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While the MND\/ALS literature is dominated by innovative brain studies, motor disability in ALS is primarily driven by neurogenic muscle change impacting mobility, dexterity, respiratory and bulbar function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>With the intention of raising awareness of muscle\u2010derived imaging markers in ALS, a systematic review has been conducted. Study designs, imaging methods, data interpretation frameworks, and cohort characteristics were systematically evaluated to identify innovative approaches and barriers to clinical implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 219 studies were screened and 73 original studies selected for systematic review; 37 muscle MRI studies and 36 studies using ultrasound, PET or CT. All of the selected studies successfully captured ALS\u2010associated muscle degeneration and their methods included the evaluation of muscle dimensions (thickness\/volumes\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200934), \u2018acute\u2019 denervation (water content,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915), fasciculation counts (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914), \u2018chronic\u2019 neurogenic change (fat content,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200921), metabolic changes (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20094), diffusion alterations (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20098) and echo intensity changes (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite the huge impact of lower motor neuron dysfunction on the patients' independence, survival and quality of life, muscle imaging is a glaringly overlooked frontier of MND\/ALS research. This is a missed opportunity, as a variety of non\u2010invasive quantitative muscle imaging techniques have been successfully used in other neurological conditions; these protocols are easy to implement on commercial MRI and ultrasound platforms and recent studies have demonstrated their ease of use and potential clinical utility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.70582","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T05:01:09Z","timestamp":1774328469000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Muscle\n                    <scp>MRI<\/scp>\n                    and Muscle Ultrasound Applications in\n                    <scp>MND<\/scp>\n                    \/\n                    <scp>ALS<\/scp>\n                    : Academic Insights and Clinical Opportunities"],"prefix":"10.1111","volume":"33","author":[{"given":"Alison","family":"Toomey","sequence":"first","affiliation":[{"name":"Computational Neuroimaging Group (CNG), School of Medicine Trinity College Dublin  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Kleinerova","sequence":"additional","affiliation":[{"name":"Computational Neuroimaging Group (CNG), School of Medicine Trinity College Dublin  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ee Ling","family":"Tan","sequence":"additional","affiliation":[{"name":"Computational Neuroimaging Group (CNG), School of Medicine Trinity College Dublin  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"We Fong","family":"Siah","sequence":"additional","affiliation":[{"name":"Computational Neuroimaging Group (CNG), School of Medicine Trinity College Dublin  Dublin 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