Editorial For "Quantitative MRI Predicts Electromyography Severity Grades of Denervated Muscle in Neuropathy of the Brachial Plexus".
Editorial For "Quantitative MRI Predicts Electromyography Severity Grades of Denervated Muscle in Neuropathy of the Brachial Plexus".
复制标题
“定量 MRI 预测臂丛神经病变中失神经肌肉的肌电图严重程度”的社论。
DOI：
10.1002/jmri.28181
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Blamire AM
中科院分区：
文献类型：
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作者：
Blamire AM
2肌肉T2、AFD和脂肪分数，包括直接肌内肌电图确认失神经支配的关键步骤。该研究分析了30名参与者的127块肌肉，这些参与者患有肩胛上神经、腋神经或两者的神经病变，这些神经病变跨越了亚急性至慢性症状后持续时间的范围。使用T2加权快速自旋回波序列测量整体肌肉T2，使用具有信号建模的多壳扩散张量成像序列评估AFD（7），使用2 pt狄克逊序列评估脂肪分数。扫描时间约为10分钟，使其成为临床上有用的检查。该研究报告称，整体肌肉T2的分级增加与运动单位募集减少的程度相关，而相反，AFD有分级但较弱的减少，表明肌纤维萎缩。在一些患者中，肌肉脂肪分数升高，虽然这可能使受影响肌肉中的T2测量部分偏倚，但T2变化仍然由去神经支配主导。T2延长和AFD降低可预测异常运动单位募集水平和纤颤电位以及用针EMG观察到的正尖波，这提供了直接证据，表明这些指标可用作EMG无法访问的肌肉中电诊断措施的替代物。这项研究在发展非侵入性成像诊断神经病变方面迈出了积极的一步。AFD测量还处于起步阶段，仍然需要证实的组织病理学证据，他们真正检测到纤维大小的变化。未来的研究必须努力提供这一基础证据。虽然这些技术与去神经支配的EMG指数显示出良好的相关性是令人鼓舞的，但对患者来说重要的是功能结果。这将是重要的，以显示这一令人兴奋的新发展是更准确地预测手臂功能的恢复比肌电图，不仅在慢性臂丛神经损伤，而且在早期阶段，手术干预仍然是一种选择。
2 muscle T2, AFD and fat fraction, including the critical step of direct intramuscular EMG confirmation of denervation. The study analysed 127 muscles in 30 participants with neuropathy of either the superscapular nerve, the axillary nerve or both across a range of sub-acute to chronic post-symptom durations. Global muscle T2 was measured with a T2-weighted turbo-spin echo sequence, AFD was assessed using a multi-shell diffusion tensor imaging sequence with signal modelling (7) and fat fraction was assessed with a 2pt Dixon sequence. Scan time was~ 10 minutes making this a clinically useful examination.The study reports graded increase in global muscle T2 correlated to the degree of reduced motor unit recruitment, while conversely there was a graded, but weaker decrease in AFD, suggesting muscle fibre atrophy. Muscle fat fraction was elevated in some patients and, while this may have partially biased the T2 measurement in affected muscles, the T2 change remains dominated by denervation. The prolonged T2 and reduced AFD were predictive of abnormal motor unit recruitment levels and fibrillation potentials and positive sharp waves observed with needle EMG, providing direct evidence that these metrics could be used as surrogates of electro-diagnostic measures in muscles which cannot be accessed by EMG. This study takes a further positive step in the development of non-invasive imaging to diagnose neuropathies. The AFD measurements are in their infancy and still require the substantiating histopathological evidence that they truly detect alterations in fibre size. Future studies must work to provide this underpinning evidence. Whilst it is encouraging that these techniques shows good correlation with EMG indices of denervation, what matters to patients is functional outcome. It will be important to show whether this exciting new development is more accurate than EMG in predicting recovery of arm function; not just in chronic brachial plexus injury, but also in the early stages when surgical intervention is still an option.