 3.372, p = 0.003). Passive muscle stiffness may potentially serve as a useful non-invasive tool to monitor disease progression in DMD patients.
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Affiliation(s)
- Hong-Kui Yu
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiao Liu
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Fu-tian), Shenzhen, Guangdong, China
| | - Min Pan
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Fu-tian), Shenzhen, Guangdong, China
| | - Jin-Wei Chen
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chen Liu
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yu Wu
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhi-Bin Li
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hong-Ying Wang
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.
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Coiffard B, Riegler S, Sklar MC, Dres M, Vorona S, Reid WD, Brochard LJ, Ferguson ND, Goligher EC. Diaphragm echodensity in mechanically ventilated patients: a description of technique and outcomes. Crit Care 2021; 25:64. [PMID: 33593412 PMCID: PMC7884870 DOI: 10.1186/s13054-021-03494-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Acute increases in muscle sonographic echodensity reflect muscle injury. Diaphragm echodensity has not been measured in mechanically ventilated patients. We undertook to develop a technique to characterize changes in diaphragm echodensity during mechanical ventilation and to assess whether these changes are correlated with prolonged mechanical ventilation. Methods Diaphragm ultrasound images were prospectively collected in mechanically ventilated patients and in 10 young healthy subjects. Echodensity was quantified based on the right-skewed distribution of grayscale values (50th percentile, ED50; 85th percentile, ED85). Intra- and inter-analyzer measurement reproducibility was determined. Outcomes recorded included duration of ventilation and ICU complications (including reintubation, tracheostomy, prolonged ventilation, or death). Results Echodensity measurements were obtained serially in 34 patients comprising a total of 104 images. Baseline (admission) diaphragm ED85 was increased in mechanically ventilated patients compared to younger healthy subjects (median 56, interquartile range (IQR) 42–84, vs. 39, IQR 36–52, p = 0.04). Patients with an initial increase in median echodensity over time (≥ + 10 in ED50 from baseline) had fewer ventilator-free days to day 60 (n = 13, median 46, IQR 0–52) compared to patients without this increase (n = 21, median 53 days, IQR 49–56, unadjusted p = 0.03). Both decreases and increases in diaphragm thickness during mechanical ventilation were associated with increases in ED50 over time (adjusted p = 0.03, conditional R2 = 0.80) and the association between increase in ED50 and outcomes persisted after adjusting for changes in diaphragm thickness. Conclusions Many patients exhibit increased diaphragm echodensity at the outset of mechanical ventilation. Increases in diaphragm echodensity during the early course of mechanical ventilation are associated with prolonged mechanical ventilation. Both decreases and increases in diaphragm thickness during mechanical ventilation are associated with increased echodensity.
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Affiliation(s)
- Benjamin Coiffard
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada
| | - Stephen Riegler
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada
| | - Michael C Sklar
- Inter-Departmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Martin Dres
- AP-HP, Service de Pneumologie, Médecine Intensive-Réanimation (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Stefannie Vorona
- Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Laurent J Brochard
- Inter-Departmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Niall D Ferguson
- Inter-Departmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada.,Toronto General Hospital Research Institute, Toronto, Canada
| | - Ewan C Goligher
- Inter-Departmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. .,Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada. .,Toronto General Hospital Research Institute, Toronto, Canada.
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6
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Chiou HJ, Yeh CK, Hwang HE, Liao YY. Efficacy of Quantitative Muscle Ultrasound Using Texture-Feature Parametric Imaging in Detecting Pompe Disease in Children. ENTROPY 2019; 21:e21070714. [PMID: 33267428 PMCID: PMC7515229 DOI: 10.3390/e21070714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/18/2019] [Accepted: 07/21/2019] [Indexed: 12/12/2022]
Abstract
Pompe disease is a hereditary neuromuscular disorder attributed to acid α-glucosidase deficiency, and accurately identifying this disease is essential. Our aim was to discriminate normal muscles from neuropathic muscles in children affected by Pompe disease using a texture-feature parametric imaging method that simultaneously considers microstructure and macrostructure. The study included 22 children aged 0.02-54 months with Pompe disease and six healthy children aged 2-12 months with normal muscles. For each subject, transverse ultrasound images of the bilateral rectus femoris and sartorius muscles were obtained. Gray-level co-occurrence matrix-based Haralick's features were used for constructing parametric images and identifying neuropathic muscles: autocorrelation (AUT), contrast, energy (ENE), entropy (ENT), maximum probability (MAXP), variance (VAR), and cluster prominence (CPR). Stepwise regression was used in feature selection. The Fisher linear discriminant analysis was used for combination of the selected features to distinguish between normal and pathological muscles. The VAR and CPR were the optimal feature set for classifying normal and pathological rectus femoris muscles, whereas the ENE, VAR, and CPR were the optimal feature set for distinguishing between normal and pathological sartorius muscles. The two feature sets were combined to discriminate between children with and without neuropathic muscles affected by Pompe disease, achieving an accuracy of 94.6%, a specificity of 100%, a sensitivity of 93.2%, and an area under the receiver operating characteristic curve of 0.98 ± 0.02. The CPR for the rectus femoris muscles and the AUT, ENT, MAXP, and VAR for the sartorius muscles exhibited statistically significant differences in distinguishing between the infantile-onset Pompe disease and late-onset Pompe disease groups (p < 0.05). Texture-feature parametric imaging can be used to quantify and map tissue structures in skeletal muscles and distinguish between pathological and normal muscles in children or newborns.
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Affiliation(s)
- Hong-Jen Chiou
- Division of Ultrasound and Breast Imaging, Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- National Defense Medical Center, Taipei 11490, Taiwan
| | - Chih-Kuang Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan
| | - Hsuen-En Hwang
- Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Yin-Yin Liao
- Department of Biomedical Engineering, Hungkuang University, Taichung 43302, Taiwan
- Correspondence: ; Tel.: +886-4-26318652
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Weng WC, Lin CW, Shen HC, Chang CC, Tsui PH. Instantaneous frequency as a new approach for evaluating the clinical severity of Duchenne muscular dystrophy through ultrasound imaging. ULTRASONICS 2019; 94:235-241. [PMID: 30287072 DOI: 10.1016/j.ultras.2018.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/24/2018] [Accepted: 09/09/2018] [Indexed: 06/08/2023]
Abstract
Duchenne muscular dystrophy (DMD) results in loss of ambulation for the patients. Ultrasound attenuation correlates with fat content in muscles, resulting in changes in signal frequency. The Hilbert-Huang transform (HHT) allows time-frequency analysis with high time-frequency resolution. This study explored the feasibility of using the instantaneous frequency (IF) obtained from the HHT to diagnose the walking function of patients with DMD. Eighty-five participants (12 control and 73 patients with DMD) underwent a standard-care ultrasound examination of the gastrocnemius to acquire raw image data for ultrasound B-mode and IF calculations, which were compared with the DMD stage using Pearson correlation and receiver operating characteristic (ROC) curve analyses. With increasing DMD stage, the median IF decreased from 7.25 to 7.01 MHz (the correlation coefficient r = -0.73; the probability value p < 0.0001). The area under the ROC curve was 0.97 when using ultrasound IF to discriminate between ambulatory and nonambulatory patients (accuracy: 91.76%; sensitivity: 93.75%; and specificity: 90.57%). The study reveals that ultrasound IF has great potential in DMD evaluation and management.
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Affiliation(s)
- Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chia-Wei Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Hui-Chung Shen
- Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan
| | - Chien-Cheng Chang
- Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan.
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Calvo-Lobo C, Useros-Olmo AI, Almazán-Polo J, Martín-Sevilla M, Romero-Morales C, Sanz-Corbalán I, Rodríguez-Sanz D, López-López D. Quantitative Ultrasound Imaging Pixel Analysis of the Intrinsic Plantar Muscle Tissue between Hemiparesis and Contralateral Feet in Post-Stroke Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112519. [PMID: 30423860 PMCID: PMC6265729 DOI: 10.3390/ijerph15112519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 12/12/2022]
Abstract
Quantitative ultrasound imaging of the muscle tissue may be applied in the neurology field, due to B-mode grayscale pixels values could be used as potential biomarkers for disease progression and intervention effects in poststroke patients. Thus, the study aim was to compare and analyze the ultrasound imaging B-mode pixels differences between the intrinsic plantar muscles cross-sectional area (CSA) in hemiparetic and contralateral feet from poststroke patients by means of the Image J software. A case-control design and a convenience sampling method were used in order to recruit 22 feet from 11 poststroke patients. This total sample was divided into 11 hemiparetic feet and 11 contralateral feet. The Image J software was used in order to evaluate the interface distance, CSA as well as measure the pixels mean, standard deviation (SD) and count from all offline images in the flexor digitorum brevis, abductor hallucis (AbH), and flexor hallucis brevis muscles. Statistically significant differences (p = 0.003) were only shown for the pixels count in the AbH muscle. The rest of outcome measurements did not show any statistically significant difference (p > 0.05). Therefore, B-mode ultrasound imaging Image J software differences for the pixels count reduction were shown in the AbH muscle between hemiparetic and contralateral feet from poststroke patients. Further studies are necessary in order to apply our findings as potential biomarkers during the stroke disease course.
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Affiliation(s)
- Cesar Calvo-Lobo
- Nursing and Physical Therapy Department, Faculty of Health Sciences, Universidad de León, 24401 Ponferrada, Spain.
| | - Ana Isabel Useros-Olmo
- Departamento de Fisioterapia, Centro superior de estudios Universitarios La Salle, Motion in Brains Research Group, Universidad Autónoma de Madrid, 28023 Madrid, Spain.
- Unidad de Daño Cerebral, Hospital Beata Maria Ana, 28007 Madrid, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain.
| | | | - Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - Irene Sanz-Corbalán
- School of Nursing, Physiotherapy and Podiatry, University Complutense of Madrid, 28040 Madrid, Spain.
| | - David Rodríguez-Sanz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
- School of Nursing, Physiotherapy and Podiatry, University Complutense of Madrid, 28040 Madrid, Spain.
| | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain.
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Kapur K, Sanchez B, Pacheck A, Darras B, Rutkove SB, Selukar R. Functional Mixed-Effects Modeling of Longitudinal Duchenne Muscular Dystrophy Electrical Impedance Myography Data Using State-Space Approach. IEEE Trans Biomed Eng 2018; 66:1761-1768. [PMID: 30387720 DOI: 10.1109/tbme.2018.2879227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Electrical impedance myography (EIM) is a quantitative and objective tool to evaluate muscle status. EIM offers the possibility to replace conventional physical functioning scores or quality of life measures, which depend on patient cooperation and mood. METHODS Here, we propose a functional mixed-effects model using a state-space approach to describe the response trajectories of EIM data measured on 16 boys with Duchenne muscular dystrophy and 12 healthy controls, both groups measured over a period of two years. The modeling framework presented imposes a smoothing spline structure on EIM data collected at each visit and taking into account of within subject correlations of these curves along the longitudinal measurements. The modeling framework is recast in a state-space approach, thereby allowing for the employment of computationally efficient diffuse Kalman filtering and smoothing algorithms for the model estimation, as well as the estimates of the posterior variance-covariance matrix for the construction of the Bayesian [Formula: see text] confidence bands. RESULTS The proposed model allows us to simultaneously adjust for baseline variables, differentiate the longitudinal changes in the smooth functional response and estimate the subject and subject-time specific deviations from the population-averaged response curves. The code is made publicly available in the supplementary material. SIGNIFICANCE The modeling approach presented will potentially enhance EIM capability to serve as a biomarker for testing therapeutic efficacy in DMD and other clinical trials.
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10
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Mul K, Horlings CGC, Vincenten SCC, Voermans NC, van Engelen BGM, van Alfen N. Quantitative muscle MRI and ultrasound for facioscapulohumeral muscular dystrophy: complementary imaging biomarkers. J Neurol 2018; 265:2646-2655. [PMID: 30191320 PMCID: PMC6182682 DOI: 10.1007/s00415-018-9037-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/14/2018] [Accepted: 08/27/2018] [Indexed: 11/11/2022]
Abstract
Objective To assess the overlap of and differences between quantitative muscle MRI and ultrasound in characterizing structural changes in leg muscles of facioscapulohumeral muscular dystrophy (FSHD) patients. Methods We performed quantitative MRI and quantitative ultrasound of ten leg muscles in 27 FSHD patients and assessed images, both quantitatively and visually, for fatty infiltration, fibrosis and edema. Results The MRI fat fraction and ultrasound echogenicity z-score correlated strongly (CC 0.865, p < 0.05) and both correlated with clinical severity (MRI CC 0.828, ultrasound CC 0.767, p < 0.001). Ultrasound detected changes in muscle architecture in muscles that looked normal on MRI. MRI was better in detecting late stages of fatty infiltration and was more suitable to assess muscle edema. Correlations between quantitative and semi-quantitative scores were strong for MRI (CC 0.844–0.982, p < 0.05), and varied for ultrasound (CC 0.427–0.809, p = 0.026–p < 0.001). Conclusions Quantitative muscle MRI and ultrasound are both promising imaging biomarkers for differentiating between degrees of structural muscle changes. As ultrasound is more sensitive to detect subtle structural changes and MRI is more accurate in end stage muscles and detecting edema, the techniques are complementary. Hence, the choice for a particular technique should be considered in light of the trial design.
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Affiliation(s)
- Karlien Mul
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Corinne G C Horlings
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sanne C C Vincenten
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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