MRI texture analysis (MRTA) of T2-weighted images in Crohn’s disease may provide information on histological and MRI disease activity in patients undergoing ileal resection

Objectives

To associate MRI textural analysis (MRTA) with MRI and histological Crohn’s disease (CD) activity.

Methods

Sixteen patients (mean age 39.5 years, 9 male) undergoing MR enterography before ileal resection were retrospectively analysed. Thirty-six small (≤3 mm) ROIs were placed on T2-weighted images and location-matched histological acute inflammatory scores (AIS) measured. MRI activity (mural thickness, T2 signal, T1 enhancement) (CDA) was scored in large ROIs. MRTA features (mean, standard deviation, mean of positive pixels (MPP), entropy, kurtosis, skewness) were extracted using a filtration histogram technique. Spatial scale filtration (SSF) ranged from 2 to 5 mm. Regression (linear/logistic) tested associations between MRTA and AIS (small ROIs), and CDA/constituent parameters (large ROIs).

Results

Skewness (SSF?=?2 mm) was associated with AIS [regression coefficient (rc) 4.27, p?=?0.02]. Of 120 large ROI analyses (for each MRI, MRTA feature and SSF), 15 were significant. Entropy (SSF?=?2, 3 mm) and kurtosis (SSF?=?3 mm) were associated with CDA (rc 0.9, 1.0, ?0.45, p?=?0.006–0.01). Entropy and mean (SSF?=?2–4 mm) were associated with T2 signal [odds ratio (OR) 2.32–3.16, p?=?0.02–0.004], [OR 1.22–1.28, p?=?0.03–0.04]. MPP (SSF?=?2 mm) was associated with mural thickness (OR 0.91, p?=?0.04). Kurtosis (SSF?=?3 mm), standard deviation (SSF?=?5 mm) were associated with decreased T1 enhancement (OR 0.59, 0.42, p?=?0.004, 0.007).

Conclusions

MRTA features may be associated with CD activity.

Key Points

? MR texture analysis features may be associated with Crohn’s disease histological activity.? Texture analysis features may correlate with MR-dependent Crohn’s disease activity scores.? The utility of MR texture analysis in Crohn’s disease merits further investigation.

     

Spatio-temporal and kinematic gait analysis in patients with Frontotemporal dementia and Alzheimer’s disease through 3D motion capture

Alzheimer’s disease (AD) and behavioral variant of Frontotemporal Dementia (bvFTD) are characterized respectively by atrophy in the medial temporal lobe with memory loss and prefrontal and anterior temporal degeneration with dysexecutive syndrome. In this study, we hypothesized that specific gait patterns are induced by either frontal or temporal degeneration. To test this hypothesis, we studied the gait pattern in bvFTD (23) and AD (22) patients in single and dual task (“motor” and “cognitive”) conditions. To detect subtle alterations, we performed motion analysis estimating both spatio-temporal parameters and joint excursions. In the single task condition, the bvFTD group was more unstable and slower compared to healthy subjects, while only two stability parameters were compromised in the AD group. During the motor dual task, both velocity and stability parameters worsened further in the bvFTD group. In the same experimental conditions, AD patients showed a significantly lower speed and stride length than healthy subjects. During the cognitive dual task, a further impairment of velocity and stability parameters was observed in the bvFTD group. Interestingly, during the cognitive dual task, the gait performance of the AD group markedly deteriorated, as documented by the impairment of more indices of velocity and stability. Finally, the kinematic data of thigh, knee, and ankle were more helpful in revealing gait impairment than the spatio-temporal parameters alone. In conclusion, our data showed that the dysexecutive syndrome induces specific gait alterations. Furthermore, our results suggest that the gait worsens in the AD patients when the cognitive resources are stressed.     

Construct validity and test-retest reliability of a free mobile application for spatio-temporal gait analysis in Parkinson’s disease patients

BackgroundMobile applications may be used to assess gait pattern deviation through mobile smartphones in people with Parkinson’s disease (PD). However, few studies have investigated their psychometrics properties.Research questionTo study the construct validity and test-retest reliability of the RUNZI® free mobile application in people with mild to moderate PD.MethodsThirty individuals were evaluated with the RUNZI® app and with the 10-meter walking test (10 MW), simultaneously. In addition, the Timed Up & Go test (TUG), Tinetti scale, and the Berg Balance Scale (BBS) were used to study the construct validity. Also, test-retest reliability of the mobile for spatio-temporal gait parameters was explored.ResultsThe correlation indices of the 10 MW test with the RUNZI® app at fast speeds was moderate to excellent (r = .588–.957). At a comfortable speed, the correlation was excellent for walking speed (r = 0.944), moderate for steps (r = 0.780) and stride length (r = 0.760), and poor for cadence (r = .424). Results showed significant correlations between TUG and spatio-temporal gait parameters at fast and comfortable speeds. There were no significant correlations or consistent associations between Tinetti and BBS and RUNZI®. The test-retest reliability was good to excellent for parameters measured with the RUNZI®.SignificanceOur findings highlight specific opportunities for a free smartphone-based spatio-temporal gait analysis to serve as a complement to conventional gait analysis methods in clinical practice with a moderate to excellent construct validity with the 10 MW test and good to excellent test-retest reliability in PD patients.     

Functional volumetric analysis of striatum using F-18 FP-CIT PET in patients with idiopathic Parkinson’s disease and normal subjects

Objective

We applied a simple isocontour volume-of-interest (VOI) method to analyze the whole striatum in an F-18 FP-CIT PET image and to investigate the usefulness of the method in differentiating healthy subjects from idiopathic Parkinson’s disease (IPD) patients and the correlation of the value of functional volume parameters with the motor symptoms in patients with IPD.

Methods

Forty-three IPD patients and 23 age-matched healthy controls underwent F-18 FP-CIT PET. Using a dedicated workstation, VOIs for the whole striatum were drawn automatically with the gradient delineation method. The SUVmax, SUVmean, functional volume (FV), striatal volume activity (SVA), striatal-specific binding (SSB), and volume-specific uptake ratio (VSUR) were compared between the IPD patients and the normal subjects. In the IPD patients, the correlation between the clinical factor and the functional parameters was assessed.

Results

The SUVmax, SUVmean, FV, SVA, SSB, and VSUR were significantly lower in the IPD patients than in the normal subjects. In the receiver operating characteristic analysis, those parameters had significant and good-to-excellent accuracy. In the patients with IPD, a moderate negative correlation was revealed between the SUVmax and H&Y stage, the SUVmean and H&Y stage, SVA and H&Y stage, the VSUR and H&Y stage, the FV and bradykinesia, and the SVA and bradykinesia.

Conclusion

The functional volumetric analysis of the striatum based on simple isocontour VOI was a useful method of analyzing the F-18 FP-CIT PET image. Not only can it be easily applied in daily clinical practice, but it can also be used as a clinical parameter to discriminate IPD and to correlate it with the disease severity.

     

Textured and stimulating insoles for balance and gait impairments in patients with multiple sclerosis and Parkinson’s disease: A systematic review and meta-analysis

The aim of this systematic review with meta-analysis was to investigate if using textured or other types of stimulating insoles improve gait characteristics and balance/postural control in patients with multiple sclerosis and Parkinson’s disease. Primary outcomes for balance were the center of pressure (CoP) displacement and CoP velocity/sway rate. Primary outcomes for gait were the cadence, velocity, and step length. Standardized mean differences (SMD) were used to verify the efficacy of wearing the insoles on gait and balance outcome measures. Study quality was evaluated using the checklist of the CONSORT- Statement. Six studies were included in the review. Five studies had low methodological quality, scoring <17/37 on the checklist, one study had moderate methodological quality, scoring 27/37 on the checklist. Due to designs of the included studies, only immediate effects could be calculated. Among the primary outcome measures cadence, gait velocity and step length, there was no evidence of an effect of using textured/stimulating insoles compared with the respective control condition (Totals: SMD −0.09, 95% CI −0.35 to 0.16; SMD 0.18, 95% CI −0.17 to 0.53; SMD −0.13, 95% CI −0.31 to 0.05). Furthermore, among the primary outcome measures CoP displacement and CoP velocity, no evidence of an effect was found as well (Subtotals multiple sclerosis: SMD 0.07, 95% CI −0.15 to 0.28; SMD −0.08, 95% CI −0.55 to 0.39). Therefore, using textured or other types of stimulating insoles for the treatment of balance and gait impairments in patients with multiple sclerosis and Parkinson’s disease seem to have no effect.     

Self-paced treadmills do not allow for valid observation of linear and nonlinear gait variability outcomes in patients with Parkinson’s disease

BackgroundDue to the imposed constant belt speed, motorized treadmills are known to affect linear and nonlinear gait variability outcomes. This is particularly true of patients with Parkinson’s Disease where the treadmill can act as an external pacemaker. Self-paced treadmills update the belt speed in response to the subject's walking speed and might, therefore, be a useful tool for measurement of gait variability in this patient population. This study aimed to compare gait variability during walking at self-paced and constant treadmill speeds with overground walking in individuals with PD and individuals with unimpaired gait.MethodsThirteen patients with Parkinson’s Disease and thirteen healthy controls walked under three conditions: overground, on a treadmill at a constant speed, and using three self-paced treadmill modes. Gait variability was assessed with coefficient of variation (CV), sample entropy (SampEn), and detrended fluctuation analysis (DFA) of stride time and length. Systematic and random error between the conditions was quantified.ResultsFor individuals with PD, error in variability measurement was less during self-paced modes compared with constant treadmill speed for stride time but not for stride length. However, there was substantial error for stride time and length variability for all treadmill conditions. For healthy controls the error in measurement associated with treadmill walking was substantially less.SignificanceThe large systematic and random errors between overground and treadmill walking prohibit meaningful gait variability observations in patients with Parkinson’s Disease using self-paced or constant-speed treadmills.     

Differences in [99mTc]TRODAT-1 SPECT binding to dopamine transporters in patients with multiple system atrophy and Parkinson’s disease

Purpose Multiple system atrophy (MSA), a disorder causing autonomic dysfunction, parkinsonism, and cerebellar dysfunction, is difficult to differentiate from other movement disorders, particularly early in the course of disease. This study evaluated whether [^99mTc]TRODAT-1 binding to the dopamine transporter differentiates MSA from other movement disorders.Methods Single-photon emission computed tomographic brain scans were acquired in 25 MSA patients, 48 age-matched controls, and 130 PD patients, 3 h after the injection of 740 MBq (20 mCi) of [^99mTc]TRODAT-1. Regions of interest (ROIs) were placed manually on subregions of both basal ganglia and distribution volume ratios (DVRs) were calculated. Regional DVRs were compared between study groups in MSA patients. Students t tests were used to compare MSA patients with other study groups. Spearman correlations were used to compare DVRs with NP measures.Results Based upon various motor scores, MSA and PD patients had comparable motor impairment, and were significantly impaired compared with controls. Mean DVRs in the basal ganglia of MSA patients were significantly less than those of controls, but generally higher (p<0.05) than in PD patients. In particular, the MSA patients had significantly increased DVRs in the posterior putamen (mean 0.49±0.30) compared with PD patients (0.74±0.25).Conclusion Movement disorder patients could be differentiated from controls, but MSA and PD patients could not be easily differentiated from each other. As a group, MSA patients had significantly higher mean [^99mTc]TRODAT-1 binding, particularly in the posterior putamen, compared with PD patients and significantly lower binding compared with controls. This may reflect different pathophysiological processes of the two neurodegenerative diseases.