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Is Infrared Thermography (IRT) a Possible Tool for the Evaluation and Follow up of Emery-Dreifuss Muscular Dystrophy? a Preliminary Study T ⁎ A

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Is Infrared Thermography (IRT) a Possible Tool for the Evaluation and Follow up of Emery-Dreifuss Muscular Dystrophy? a Preliminary Study T ⁎ A Medical Hypotheses 127 (2019) 91–96 Contents lists available at ScienceDirect Medical Hypotheses journal homepage: www.elsevier.com/locate/mehy Is infrared thermography (IRT) a possible tool for the evaluation and follow up of Emery-Dreifuss muscular dystrophy? A preliminary study T ⁎ A. Cabizosua, , N. Carbonib, A. Figusb, J.M. Vegara-Meseguera, G. Casub, P. Hernández Jiménezc, A. Martinez-Almagro Andreoa a Universidad Católica de Murcia (UCAM), Spain b Azienda Sanitaria Locale Nuoro, Hospital San Francesco, Italy c Cátedra de investigación Hospital de Molina, Spain ABSTRACT Hypothesis: The hypothesis of this work is that infrared thermography could become a valid tool for the diag- nosis and follow-up of the Emery-Dreifuss disease due to putative temperature changes produced by a constant degenerative evolution of this muscular dystrophy. Testing the hypothesis: To justify this hypothesis we proposed a pilot study with 2 brothers affected of Emery- Dreifuss who present a very different age, with the principal objective to evidence a possible evolution of this pathology. Acquisition and comparison of images of computerized axial tomography (CT) and thermography (IRT) of the distal limbs in 2 affected brothers. Data and discussion: Important image correlations in the region of the thighs and the posterior region of the legs have been highlighted. The comparison between the CT and the thermography showed how the first results are encouraged and promising and open a possible new line of research on the evaluation and follow-up of this disease. Despite this, a larger number of studies are needed to validate the thermography as a diagnostic technique and follow-up of this pathology. Background [7]. The CT is defined as an imaging technique based on the use of X- rays, which, producing ionizing radiations, can generate changes or Emery-Dreifuss muscular dystrophy (EDMD MIM 310300) is a de- biochemical effects in the human body [8]. generative pathology of the skeletal neuro-muscular system with an Although magnetic resonance imaging is a very important diag- incidence of 1 in 100.000 patients creating articular deformations and nostic tool for precision and efficiency in diagnostic imaging, it is a very cardiac changes [1–3]. According to the description made by Emery in expensive technique and also generating an electromagnetic field, 1966, the disease is characterized by the triad of contractures and cannot be used in some types of diseases that lead to defibrillator im- stiffness in the tibialis, elbows and rachis, loss of the humeral-peroneal plantation or a monitoring systems subcutaneous as the cardiac Reveal distribution and finally alterations of the heart muscle that, if not LINQ, due to electrical interference that may occur. These types of treated, can lead to death sudden [1–3]. systems are common in patients suffering from cardiac abnormalities, To try to clarify the clinical evolution and the pathophysiology of as happens in our patients with EDMD. this disease, in the bibliography there are some studies that included On the other hand, as mentioned in the in the previous section, the family groups, incorporating the functional magnetic resonance (MRI) CT is an examination that, even if few, presents risks of radioactive and computerized axial tomography (CT) to find the muscular altera- contamination, and this is why according to a very recent study pub- tions of the lower limb which had not been registered previously [4–6]. lished in 2018 the thermography could be a good evaluation technique Magnetic resonance imaging (MRI) is defined by the National and follow-up for this pathology [9]. Institute of Bioengineering and Biomedical Images, based in the USA, as In fact, thermography is defined as a rapid, economic and non-in- a non-invasive diagnostic imaging technique that use an electro- vasive diagnostic imaging technique that allows the infrared radiation magnetic field to detect lesions and alterations in non-bone or soft parts emitted by a particular body or surface to be encoded and to provide a Abbreviations: CT, Computed axial tomography; EDMD, Emery Dreifuss muscular dystrophy; IRT, Infrared thermography; MRI, Magnetic resonance ⁎ Corresponding author at: Av. de los Jerónimos, 135, 30107 Guadalupe, Murcia, Spain. E-mail address: [email protected] (A. Cabizosu). https://doi.org/10.1016/j.mehy.2019.04.011 Received 4 December 2018; Accepted 12 April 2019 0306-9877/ © 2019 Elsevier Ltd. All rights reserved. A. Cabizosu, et al. Medical Hypotheses 127 (2019) 91–96 clear and direct image based on the recorded temperature [10,11]. Table 1 The authors try to justify the use of infrared thermography in pa- Patient,s data. tient with Emery Dreifuss, taking into account that the changes pro- Patient 01 Patient 02 duced in the vascularization of muscle by avascular scar tissue, typical of this disease, could be reflected in the analysis of thermograms [9]. Time 15:30 16:10 According to literature data, thermography sees recent applications Sex M M fi Age 22 38 above all in the eld of sports and ocular medicine, but also the mus- Surgery N0 INTERNAL CARDIA culoskeletal system is starting to be the subject of important research DEFIBRILLATOR work [12,13]. Eva 0 0 The need for a rapid, objective and non-invasive diagnostic tech- Weight 51.2 Kg 66.5 Kg nique should be a priority for the evaluation of this disease and for this Height 170 Cm 173 Cm IMC 17,72 22,22 reason, to justify the hypothesis that thermography could be a valid tool Alcohol NO NO for evaluation and monitoring this disease, we propose a pilot study Coffee NO NO with 2 brothers affected of Emery-Dreifuss who present a very different Drug NO NO age, with the objectives on the one hand, to describe, in this pathology, Smoke NO NO Food 5 HOURS BEFORE THE 5 HOURS BEFORE THE VISIT a possible correlation between TC and IRT in the muscular lesions of the VISIT lower limbs and on the other hand to evidence a possible evolution of Cosmetics NO NO this illness. Shower 5 HOURS BEFORE THE 5 HOURS BEFORE THE VISIT VISIT Hypothesis Sun rays NO NO Sport NO NO Frequency NO NO The hypothesis of this work is that inferred thermography, due to Duration NO NO the possible temperature changes produced by the constant degen- Intensity NO NO erative evolution of muscular dystrophy of Emery-Dreifuss, could be a Physical therapy NO NO valid tool for the diagnosis and follow-up of the disease. BMI: Body Mass Index, EVA: Visual analogic scale; KG: Kilograms. Testing the hypothesis In the anterior view of the leg the ROIs starts 2 cm below the inferior border of the patella up to 2 cm higher than the tibialis malleolus (ti- Given that one of the patients has an internal defibrillator that is not bialis region), while in the posterior view it identified from the inferior compatible with MRI, the study will be carried out with analysis of CT border of the Popliteus ditch up to 8 cm higher than the inferior border and IRT. For the recording of thermographic images, we followed the of the heel (gastrocnemius region) [18]. Regions of interest (ROI) were TISEM (Thermographic imaging in sports and medical exercise) re- analyzed with the Flir research IR program. commendations, that ensure an adequate methodological precision of the work [14], whereas for the acquisition of the CT data of the lower limbs we followed a normal protocol, already used in other studies Thermograph [15,16]. The thermograph used for the realization of this work is the Flir E60 Patients model. This thermograph has a thermal image quality of: 20 × 240 pixels, thermal sensitivity: < 0.05 °C, and records from −20 °C to ff The patients were recruited from the neurology service, underwent +650 °C. The thermograph also o ers the possibility to record up to 3 ff a medical check-up (Table 1), a thermographic record, and as a last test di erent points inside a narrow anatomic segment, giving information the analysis of tomography. Once at the hospital center all patients on the maximum and minimum temperature and the average variation were allowed to acclimatize to the environment during a period of 15/ with respect to the reference temperature. fi 20 min in a room of 14 m2, at a temperature between 23° and 24°, To allow the correct con guration of the machine to the room, the fi humidity 40 ( ± 0.8) %, free of electronic devices and with sunlight main researcher turned on the machine an hour before the rst regis- that passed through a large window far from the point of measurement tration made, placing it in a tripod at 1 m away from the patient re- [14,17]. During this period, the patients underwent a body temperature gistration point with an inclination of 10°/15°. The emissivity was 0.98 fi check (with a digital thermometer) to discard alterations of the basal as suggested by the manufacturer and this gure was corroborated in temperature, and being in both cases less than 37° the researchers other studies [19,20]. continued with the recording of the data of each patient in Table 1. The analysis of the images was carried out with the Flir research IR Before proceeding with the registration of the distal limbs, the pa- program [19]. This study has been approved by the ethical committee tient was placed only with intimate clothing on a 1 centimeters (cm) dated 16/10/2018 acceptance number: 110/2018/CE. thick cotton pad to avoid direct contact with the floor and thus generate temperature changes. When the thermographic recording period was Data of the test over, 2 different radiologists in a blind form analyzed the tomographic and thermographic images.
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