Evaluation of muscular changes by ultrasound Nakagami imaging in Duchenne muscular dystrophy

Abstract

Duchenne muscular dystrophy (DMD) is the most common debilitating muscular disorder. Developing a noninvasive measure for monitoring the progression of this disease is critical. The present study tested the effectiveness of using ultrasound Nakagami imaging to evaluate the severity of the dystrophic process. A total of 47 participants (40 with DMD and 7 healthy controls) were recruited. Patients were classified into stage 1 (presymptomatic and ambulatory), stage 2 (early nonambulatory), and stage 3 (late nonambulatory). All participants underwent ultrasound examinations on the rectus femoris, tibialis anterior, and gastrocnemius. The results revealed that the ultrasound Nakagami parameter correlated positively with functional severity in the patients with DMD. The median Nakagami parameter of the gastrocnemius muscle increased from 0.50 to 0.85, corresponding to the largest dynamic range between normal and stage 3. The accuracy, sensitivity, and specificity of diagnosing walking function were 85.52%, 76.31%, and 94.73%, respectively. The Nakagami parameter of the rectus femoris and gastrocnemius muscles correlated negatively with the 6-minute walking distance in the ambulatory patients. Therefore, changes in the Nakagami parameter for the gastrocnemius muscle are suitable for monitoring disease progression in ambulatory patients and for predicting ambulation loss. Ultrasound Nakagami imaging shows potential for evaluating patients with DMD.

Local Texture Anisotropy as an Estimate of Muscle Quality in Ultrasound Imaging

“…Extensive robustness analysis in more muscles with larger numbers of patients and controls remains to be conducted to evaluate the diagnostic validity of the TAI (Martinez-Paya et al 2017;Sogawa et al 2017). In patients with IBM, the correlation observed between muscle weakness and TAI values supports an association between local texture anisotropy and the magnitude of muscle changes, as previously observed using EI (Jansen et al 2012;Nodera et al 2016) and other texturebased approaches (Weng et al 2017). Similarly to other metrics, such as mean EI, the TAI provides a non-specific estimate of muscle quality (Pillen and Van Alfen 2015), and data regarding tissue composition (e.g., fat infiltration, fibrosis) are thus required to identify the main factors influencing TAI values.…”

“…This parameter is highly dependent on the ultrasound device and settings (Pillen and Van Alfen 2015;Zaidman et al 2008). In contrast to mean EI and other first-order descriptors (e.g., standard deviation, skewness, kurtosis and entropy), higher-order texture features (e.g., Haralick features, Galloway features, local binary pattern) have been identified as promising tools for diagnosis, characterization and follow-up of muscle alterations (Konig et al 2015;Martinez-Paya et al 2017;Molinari et al 2015;Sogawa et al 2017;Weng et al 2017). These descriptors may have the advantage of being less affected by variables such as intensity.…”

Neuromuscular Ultrasound: Clinical Applications and Diagnostic Values

“…23,30 Alternative methods using texture analysis and acoustic structural quantification of sonographic images may further increase the diagnostic utility of ultrasound for many patients with neuromuscular diseases. 122,123…”

Quantitative Ultrasound and B-Mode Image Texture Features Correlate with Collagen and Myelin Content in Human Ulnar Nerve Fascicles

“…QUS is now considered an efficient and reliable method of tissue characterization (Oelze and Mamou, 2016) with wide-ranging applications including liver disease assessment (Lin, et al, 2015, Zhou, et al, 2018, breast mass characterization (Byra, et al, 2016, Sadeghi-Naini, et al, 2017 and evaluation of muscular changes (Weng, et al, 2017). QUS methods have also been used with high frequency data for characterization of the annular pulleys of the fingers and skin tissue (Pereyra andBatatia, 2012, Piotrzkowska-Wroblewska, et al, 2015).…”