TY - JOUR
T1 - MRI shows thickening and altered diffusion in the median and ulnar nerves in multifocal motor neuropathy
AU - Haakma, Wieke
AU - Jongbloed, Bas A.
AU - Froeling, Martijn
AU - Goedee, H. Stephan
AU - Bos, Clemens
AU - Leemans, Alexander
AU - van Den Berg, Leonard H.
AU - Hendrikse, Jeroen
AU - van der Pol, W. Ludo
N1 - Funding Information:
We would like to thank Niels Blanken (MRI radiographer, department of radiology) for his help in performing the MRI scans. We would like to thank Dirk Rutgers (radiologist) and Hessel Franssen (neurologist) for sharing their expert opinions on this topic. The scientific guarantor of this publication is Jeroen Hendrikse. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study received funding as follows: H.S. Goedee receives research support from the Prinses Beatrix Spierfonds. A. Leemans receives research support of the VIDI Grant 639.072.411 from the Netherlands Organisation for Scientific Research (NWO). L.H. van den Berg serves on scientific advisory boards for the Prinses Beatrix Spierfonds, Thierry Latran Foundation, Biogen Idec and Cytokinetics; received an educational grant from Baxter International Inc.; serves on the editorial board of Amyotrophic Lateral Sclerosis and the Journal of Neurology, Neurosurgery and Psychiatry; and receives research support from the Prinses Beatrix Spierfonds, Netherlands ALS Foundation, The European Community's Health Seventh Framework Programme (grant agreement n?? 259867), The Netherlands Organization for Health Research and Development (Vici Scheme, JPND (SOPHIA, STRENGTH)). J. Hendrikse receives support from the Netherlands Organization for Scientific Research (NWO) under grant n??91712322, the European Research Council under grant agreements n??637024. W.L. van der Pol receives research support from the Prinses Beatrix Spierfonds; The Netherlands ALS Foundation; Stichting Spieren voor Spieren. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: case-control study, performed at one institution.
Publisher Copyright:
© 2016, The Author(s).
PY - 2017/5
Y1 - 2017/5
N2 - Objectives: To study disease mechanisms in multifocal motor neuropathy (MMN) with magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) of the median and ulnar nerves. Methods: We enrolled ten MMN patients, ten patients with amyotrophic lateral sclerosis (ALS) and ten healthy controls (HCs). Patients underwent MRI (in a prone position) and nerve conduction studies. DTI and fat-suppressed T2-weighted scans of the forearms were performed on a 3.0T MRI scanner. Fibre tractography of the median and ulnar nerves was performed to extract diffusion parameters: fractional anisotropy (FA), mean (MD), axial (AD) and radial (RD) diffusivity. Cross-sectional areas (CSA) were measured on T2-weighted scans. Results: Forty-five out of 60 arms were included in the analysis. AD was significantly lower in MMN patients (2.20 ± 0.12 × 10-3 mm2/s) compared to ALS patients (2.31 ± 0.17 × 10-3 mm2/s; p <0.05) and HCs (2.31± 0.17 × 10-3 mm2/s; p <0.05). Segmental analysis showed significant restriction of AD, RD and MD (p <0.005) in the proximal third of the nerves. CSA was significantly larger in MMN patients compared to ALS patients and HCs (p <0.01). Conclusions: Thickening of nerves is compatible with changes in the myelin sheath structure, whereas lowered AD values suggest axonal dysfunction. These findings suggest that myelin and axons are diffusely involved in MMN pathogenesis. Key Points: • Diffusion magnetic resonance imaging provides quantitative information about multifocal motor neuropathy (MMN).• Diffusion tensor imaging allows non-invasive evaluation of the forearm nerves in MMN.• Nerve thickening and lowered diffusion parameters suggests myelin and axonal changes.• This study can help to provide insight into pathological mechanisms of MMN.
AB - Objectives: To study disease mechanisms in multifocal motor neuropathy (MMN) with magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) of the median and ulnar nerves. Methods: We enrolled ten MMN patients, ten patients with amyotrophic lateral sclerosis (ALS) and ten healthy controls (HCs). Patients underwent MRI (in a prone position) and nerve conduction studies. DTI and fat-suppressed T2-weighted scans of the forearms were performed on a 3.0T MRI scanner. Fibre tractography of the median and ulnar nerves was performed to extract diffusion parameters: fractional anisotropy (FA), mean (MD), axial (AD) and radial (RD) diffusivity. Cross-sectional areas (CSA) were measured on T2-weighted scans. Results: Forty-five out of 60 arms were included in the analysis. AD was significantly lower in MMN patients (2.20 ± 0.12 × 10-3 mm2/s) compared to ALS patients (2.31 ± 0.17 × 10-3 mm2/s; p <0.05) and HCs (2.31± 0.17 × 10-3 mm2/s; p <0.05). Segmental analysis showed significant restriction of AD, RD and MD (p <0.005) in the proximal third of the nerves. CSA was significantly larger in MMN patients compared to ALS patients and HCs (p <0.01). Conclusions: Thickening of nerves is compatible with changes in the myelin sheath structure, whereas lowered AD values suggest axonal dysfunction. These findings suggest that myelin and axons are diffusely involved in MMN pathogenesis. Key Points: • Diffusion magnetic resonance imaging provides quantitative information about multifocal motor neuropathy (MMN).• Diffusion tensor imaging allows non-invasive evaluation of the forearm nerves in MMN.• Nerve thickening and lowered diffusion parameters suggests myelin and axonal changes.• This study can help to provide insight into pathological mechanisms of MMN.
KW - Amyotrophic lateral sclerosis
KW - Diffusion tensor imaging
KW - Magnetic resonance imaging
KW - Median and ulnar nerve
KW - Multifocal motor neuropathy
UR - http://www.scopus.com/inward/record.url?scp=84988600877&partnerID=8YFLogxK
U2 - 10.1007/s00330-016-4575-0
DO - 10.1007/s00330-016-4575-0
M3 - Article
C2 - 27655303
AN - SCOPUS:84988600877
SN - 0938-7994
VL - 27
SP - 2216
EP - 2224
JO - European Radiology
JF - European Radiology
IS - 5
ER -