Clinical Evaluation of Duchenne Muscular Dystrophy Severity Using Ultrasound Small-Window Entropy Imaging.

Dong Yan,Po-Hsiang Tsui,Jeng-Yi Shieh,Chia-Wei Lin,Qiang Li,Wen-Chin Weng

doi:10.3390/e22070715

Abstract

Information entropy of ultrasound imaging recently receives much attention in the diagnosis of Duchenne muscular dystrophy (DMD). DMD is the most common muscular disorder; patients lose their ambulation in the later stages of the disease. Ultrasound imaging enables routine examinations and the follow-up of patients with DMD. Conventionally, the probability distribution of the received backscattered echo signals can be described using statistical models for ultrasound parametric imaging to characterize muscle tissue. Small-window entropy imaging is an efficient nonmodel-based approach to analyzing the backscattered statistical properties. This study explored the feasibility of using ultrasound small-window entropy imaging in evaluating the severity of DMD. A total of 85 participants were recruited. For each patient, ultrasound scans of the gastrocnemius were performed to acquire raw image data for B-mode and small-window entropy imaging, which were compared with clinical diagnoses of DMD by using the receiver operating characteristic curve. The results indicated that entropy imaging can visualize changes in the information uncertainty of ultrasound backscattered signals. The median with interquartile range (IQR) of the entropy value was 4.99 (IQR: 4.98–5.00) for the control group, 5.04 (IQR: 5.01–5.05) for stage 1 patients, 5.07 (IQR: 5.06–5.07) for stage 2 patients, and 5.07 (IQR: 5.06–5.07) for stage 3 patients. The diagnostic accuracies were 89.41%, 87.06%, and 72.94% for ≥stage 1, ≥stage 2, and ≥stage 3, respectively. Comparisons with previous studies revealed that the small-window entropy imaging technique exhibits higher diagnostic performance than conventional methods. Its further development is recommended for potential use in clinical evaluations and the follow-up of patients with DMD.

Highlights

Information entropy of ultrasound imaging recently receives much attention in the diagnosis of Duchenne muscular dystrophy (DMD)
We explored the feasibility of using ultrasound small-window entropy imaging in evaluating the severity of the dystrophic process in patients with DMD
Observations indicate the region of interest (ROI) corresponding to the gastrocnemius for ultrasound entropy imaging

Summary

Introduction

Information entropy of ultrasound imaging recently receives much attention in the diagnosis of Duchenne muscular dystrophy (DMD). DMD is the most common muscular disorder caused by mutations in the dystrophin gene [1] and results in absent or insufficient functional dystrophin, which leads to reduced sarcolemma stability and rendering the muscle fibers vulnerable to mechanical stretching-induced injury [2]. As a consequence, repeated contraction leads to necrosis and the regeneration of muscle fibers, which are gradually replaced by fat and fibrous tissue. This disease is primarily an X-linked condition affecting males; some female carriers exhibit symptoms of the disorder, but usually with a milder phenotype [3].

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Conclusion