Quantitative MRI-Derived Muscle Fat Fractions for Diagnosing Cubital Tunnel Syndrome
Alna Dony, Year 4 Medical Student1, Ryckie George Wade, MBBS MSc MClinEd MRCS FHEA GradStat PhD2, Matthew Marzetti, MSc3, John Biglands, BSc, MSc, PhD3 and Gráinne Bourke, MB BCh BAO FRCSI FRCS(Plast) PhD4, 1Leeds School of Medicine, Leeds, West Yorkshire, United Kingdom, 2Department of Plastic and Reconstructive Surgery, University of Leeds, Leeds, United Kingdom, 3University of Leeds, Leeds, West Yorkshire, United Kingdom, 4Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
Background: Cubital tunnel syndrome (CuTS) is the 2nd most common compressive peripheral neuropathy, affecting up to 6% of the population. Before changes are clinically evident, muscle fat fractions and the T2-decay increase in response to chronic neuropathy. Quantitative MRI (qMRI) can non-invasively measure muscle fat fractions (FF, %) and T2 (ms) rapidly and reliably – the use of which has never been studied in the context of CuTS. This study aims to evaluate muscle fatty infiltration (via FF) and oedema/inflammation (via T2) as potential biomarkers of disease.
Methods: 29 healthy volunteers and 20 patients with CuTS who were awaiting surgical decompression were included in the study. FF using multi-point Dixon methods and T2-decay by multi-echo spin-echo was measured in the brachioradialis (control muscle), flexor carpi ulnaris (FCU), first dorsal interosseous (DI) and adductor pollicis (AddPol). All measurements were made using a 3.0 T Siemens Magnetom Prisma MRI scanner. Mean differences with their 95% confidence intervals (CI) were calculated for volunteers versus patients, using linear methods.
Results: In patients with CuTS as compared to controls, FFs were elevated in the FCU by 2.2% [CI 0.4-4.1], DI by 2.2% [CI 0.2 – 4.6] and AP by 1.8% [CI 0.7 – 4.2] as shown in Figure 1). Similarly, the T2 was prolonged in the FCU by 2.8 ms [CI 0.5-5.1], DI by 5.9 ms [CI 2.3-9.5] and AddPol by 5.4 ms [CI 1.7-9.0], as shown in Figure 2. In the control muscle brachioradialis, we observed no significant differences in FF or T2 between the two groups.
Conclusion: Patients with CuTS have higher muscle fat fractions (%) and prolonged T2 in ulnar-innervated muscles. This indicates that neuropathy induced fatty infiltration and inflammation may be detected non-invasively before clinical signs are apparent and used to guide patient treatment.
Please find figures in images attached.
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