Wren Tishya A L, Bluml Stefan, Tseng-Ong Linda, Gilsanz Vicente
Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS#81, Los Angeles, CA 90027, USA.
AJR Am J Roentgenol. 2008 Jan;190(1):W8-12. doi: 10.2214/AJR.07.2732.
Clinical trials involving patients with Duchenne muscular dystrophy are hindered by the lack of suitable objective end points. The purpose of this study was to examine whether muscle lipid infiltration measured with the three-point Dixon MRI technique has value as a marker of disease severity.
Disease severity in nine boys (mean age, 8.6 +/- 2.7 years) with Duchenne muscular dystrophy was determined with the functional ability scale of Brooke and associates. Functional scores were compared with strength measurements obtained by manual testing of muscles of the lower extremities, knee extensor strength measured with an isokinetic dynamometer, and muscle fat percentage in the quadriceps and hamstrings determined with the three-point Dixon MRI technique.
MRI measurements of fat infiltration had stronger correlation (p < 0.05) with functional grade than did measurements obtained with manual muscle testing (p = 0.07) or quantitative strength measured with the isokinetic dynamometer (p = 0.54). Muscle fat percentage did not correlate with strength measurements from manual or dynamometer muscle testing but increased with age in subjects with Duchenne muscular dystrophy.
Muscle adiposity values obtained with three-point Dixon MRI are accurate in assessment of disease severity in patients with Duchenne muscular dystrophy. Because they are not influenced by patient effort or examiner variability, these measurements are more objective and reproducible than measurements of muscle strength.
缺乏合适的客观终点阻碍了涉及杜氏肌营养不良症患者的临床试验。本研究的目的是检验用三点 Dixon MRI 技术测量的肌肉脂质浸润是否具有作为疾病严重程度标志物的价值。
采用布鲁克及其同事的功能能力量表确定 9 名杜氏肌营养不良症男孩(平均年龄 8.6±2.7 岁)的疾病严重程度。将功能评分与通过手动测试下肢肌肉获得的力量测量值、用等速测力计测量的膝关节伸肌力量以及用三点 Dixon MRI 技术测定的股四头肌和腘绳肌的肌肉脂肪百分比进行比较。
脂肪浸润的 MRI 测量值与功能分级的相关性比手动肌肉测试(p = 0.07)或用等速测力计测量的定量力量(p = 0.54)更强(p < 0.05)。肌肉脂肪百分比与手动或测力计肌肉测试的力量测量值无关,但在杜氏肌营养不良症患者中随年龄增加。
用三点 Dixon MRI 获得的肌肉肥胖值在评估杜氏肌营养不良症患者的疾病严重程度方面是准确的。由于它们不受患者努力程度或检查者差异的影响,这些测量比肌肉力量测量更客观且可重复。