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Meta-analysis of the normal diffusion tensor imaging values of the peripheral nerves in the upper limb

Peripheral neuropathy affects 1 in 10 adults over the age of 40 years. Given the absence of a reliable diagnostic test for peripheral neuropathy, there has been a surge of research into diffusion tensor imaging (DTI) because it characterises nerve microstructure and provides reproducible proxy measu...

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Autores principales: Wade, Ryckie G., Lu, Fangqing, Poruslrani, Yohan, Karia, Chiraag, Feltbower, Richard G., Plein, Sven, Bourke, Grainne, Teh, Irvin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10039047/
https://www.ncbi.nlm.nih.gov/pubmed/36964186
http://dx.doi.org/10.1038/s41598-023-31307-2
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author Wade, Ryckie G.
Lu, Fangqing
Poruslrani, Yohan
Karia, Chiraag
Feltbower, Richard G.
Plein, Sven
Bourke, Grainne
Teh, Irvin
author_facet Wade, Ryckie G.
Lu, Fangqing
Poruslrani, Yohan
Karia, Chiraag
Feltbower, Richard G.
Plein, Sven
Bourke, Grainne
Teh, Irvin
author_sort Wade, Ryckie G.
collection PubMed
description Peripheral neuropathy affects 1 in 10 adults over the age of 40 years. Given the absence of a reliable diagnostic test for peripheral neuropathy, there has been a surge of research into diffusion tensor imaging (DTI) because it characterises nerve microstructure and provides reproducible proxy measures of myelination, axon diameter, fibre density and organisation. Before researchers and clinicians can reliably use diffusion tensor imaging to assess the ‘health’ of the major nerves of the upper limb, we must understand the “normal” range of values and how they vary with experimental conditions. We searched PubMed, Embase, medRxiv and bioRxiv for studies which reported the findings of DTI of the upper limb in healthy adults. Four review authors independently triple extracted data. Using the meta suite of Stata 17, we estimated the normal fractional anisotropy (FA) and diffusivity (mean, MD; radial, RD; axial AD) values of the median, radial and ulnar nerve in the arm, elbow and forearm. Using meta-regression, we explored how DTI metrics varied with age and experimental conditions. We included 20 studies reporting data from 391 limbs, belonging to 346 adults (189 males and 154 females, ~ 1.2 M:1F) of mean age 34 years (median 31, range 20–80). In the arm, there was no difference in the FA (pooled mean 0.59 mm(2)/s [95% CI 0.57, 0.62]; I(2) 98%) or MD (pooled mean 1.13 × 10(–3) mm(2)/s [95% CI 1.08, 1.18]; I(2) 99%) of the median, radial and ulnar nerves. Around the elbow, the ulnar nerve had a 12% lower FA than the median and radial nerves (95% CI − 0.25, 0.00) and significantly higher MD, RD and AD. In the forearm, the FA (pooled mean 0.55 [95% CI 0.59, 0.64]; I(2) 96%) and MD (pooled mean 1.03 × 10(–3) mm(2)/s [95% CI 0.94, 1.12]; I(2) 99%) of the three nerves were similar. Multivariable meta regression showed that the b-value, TE, TR, spatial resolution and age of the subject were clinically important moderators of DTI parameters in peripheral nerves. We show that subject age, as well as the b-value, TE, TR and spatial resolution are important moderators of DTI metrics from healthy nerves in the adult upper limb. The normal ranges shown here may inform future clinical and research studies.
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spelling pubmed-100390472023-03-26 Meta-analysis of the normal diffusion tensor imaging values of the peripheral nerves in the upper limb Wade, Ryckie G. Lu, Fangqing Poruslrani, Yohan Karia, Chiraag Feltbower, Richard G. Plein, Sven Bourke, Grainne Teh, Irvin Sci Rep Article Peripheral neuropathy affects 1 in 10 adults over the age of 40 years. Given the absence of a reliable diagnostic test for peripheral neuropathy, there has been a surge of research into diffusion tensor imaging (DTI) because it characterises nerve microstructure and provides reproducible proxy measures of myelination, axon diameter, fibre density and organisation. Before researchers and clinicians can reliably use diffusion tensor imaging to assess the ‘health’ of the major nerves of the upper limb, we must understand the “normal” range of values and how they vary with experimental conditions. We searched PubMed, Embase, medRxiv and bioRxiv for studies which reported the findings of DTI of the upper limb in healthy adults. Four review authors independently triple extracted data. Using the meta suite of Stata 17, we estimated the normal fractional anisotropy (FA) and diffusivity (mean, MD; radial, RD; axial AD) values of the median, radial and ulnar nerve in the arm, elbow and forearm. Using meta-regression, we explored how DTI metrics varied with age and experimental conditions. We included 20 studies reporting data from 391 limbs, belonging to 346 adults (189 males and 154 females, ~ 1.2 M:1F) of mean age 34 years (median 31, range 20–80). In the arm, there was no difference in the FA (pooled mean 0.59 mm(2)/s [95% CI 0.57, 0.62]; I(2) 98%) or MD (pooled mean 1.13 × 10(–3) mm(2)/s [95% CI 1.08, 1.18]; I(2) 99%) of the median, radial and ulnar nerves. Around the elbow, the ulnar nerve had a 12% lower FA than the median and radial nerves (95% CI − 0.25, 0.00) and significantly higher MD, RD and AD. In the forearm, the FA (pooled mean 0.55 [95% CI 0.59, 0.64]; I(2) 96%) and MD (pooled mean 1.03 × 10(–3) mm(2)/s [95% CI 0.94, 1.12]; I(2) 99%) of the three nerves were similar. Multivariable meta regression showed that the b-value, TE, TR, spatial resolution and age of the subject were clinically important moderators of DTI parameters in peripheral nerves. We show that subject age, as well as the b-value, TE, TR and spatial resolution are important moderators of DTI metrics from healthy nerves in the adult upper limb. The normal ranges shown here may inform future clinical and research studies. Nature Publishing Group UK 2023-03-24 /pmc/articles/PMC10039047/ /pubmed/36964186 http://dx.doi.org/10.1038/s41598-023-31307-2 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Wade, Ryckie G.
Lu, Fangqing
Poruslrani, Yohan
Karia, Chiraag
Feltbower, Richard G.
Plein, Sven
Bourke, Grainne
Teh, Irvin
Meta-analysis of the normal diffusion tensor imaging values of the peripheral nerves in the upper limb
title Meta-analysis of the normal diffusion tensor imaging values of the peripheral nerves in the upper limb
title_full Meta-analysis of the normal diffusion tensor imaging values of the peripheral nerves in the upper limb
title_fullStr Meta-analysis of the normal diffusion tensor imaging values of the peripheral nerves in the upper limb
title_full_unstemmed Meta-analysis of the normal diffusion tensor imaging values of the peripheral nerves in the upper limb
title_short Meta-analysis of the normal diffusion tensor imaging values of the peripheral nerves in the upper limb
title_sort meta-analysis of the normal diffusion tensor imaging values of the peripheral nerves in the upper limb
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10039047/
https://www.ncbi.nlm.nih.gov/pubmed/36964186
http://dx.doi.org/10.1038/s41598-023-31307-2
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