New MRI technique allows detailed imaging of complex muscle structures and muscle damage

8 01 2015

TU/e and the Academic Medical Center in Amsterdam have together developed a technique that allows detailed 3D imaging of complex muscle structures of patients. It also allows muscle damage to be detected very precisely. This new technique opens the way to much better and more patient-friendly diagnosis of muscular diseases. It also allows accurate, non-invasive muscle examinations among top athletes. Martijn Froeling will receive a PhD for this research at TU/e today, Monday 29 October.

muscle structure pelvis | image: Martijn Froeling

Froeling uses diffusion tensor imaging (DTI), an MRI technique that allows the movements of water molecules in living tissue to be viewed. Because muscles are made of fibers, the movements of water molecules in the direction of the fibers are different from those in other directions. This characteristic allows muscles to be imaged with a high level of detail. This was already possible on a small scale with simple muscles, but thanks to Froeling’s work it can now also be done on a larger scale and with complex muscle structures. More importantly, this improved technique also reveals very small muscle damage, because of the different movements of the water molecules in damaged muscle fibers.

3D images

To reach these results, Froeling improved the data acquisition process – the way the MRI scanner images the muscle under examination. This has to be performed relatively quickly, because it is uncomfortable for patients to lie in an MRI scanner for a long time, but at the same time it has to provide sufficiently detailed data. He also improved the processing of the acquired data into reliable 3D images. Physicians can now easily view complex muscle structures from all angles on-screen. No new equipment was needed; the researchers used standard widely available clinical systems.

Marathon runners

As a practical study, Froeling imaged a range of subjects including the thighs of marathon runners at different times: one week before a marathon, two days after it, and again three weeks after. He was able to visualize the muscle damage following the marathon. This was still visible after three weeks, even though the runners themselves in many cases no longer reported any pain in their muscles. Another study was of the pelvic floor in women; a good example of a highly complex muscle structure. The technique has proved to be capable of imaging this structure with great accuracy, which makes it potentially very valuable for the diagnosis of conditions such as uterine prolapse.

Wide application area

AMC Amsterdam and TU/e now intend to use this technique in studies of post polio syndrome and spinal muscular atrophy. Froeling believes there are numerous potential applications: there are around 600 different types of muscle disease and damage, and the new technique will improve the ability to study these. However further studies will first be needed: although the technique allows muscle disease or injury to be imaged it does not reveal the precise cause, which may be tearing, fat infiltration or other abnormalities. Clarification is also still needed on what are the normal values for healthy men and women of different ages, to provide a reference framework for identifying abnormalities in different groups of patients. Another kind of application is in examinations of top athletes, to allow timely detection of muscle damage or better estimation of the recovery time needed after injuries.

Martijn Froeling will gain his PhD at Eindhoven University of Technology on Monday 29 October for his thesis entitled ‘DTI of Human Skeletal Muscle, From Simulation to Clinical Implementation’. His thesis supervisor is prof.dr. Klaas Nicolay, professor of Biomedical NMR at TU/e. Co-supervisors are dr.ir. Gustav Strijkers (TU/e) and dr.ir. Aart Nederveen (AMC).

 

Tue.nl [en línea] Eindhoven (NL): tue.nl, 08 de enero de 2015 [ref. 29 de octubre de 2012] Disponible en Internet: http://www.tue.nl/en/university/departments/biomedical-engineering/news/29-10-2012-new-mri-technique-allows-detailed-imaging-of-complex-muscle-structures-and-muscle-damage/



Hacia dónde va el mercado de diagnóstico

2 01 2014

Conforme avanza la tecnología médica, hay una tendencia muy clara de unión entre dos portafolios del negocio de la salud antes separados: medicamentos y pruebas de diagnóstico. El ejemplo más clásico está en cáncer de mama: actualmente, en cuanto una mujer recibe el diagnóstico, ya es prácticamente obligado que el médico le mande a aplicar ciertas pruebas conocidas como marcadores, para definir qué tipo de tumor la ha atacado, porque en función de ello, es posible enviarle el medicamento más indicado a esa paciente.

 

Esto significa que con las pruebas de diagnóstico actualmente existentes ya no sólo se sabe si alguien tiene o no la enfermedad -en este caso el cáncer-, sino que es factible definir entre una serie de diferentes tipos de tumores cancerígenos. Con ello hoy también se sabe que el cáncer ya no es una única enfermedad, sino es un conjunto de innumerables tipos y subtipos de enfermedades. Algo similar ya está sucediendo con la hepatitis C y con el cáncer cervicouterino, que tiene la prueba de Virus de Papiloma Humano.

Y para como van las cosas, en función de cuál se sufra, habrá un tratamiento distinto para cada quien. Por ello se habla de que vamos rumbo a una medicina personalizada para cada paciente.

Uno de los laboratorios más avanzados en esto es la suiza Roche, cuya área de Diagnóstico Roche es líder mundial en este ámbito y ha sabido ligar exitosamente su unidad de Farma, es decir, de medicamentos.

De hecho, hoy en día su unidad de negocio de Diagnóstico registra ventas por unos 10,000 millones de francos suizos, y ya no hay gran diferencia respecto de lo que vende Roche en medicamentos que como farmacéutica había sido su negocio tradicional.

Uwe Oberlaender, el director general de Diagnostico Roche en México, menciona que de lo vendido en Diagnóstico, reinvierten casi 10% en investigación y desarrollo, dado que es un negocio de alta y constante innovación. Dice que gracias a Diagnosticos, Roche Farma puede tener más medicamentos especializados porque con los estudios es posible saber a qué pacientes se les da determinado medicamento. Ahí está el caso de Herceptin, un fármaco que no es quimioterapia (son anticuerpos) y sólo se le aplica a quien tenga un subtipo muy específico de cáncer de seno (el Her2 positivo), con un resultado de recuperación prácticamente seguro.

Con las pruebas moleculares, por ejemplo, se prevé que pronto pueda saberse si la hija de una mujer que murió por cáncer de mama puede desarrollar igualmente el mal. De hecho, Roche tiene un aparato enorme en el Instituto de Cancerología, donde se está aplicando un estudio con estas pruebas con el fin de ver qué medidas preventivas se pueden tomar entre las mujeres que son más susceptibles de sufrir ese cáncer.

De acuerdo con Oberlaender, Roche tiene hoy unos cinco medicamentos aprobados que ya cuentan con su propio marcador o prueba molecular, incluso recientemente en Estados Unidos la FDA ya aprobó una molécula de medicamento ligado a un marcador específico, ambas de Roche; ha sido la primera vez que sucede, pero es de esperarse que vendrán muchas más.

Las tabacaleras siguen presionando…

Tal parece que las empresas tabacaleras no han dejado de presionar al gobierno y al Legislativo para trabajar contra cigarrillos ilegales. Pero la Cofepris, de Mikel Arriola, no ha cejado en actuar en contra de ese azote, aunque tiene muchas otras cosas que hacer; no puede dedicarse sólo a eso. Ayer, la agencia sanitaria dio a conocer un informe de acciones en contra del tabaco ilegal que solicitó la Cámara Alta la semana pasada.

¿Sabe cuántos cigarrillos ilegales de unas 100 marcas apócrifas ha decomisado la Cofepris en el 2013? Más de 56 millones en ocho estados de la República; DF, Quintana Roo, Jalisco, Chihuahua, Chiapas, Durango, Coahuila y Oaxaca.

 

Maribel R. Coronel

 

Eleconomista.com.mx [en línea] México, DF (MEX): eleconomista.com.mx, 02 de enero de 2014 [ref. 10 de diciembre de 2013] Disponible en Internet: http://eleconomista.com.mx/columnas/salud-negocios/2013/12/10/hacia-donde-va-mercado-diagnostico



New markers for sick hearts

13 06 2013

Two new markers have been discovered for the type of heart failure whereby the heart muscle becomes stiff and unable to fill the heart with blood properly. ‘Estimating the gravity of the stiff type of heart failure is difficult with the regular markers’, explains cardiologist Dirk Lok. ‘But now it has become possible. The new NT-proCNP marker appears to have good predictive values for this condition. Another new marker, Galectin-3, does not only predict this type of heart failure, but also another more recognizable type whereby the heart muscle weakens.’ Lok, a cardiologist in Deventer Hospital, conducted his research in collaboration with the Cardiology Department of the UMCG. He will be awarded a PhD by the University of Groningen on 22 May 2013.

 

There are two types of heart failure. In the most well-known type, the heart muscle weakens and the pump action becomes ineffective. The other type of heart failure involves a stiffening of the heart muscle, which prevents the heart from filling with blood properly. In both cases, blood is not pumped around the body efficiently, causing patients to develop symptoms such as fatigue, shortness of breath, swollen legs and ankles, restless nights and frequent night-time urination. A total number of 150,000 patients in The Netherlands is affected by heart failure and both types occur in the same number of people. Patients suffering from heart failure due to a stiff heart muscle are mostly female, older, have hypertension, diabetes and are overweight. The prognosis is sombre.

Patients

‘Diagnosing heart failure due to a stiff heart muscle is difficult using the regular methods, particularly for GPs’ says Lok. ‘As a result, a large number of people are going through life undiagnosed, despite showing the classic symptoms. The techniques currently used do not always detect heart problems. The new markers will make it much easier to diagnose heart failure.’ Lok measured the values of the Galectin-3 and NT-proCNP markers in large groups of patients with heart failure. He discovered that it was easier to estimate the risk of complications in patients with heart failure due to a stiff heart muscle using both markers than when using the regular marker used up until now.

Better care

‘Measuring markers in the blood to clarify the diagnosis heart failure and predict the progress of the disease has improved patient care considerably over the past few years’, according to Lok. At present, drug treatment is chosen according to the amount by which the marker levels have risen. ‘The introduction of these new markers means that we are ready for the next step: diagnosing the disease at an early stage and providing prompt and targeted treatment. This may lead to fewer hospital admissions for heart failure and possibly a lower mortality rate’, claims Lok.

Curriculum Vitae

Dirk Lok (Groningen, 1953) studied Medicine at the University of Groningen and has worked as a cardiologist in Deventer Hospital since 1984. He conducted his research under the supervision of Prof. D.J. van Veldhuisen and Dr P. van der Meer in a partnership between the Cardiology Department of the University Medical Center Groningen (UMCG) and the cardiology research department of Deventer Hospital. Lok’s thesis is entitled ‘Novel markers in chronic heart failure.’

 

 

rug.nl [en línea] Groningen (NED): rug.nl, 13 de junio de 2013 [ref. 17 de mayo de 2013] Disponible en Internet: http://www.rug.nl/news-and-events/news/archief2013/nieuwsberichten/nieuwe-markers-voor-zieke-harten