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Research ArticlePediatric Neuroimaging

In Vivo Evaluation of White Matter Abnormalities in Children with Duchenne Muscular Dystrophy Using DTI

V. Preethish-Kumar, A. Shah, M. Kumar, M. Ingalhalikar, K. Polavarapu, M. Afsar, J. Rajeswaran, S. Vengalil, S. Nashi, P.T. Thomas, A. Sadasivan, M. Warrier, A. Nalini and J. Saini
American Journal of Neuroradiology July 2020, 41 (7) 1271-1278; DOI: https://doi.org/10.3174/ajnr.A6604
V. Preethish-Kumar
aFrom the Departments of Neurology (V.P.-K., K.P., S.V., S.N., A.N.)
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A. Shah
eSymbiosis Centre for Medical Image Analysis (A.Shah, M.I.), Symbiosis International University, Mulshi Pune, Maharashtra, India.
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M. Kumar
bNeuroimaging and Interventional Radiology (M.K., J.S.)
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M. Ingalhalikar
eSymbiosis Centre for Medical Image Analysis (A.Shah, M.I.), Symbiosis International University, Mulshi Pune, Maharashtra, India.
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K. Polavarapu
aFrom the Departments of Neurology (V.P.-K., K.P., S.V., S.N., A.N.)
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M. Afsar
cNeuropsychology (M.A., J.R.)
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J. Rajeswaran
cNeuropsychology (M.A., J.R.)
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S. Vengalil
aFrom the Departments of Neurology (V.P.-K., K.P., S.V., S.N., A.N.)
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S. Nashi
aFrom the Departments of Neurology (V.P.-K., K.P., S.V., S.N., A.N.)
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P.T. Thomas
dPsychiatric Social Work (P.T.T., A.Sadasivan, M.W.), National Institute of Mental Health and Neurosciences, Bangalore, India
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A. Sadasivan
dPsychiatric Social Work (P.T.T., A.Sadasivan, M.W.), National Institute of Mental Health and Neurosciences, Bangalore, India
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M. Warrier
dPsychiatric Social Work (P.T.T., A.Sadasivan, M.W.), National Institute of Mental Health and Neurosciences, Bangalore, India
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A. Nalini
aFrom the Departments of Neurology (V.P.-K., K.P., S.V., S.N., A.N.)
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J. Saini
bNeuroimaging and Interventional Radiology (M.K., J.S.)
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  • FIG 1.
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    FIG 1.

    DTI TBSS analysis comparing healthy controls with patients with DMD shows areas with significantly (P < .01, family-wise error corrected) decreased FA and increased MD and RD in patients with DMD. Green represents the WM skeleton, while red and maroon are clusters of significance.

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    FIG 2.

    Healthy control versus DMD (distal) Dp140– TBSS results. RD (A), MD (B), and AD (C) are significantly increased in patients compared with healthy controls in both the cerebellar WM and cerebral WM with relative sparing of the frontal WM (P < .01 family-wise error–corrected). D, FA did not show any significant differences; however, the trend was noted because many areas showed FA differences at the less conservative statistical threshold of P < .05 (family-wise error–corrected). Green represents the WM skeleton, while red and maroon are clusters of significance.

  • FIG 3.
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    FIG 3.

    (A) Healthy controls versus DMD (proximal) Dp140+: TBSS for FA shows significantly lower FA in the patient group in the areas highlighted in red (P < .01). No significant differences in any of the diffusivity metrics are noted. (B) DMD distal (Dp140–) versus DMD proximal (Dp140+): TBSS shows higher AD in patients with a distal mutation involving the cerebellar WM and right occipitoparietal-temporal WM. The rest of the diffusion metrics did not show any significant difference.

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    Table 1:

    Clinical characteristics and MDFRS scores

    Patients with DMD (Range)Controls (Range)
    Age at recruitment (mean) (yr)8.0 ± 1.2 (6–10)8.2 ± 1.4 (6–10)
    Age at onset (mean) (yr)4.1 ± 1.8 (1–9)
    Age at presentation (mean) (range) (yr)7.5 ± 1.4 (4–10)
    Duration (mean) (mo)40.8 ± 25.2 (6–120)
    MDFRS domains (mean)
     Mobility (maximum 36)24.35 ± 3.272 (15–30)
     Basic ADL (maximum 24)18.77 ± 2.547 (12–25)
     Arm function (maximum 28)22.07 ± 1.885 (19–25)
     Impairment (maximum 44)34.18 ± 3.568 (23–40)
     Total score (maximum 132)99.37 ± 10.55 (69–117)
    • Note:—ADL indicates activities of daily living; MDFRS, Muscular Dystrophy Functional Rating scale.

    • View popup
    Table 2:

    Comparison of the intelligent quotient (IQ) values of WISC-III scale between the two patient subgroups (DMD proximal and distal), and healthy controls

    SNTestGroup (I)Group (J)Difference (I-J)Significance95% CI, Lower-to-Upper Bounds
    1.Verbal IQControlProximal17.258a.0008.79–25.73
    Distal29.699a.00022.27–37.12
    ProximalDistal12.441a.0023.76–21.12
    2.Performance IQControlProximal15.350a.0006.88–23.82
    Distal24.442a.00017.01–31.87
    ProximalDistal9.092a.0370.41–17.77
    3.Full-scale IQControlProximal18.238a.0009.50–26.98
    Distal30.141a.00022.48–37.81
    ProximalDistal11.903a.0052.95–20.86
    4.Verbal CompositionControlProximal17.608a.0009.32–25.90
    Distal27.612a.00020.34–34.88
    ProximalDistal10.005a.0151.51–18.50
    5.Perceptual Organization IndexControlProximal15.352a.0007.47–23.23
    Distal23.272a.00016.37–30.18
    ProximalDistal7.920.056–0.15–15.99
    6.Freedom from Distractibility IndexControlProximal8.183.092–0.90–17.26
    Distal23.293a.00015.33–31.26
    ProximalDistal15.110a.0005.80–24.41
    • Note:—SN indicates serial number.

    • ↵a level of significance.

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V. Preethish-Kumar, A. Shah, M. Kumar, M. Ingalhalikar, K. Polavarapu, M. Afsar, J. Rajeswaran, S. Vengalil, S. Nashi, P.T. Thomas, A. Sadasivan, M. Warrier, A. Nalini, J. Saini
In Vivo Evaluation of White Matter Abnormalities in Children with Duchenne Muscular Dystrophy Using DTI
American Journal of Neuroradiology Jul 2020, 41 (7) 1271-1278; DOI: 10.3174/ajnr.A6604

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In Vivo Evaluation of White Matter Abnormalities in Children with Duchenne Muscular Dystrophy Using DTI
V. Preethish-Kumar, A. Shah, M. Kumar, M. Ingalhalikar, K. Polavarapu, M. Afsar, J. Rajeswaran, S. Vengalil, S. Nashi, P.T. Thomas, A. Sadasivan, M. Warrier, A. Nalini, J. Saini
American Journal of Neuroradiology Jul 2020, 41 (7) 1271-1278; DOI: 10.3174/ajnr.A6604
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