Dynamic analysis of muscles and the internal structure of the peripheral nerve as biomarkers of amyotrophic lateral sclerosis: A pilot study with ultrasound imaging.

INTRODUCTION: The aim of this study was to determine the behaviour of ultrasound biomarkers of fascicle density and muscle strength in patients with amyotrophic lateral sclerosis (ALS). METHODS: We conducted an observational, cross-sectional pilot study of 14 patients with ALS (28.6% women) and 14 controls. Bilateral cross-sectional ultrasound scans were performed in the abductor pollicis brevis (APB) and tibialis anterior (TA) muscles, with recording of muscle thickness (MT) at rest and in contraction, and the difference in thickness. In the median, sciatic, and common peroneal nerves, we analysed the cross-sectional area (CSA), number of fascicles (NF) and fascicle density (FD). Analyses were nested by laterality. RESULTS: Intra- and interrater agreement regarding NF was very good, with a minimum detectable error of < 0.7%. In patients with ALS, MT was lower in the APB both at rest (P = .003; g-Hedges = 1.03) and in contraction (P = .017; g-Hedges = 0.78) and in TA at rest (P = .002; g-Hedges = 0.15) and in contraction (P = .001; g-Hedges = 0.46), with lower thickening capacity. In the nerves, patients displayed lower CSA, with lower NF and higher FD. Significant correlations were found between MT of the ABP and Medical Research Council (MRC) scores for muscle strength (r = 0.34; r2 = 12%; P = .011) and with revised ALS Functional Rating Scale scores (r = 0.44; r2 = 19%; P < .001). The difference in TA thickening correlated with MRC scores (r = 0.30; r2 = 15%; P = .003) and with revised ALS Functional Rating Scale scores (r = 0.26; r2 = 7%; P = .049). NF in the sciatic nerve showed a significant correlation with MRC scores (r = 0.35; r2 = 12%; P = .008). CONCLUSION: MT measurements derived from dynamic testing together with NF and FD may be useful biomarkers for monitoring patients with ALS and establishing a prognosis.

New insights into the pathophysiology of fasciculations in amyotrophic lateral sclerosis: An ultrasound study.

OBJECTIVE: To describe the fasciculation pattern in ALS and to analyse its clinical and pathophysiological significance. METHODS: Ultrasound of 19 muscles was performed in 44 patients with a recent diagnosis (<90 days) of ALS. The number of fasciculations was recorded in each muscle and the muscle thickness and strength were additionally measured in limb muscles. A subgroup of patients were electromyographically assessed. RESULTS: US was performed in 835 muscles and EMG was available in 263 muscles. US detected fasciculations more frequently than EMG. Fasciculations were widespread, especially in upper limbs onset patients and in the cervical region. Fasciculations' number inversely associated with ALSFR-R and body mass index (BMI) and directly with BMI loss and upper motor neuron (UMN) impairment. Our statistical model suggest that fasciculations increase with the initial lower motor neuron (LMN) degeneration, reach their peak when the muscle became mildly to moderately weak, decreasing afterwards with increasing muscle weakness and atrophy. CONCLUSIONS: Our study suggests that both UMN and LMN degeneration trigger fasciculations causing BMI loss. The degree of LMN impairment could account for differences in fasciculations' rates within and between muscles. SIGNIFICANCE: In ALS, fasciculations could explain the link between hyperexcitability and BMI loss.

Análisis ecográfico de las modificaciones en la velocidad del flujo sanguíneo en la arteria vertebral producidas por el movimiento de rotación cervical máxima / Ultrasonography analysis of vertebral artery blood flow velocity changes on produced by the maximal cervical rotation

Objetivos Los test premanipulativos para la insuficiencia vertebrobasilar (TPIBV) suelen incorporar la rotación cervical para comprobar la solvencia de las arterias vertebrales (AV), aunque las investigaciones acerca del efecto de la rotación en el flujo de la AV discrepan y arrojan dudas en cuanto a la validez de las pruebas. Como un primer paso en esta línea el objetivo fue comprobar el efecto de la rotación cervical en los parámetros hemodinámicos de la AV en sujetos sanos. Material y método Se contó con 10 mujeres voluntarias sanas de 18 a 23 años (media: 20,3; DT: 1,64 años) a las que se le realizaron ecografías Doppler bilaterales en el segmento de la AV suboccipital (AV3) en la posición de rotación neutra, contralateral y homolateral. Se calcularon la velocidad del pico sistólico (VPS), velocidad del pico diastólico (VPD), velocidad media (VM) e índice de resistencia (IR). Los datos se analizaron con una ANOVA de medidas repetidas y las comparaciones se realizaron con la corrección de Bonferroni (SPSS v15.0; IC del 95%).Resultados No se detectaron diferencias estadísticamente significativas en cuanto a la lateralidad y la rotación cervical ni en VPS (FVPS=0,935; p=0,47) ni en VPD (FVPD=1,067; p=0,39), ni en VM (FVM=1,172; p=0,34), ni en IR (FIR=1,183; p=0,33). Debe destacarse la baja potencia de los análisis (entre el 30 y el 38%) por lo que la ausencia de diferencias debe considerarse con precaución. Conclusiones Los parámetros hemodinámicos de la AV no se modificaron en sujetos sanos con las rotaciones cervicales, cuestión que debe ser investigada en sujetos con insuficiencia vertebrobasilar (AU)

Objectives The pre-manipulative vertebrobasilar insufficiency tests (PVBIT) generally incorporate cervical rotation to verify the solvency of the vertebral arteries (VA). However, research on the effect of rotation on VA blood flow differ and question the validity of the tests. The first aim of this study was to verify the effect of cervical rotation on the hemodynamic parameters of the VAs in healthy subjects. Material and method Ten healthy female volunteers, aged 18 to 23 years (mean: 20.3, SD: 1.64 years), were subjected to bilateral Doppler ultrasonographies over the suboccipital segment of the AV (AV3) with neutral, contralateral and ipsilateral cervical rotation positions. We calculated peak systolic velocity (PSV), peak diastolic velocity (PDV), mean velocity (MV) and resistance index (RI). The data were analyzed with repeated measures ANOVA and comparisons were made with Bonferroni correction (SPSS v15.0, C.I. 95%).Results No statistically significant differences were detected regarding lateralization or rotation in the values of PSV (FPSV=0.935, P=.47), or PDV (FPDV=1.067, P=.39), or MV (FMV=1.172, P=.34), or RI (FRI=1.183, P=.33). The low power of analysis (between 30 and 38%) should be noted and thus the absence of differences should be observed with caution. Conclusions Hemodynamic parameters of the VA did not change with cervical rotations in healthy women so that this question should be studied in patients with vertebrobasilar insufficiency (AU)

Análisis discriminante del patrón textural ecográfico con matrices de concurrencia como nueva herramienta para el estudio del tendón / Discriminant analysis of the ultrasonographic textural pattern with co-occurrence matrices as a new tool for ultrasonographic of tendon

ObjetivoEvaluar el poder clasificatorio por grupo de edad y sexo de modelos discriminantes (MD) a partir de la ecotextura del tendón de Aquiles (TA).Material y métodosSe diseñó un estudio de observacional, transversal sobre 103 sujetos (49 mujeres y 54 hombres) con edades comprendidas entre los 18 y los 53 años (media = 29,8; desviación estándar = 0,86). Se tomaron ecografías transversales bilaterales a 20 mm de la inserción del TA con un ecógrafo Sonosite-Titan (L38 a 5-10 Hz). Se obtuvieron 60 variables texturales a partir de las matrices de concurrencia del nivel de gris (GLCM): contraste, homogeneidad, uniformidad, entropía y correlación para tres escalas (1, 5 y 10 píxeles) y dos orientaciones (0° y 90°) con el programa ImageJ 1.43. Se realizó un análisis multidimensional discriminante exploratorio con el método de inclusión forzosa con SPSS 15.0 (IC del 95%).ResultadosEn el MD global la sensibilidad fue del 74% y la especificidad del 91% para el grupo de edad. En el MD de mujeres la sensibilidad fue del 90% y la especificidad del 97%, mientras que en el MD de los hombres fueron del 96 y el 99%, respectivamente. Tras las validaciones cruzadas entre mujeres y hombres, las sensibilidades se redujeron a un 30%, lo que sugiere que el comportamiento ecotextural del TA en hombres y en mujeres es diferente.ConclusiónEl análisis multivariante de la ecotextura del TA con GLCM mostró una buena sensibilidad y especificidad en la clasificación de los sujetos según el grupo de edad, que mejoraron cuando los modelos se segmentaron según el sexo(AU)

AbstractObjectiveThe aim of this study was to evaluate the classification power as the age and sex of discriminant models (DM) generated from the echo-texture of the Achilles tendon (AT).Materials and methodsThe design was an observational, cross-sectional study report on 103 subjects (49 females and 54 males) 18 to 53 years old (mean = 29.8, SD = 0.86). We took bilateral transverse ultrasonographies at 20 mm from the insertion of the AT. Sixty variables were obtained from grey level co-occurrence matrices (GLCM): contrast, homogeneity, uniformity, entropy and correlation for three scales (1, 5 and 10 pixels) and two orientations (0° and 90°) with ImageJ 1.43 software. Multidimensional discriminant models were performed with forced inclusion method (CI95%).ResultsThe global MD for classification by age group showed a sensitivity of 74% and a specificity of 91%. In the DM women's ultrasound pattern sensitivity increased to 90% and specificity 97%, while sensitivity and specificity of ultrasound pattern DM men were 96% and 99% respectively. When cross-validations were performed for models of women and men, the sensitivities of the models were reduced to 30%, suggesting that the AT echotextural behavior is different.ConclusionMultidimensional analysis of Achilles tendon echotexture with GLCM showed good sensitivity and specificity in the classification of subjects by age group that improved when the models were segmented by gender(AU)