Quantitative neuromuscular ultrasound analysis as biomarkers in amyotrophic lateral sclerosis

Autores de IIS La Fe

• José Ignacio Tembl Ferrairo

  Autor

• Maria Jose Chumillas Lujan

  Autor

• Juan Francisco Vázquez Costa

  Autor

Participantes ajenos a IIS La Fe

• Rios-Diaz, J
• del Bano-Aledo, ME
• Martinez-Paya, JJ

Grupos

• Hemostasia, Trombosis, Arteriosclerosis y Biología vascular

• Patología Neuromuscular y Ataxias

Abstract

ObjectivesTo assess the differences in morphological and texture parameters of median nerve (MN) and abductor pollicis brevis (APB) between amyotrophic lateral sclerosis (ALS) patients and controls.MethodsThe cross-sectional area (CSA) of the MN and the muscle thickness (MTh) of APB were measured bilaterally in 59 recently diagnosed ALS patients and 20 matched healthy controls. Echointensity (EI), echovariation (EV) and grey-level co-occurrence matrix (GLCM) texture features of both structures were also analysed. Correlations between these parameters and clinical variables (muscle strength and disability) were analysed.ResultsThe CSA of MN was significantly lower in ALS patients (MD=-1.83mm(2) [95% CI=2.89; -0.77mm(2)]; p=0.01). ALS patients showed significantly lower MTh (-2.23mm [3.16; -1.30mm]; p<0.001) and EV (-7.40 [11.5; -3.33]; p=0.004) and higher EI (21.2 [11.9; 30.6]; p<0.001) in the APB muscle. No relevant differences were detected in GLCM features for this muscle. The model including all parameters (CSA for MN and MTh, EI and EV for APB) showed an AUC of 82% (sensitivity 87%; specificity 42%). Muscle strength and disability correlated with APB muscle ultrasound parameters but not with those of the MN.ConclusionsAPB muscle ultrasound biomarkers (especially MTh and EI) showed better discrimination capacity and correlation with clinical variables than MN biomarkers. However, the combination of both biomarkers increased their ability to detect LMN impairment, suggesting that both biomarkers could be used in a complementary manner for the diagnosis and progression monitoring in ALS.Key Points center dot Abductor pollicis brevis muscle and median nerve impairment is detectable by ultrasound in amyotrophic lateral sclerosis patients, even in those without clinical impairment.center dot Muscle ultrasound biomarkers show better discrimination capacity than nerve biomarkers in amyotrophic lateral sclerosis.center dot Quantitative neuromuscular ultrasound biomarkers could be useful in a general amyotrophic lateral sclerosis population early on the disease.

Keywords

• Amyotrophic lateral sclerosis; Biomarkers; Ultrasonography