UNIVERSITI TEKNOLOGI MARA (UiTM)

UiTM SELANGOR KAMPUS PUNCAK ALAM

RESEARCH PROPOSAL

TITLE:

LOWER LIMB MUSCLES ASSESSMENT BY USING MAGNETIC

RESONANCE SPECTROSCOPY (MRS) Commented [U1]: In health subject: a pilot study
Or among moderate/lightly active subject: a pilot study..(if ur
looking at life style activity among students)
PREPARED BY: Or in various ethnics students: a pilot study..(if u r looking at various
ethics students in puncak alam)

ABDULL FATAH FIRDAUS BIN ABDULL MANAF

WAN HASANUDDIN BIN WAN ABD HALIM

SUPERVISORS:

MISS FAIKAH BINTI ZAKARIA @ MAHMOD

BACHELOR (HONS.) IN MEDICAL IMAGING,

FACULTY OF HEALTH SCEINCES

UNIVERSITY TEKNOLOGI MARA (UiTM) SELANGOR

CAMPUS OF PUNCAK ALAM

42300 PUNCAK ALAM, SELANGOR DARUL EHSAN

Table of Contents
INTRODUCTION ................................................................................................................................... 1
1.0 NAME OF STUDENT ............................................................................................................. 1
2.0 RESEARCH TITLE ................................................................................................................. 1
3.0 RESEARCH BACKGROUND ................................................................................................ 1
4.0 PROBLEM STATEMENT....................................................................................................... 2
5.0 OBJECTIVE ............................................................................................................................ 5
5.1. General Objectives ............................................................................................................... 5
5.2. Specific Objectives ............................................................................................................... 5
6.0 RESEARCH HYPOTHESIS .................................................................................................... 5
7.0 LITERATURE REVIEW ......................................................................................................... 5
7.1 Introduction.......................................................................................................................... 5
7.2 Phosphorus Magnetic Resonance Spectroscopy (31P MRS) ................................................... 6
8.0 METHODOLOGY................................................................................................................... 7
8.1 Introduction............................................................................. Error! Bookmark not defined.
8.2 Study design ......................................................................................................................... 7
8.3 Research Setting ................................................................................................................... 7
8.4 Scope of Research ................................................................................................................ 7
8.5 Sample and Population ......................................................................................................... 7
8.6 Determining Sample Size ..................................................................................................... 8
8.7 Data Collection .................................................................................................................... 8
8.8 Data analysis ...................................................................................................................... 14
9.0 ETHICAL CONSIDERATION .............................................................................................. 14
10.0 PROBLEMS AND LIMITATIONS ............................................ Error! Bookmark not defined.
11.0 PROPOSED TIME FRAME FOR THE PROJECT ................................................................ 17
12.0 PROPOSED BUDGET .......................................................................................................... 18
13.0 REFERENCES ...................................................................................................................... 19
 CHAPTER ONE
INTRODUCTION

1.0 NAME OF STUDENT

Abdull Fatah Firdaus Bin Abdull Manaf

Wan Hasanuddin Bin Wan Abd Halim

2.0 RESEARCH TITLE

Lower Limb Muscles Assessment by using Magnetic Resonance (MR) Spectroscopy. Commented [U2]: remove

1.0 RESEARCH BACKGROUND

Diffusion tensor imaging (DTI) and MR spectroscopy (MRS) are advanced
magnetic resonance (MR) scanning techniques that permit microstructural evaluation of
water diffusivity and intramyocellular lipid content, respectively (Fayad, Deshmukh,
Subhawong, & Carrino, 2014). MRS allows the noninvasive molecular characterization
of a region of interest. MRS function by detecting the signals of water, lipids and other
metabolites (Fayad et al., 2014). Thus, this make the MRS can provide advance details
about metabolic information for lesion characterization and evaluation of therapy
response (Fayad et al., 2014). Even though MRS is familiar with practice in brain, the
study of musculoskeletal system has only more recently become impossible (Fayad et al.,
2014). This non-invasive procedure allows in vivo study of cellular metabolic Commented [U3]: I would say yg x byk study done on MSK..

contents…name the metabolic than can be study frm MRS. In vivo are studies that assess
vary biological entities on whole, whole, living organisms or cells, usually animals,
including humans, and plants (Urbanik, 2014). Other than that, MRS can detect any
changes in metabolism under the control of external factors or in the cause of diseases
(Urbanik, 2014). Commented [U4]: Same references repeated after
another…just letak 1 je at the last sentence.

Nuclei of some molecules such as hydrogen carry different types of substances

that emit electromagnetic radiation of massively different frequency (Urbanik, 2014). In
addition, it is also link to various arrangement of chemical binding within the substances
(Urbanik, 2014). The results of the study bring in form of spectral lines which is also
known as peaks form a spectrum (Urbanik, 2014). Further, each substance has their own
individual peak. Positions of spectral lines in MRS spectrum is intent on chemical shift

1
 expressed as parts-per-million (ppm) (Urbanik, 2014). In conclusion, spectra as particular
for given tissues and organs carry different metabolism elements. As said earlier, MRS
can detected quantity and spatial distributions of particular biochemical substances
involved in metabolic changes that can decide which tissues are healthy and affected
area. This study takes benefit in the characteristics of elements such as 1H, 31P, 23Na when
applying in a magnetic field (Cichocka, Kozub, & Urbanik, 2015). Thus, this make MRS
is powerful technique to study variations of the muscle structures and metabolites
changes in patients with any kinds of injury especially this technique can detect
biomechanical and functional properties of skeletal muscle in vivo in health and disease
(Renema, Kan, Wieringa, & Heerschap, 2007).

This study will focus on 1H, 31P, 23Na for assessment of the dynamic of lower
limbs muscle metabolism. This study then gained ranges from the the microscopic level
of the metabolism of the myocyte to the macroscopic level of the contractile function of
muscle complexes (Renema et al., 2007). This study will help radiologist by shows many
vital roles in reaching a better interpretation of many basic aspects of muscle function,
such as regulation of mitochondrial activity and the complex interaction between muscle
fiber organization and contractile function (Renema et al., 2007). Nowadays, this study is
growing in diagnostic procedures to monitor the effects of therapeutic and lifestyle
involvement for muscle disorders that cause bigger problem in modern society (Renema
et al., 2007). MR spectroscopy of skeletal muscle give many regarding cellular
metabolism (E. Kan, Wokke, & G. Webb, 2015). According to E. Kan et al., (2015), 1H
MRS is usually used to evaluate quantity of intramyocellular lipids in some diseases.
Another MRS, which is 31P MRS can be used to evaluate high energy phosphoryl
metabolism (E. Kan et al., 2015). Lastly. 23Na MRS used to sodium gradients and fluxes
in biological tissues and other one 13C MRS can be used to study mitochondrial fluxes
and dynamics of glycogen and creatine during resting conditions and exercise (Renema et
al., 2007).

2.0 PROBLEM STATEMENT

Magnetic Resonance Spectroscopy (MRS) is an alternative clinical tool for

explore the metabolic characteristics of pathology such as neurologic diseases. Proton
1
HMRS is the most commonly used and available in Malaysia. There is large research
about the effectiveness of MRS in detect on clinical metabolites rate, but, interestingly,
very little has been published on in Malaysia. Based on study about strength of muscle
with exercises, the evidence of the investigation shot that isometric quadriceps exercises
lead significant gains in strength of the quadriceps muscle in the experimental group after
the 5-week training program. In the between-group analysis, the improvement in strength

2
in the experimental group was 33% greater than that of the control group at the end of the
training period (Anwer & Alghadir, 2014).

The excellence output of in vivo magnetic resonance spectroscopy (MRS)

methodology used in biomedical research is its potential for noninvasively measuring a
variety of metabolites inside a living organ. It, therefore, give a crucial tool for decide
metabolites, chemical reaction rates and bioenergetics, as well as their dynamic changes
in the human and animal. The ability of in vivo MRS is further strengthen at higher
magnetic fields because of significant gain in detection sensitivity and upgrade the
spectral resolution. Recent progress of in vivo MRS technology has further reveal its
great potential in many biomedical research areas, particularly in brain research.
However, this study is crucial because there is enough study to prove of the metabolite
and muscle evaluation before and after exercises.

. Besides that, it can help radiologists to evaluate many types of pathology by Commented [U5]: Not relevant here

measuring the concentrations of different metabolites within body tissue (Duncan, 1996).
Furthermore, MRS explains to us that radiofrequency waves are translated into
biochemical composition of the scanned tissue (Duncan, 1996). But, based on Duncan
(1996), there is inefficiency of proof shows that the use of MRS upgrades health
outcomes such as increasing diagnosis rates, reducing the number of unnecessary
biopsies, and improving care or treatment planning accuracy in patients with conditions
such as psychiatric or neurological disorders, and prostate cancer. In addition, the use of
MRS techniques and way to conclude the results is different and not standardized
(Duncan, 1996). This study will be carried out to test the hypotheses.

Besides that, proton magnetic resonance spectroscopy 1HMRS has tested to

measure intramyocellular lipid (IMCL) that have more supremacy than muscle biopsy
because of its low variability on repeated measurements, the capability to differentiate
IMCL from extramyo cellular lipid (EMCL) and its noninvasiveness (White et al., 2003).
latest study using the 1HMRS have analysis the contribution of skeletal muscle lipid to
energy metabolism in males and female (White, Ferguson, McCoy, & Kim, 2003). The
differentiate results between males and female can contribute to error. Thus, the subjects
of this study must be consistent to avoid any error. Subjects body habitus also can affect
the results effectiveness. Even the magnitude of the sex difference in muscular strength
has been documented, the extent to which it reflects long-term behavioral differences in
physical activity compared to natural biological differences in muscle mass or
neuromuscular function is uncertain. The subjects’ daily activity’s also must be same to

3
 avoid any misunderstand data. Usually, individual differences in lower limb muscle
groups that are closely related to activities of daily living such as cycling running and
swimming. So that, The purpose of the study is to evaluate study of lower limb muscles
strength assessment by using magnetic resonance (MR) spectroscopy among lightly
Active subjects.

3.0 Significance of study Commented [U6]: Mention napa pentingnya tis MRS study..
Maybe u can mention tat so far dh byk therapy or intervention
done by physiotherapist for various type of patho and among sport
Magnetic Resonance (MR) spectroscopy is a noninvasive diagnostic test for injury tp xde study to measure kebekesannan of their
therapy/treatment.
measuring metabolic changes in the muscle, especially during and after exercises. In
By using MRi and MRS, u leh measure keberkesanan their
addition, in normal magnetic resonance imaging (MRI) procedure, it is only discover the treatment..esp pd metabolite changes
anatomical location, while MR spectroscopy can compares the chemical composition of
muscle strength after and before exercises (Vagal Achala, 2017). By using this study, it
will benefit the people around the world to learn new MRI protocol when investigate the
musculoskeletal properties during exercises. In addition, this study assigns a non-invasive
in vivo measure of skeletal muscle metabolism after unaccustomed exercise bouts while
all of the physiological and biochemical control and feedback mechanisms are
functioning. This study also helps deliver information’s to clinicians to provide
significant procedure during undergoes the research. Also, this study examine about how
exercises can affect the muscle structures and metabolites changes in patients.

RESEARCH QUESTION

1. What the types of exercises that causes most effect of metabolic changes during
exercises?
2. Which exercises can affect the gluteus maximus, hamstring and quadriceps muscle?
3. Can this study can be used to applying at the patient with significant injury?
4. Are MRS is significant at lower limb study?
5. What is the suitable protocol to applying MRS procedure ?

4
5.0 OBJECTIVE
5.1. General Objectives
Study of lower limb muscles strength assessment by using magnetic resonance
(MR) spectroscopy.

5.2. Specific Objectives Commented [U7]: kena pecahkn/detailkn lg the specific obj sbb
tis study going to be done by 2 person
The study is done:

i. To measure of lower limb muscle structures changes after and Commented [U8]: Meaning tat u r gonna to measure size of the
muscle before and after exercise
before exercises using measuring tape
ii. To measure variations of the muscle metabolites such as glycogen Commented [U9]: Focus on metabolite..better mention what r
the metabolite yg u going to look for. Cari yg metabolite yg
and ATP changes during pre and post-exercise using 1H MR commonly be found in muscle
Spectroscopy.
iii. To study the relationship of muscle structures and metabolites
changes before and after exercises among lightly active subjects.
iv. To investigate which exercises on lower extremity muscle that can
affect the gluteus maximus, hamstring and quadriceps muscle
v. To study the effect of the exercise towards gluteus maximus,
hamstring and quadriceps muscle.
vi. To study the efficiency of MRS in detecting metabolic changes of
the thigh muscle during and after exercises.

6.0 RESEARCH HYPOTHESIS

To achieve the study objectives, the hypothesis below are tested:

HA: There are significant differences in metabolites reading before and after exercise
among subjects.

HO: There are significant differences in metabolites reading before and after exercise
among subjects. Commented [U10]: Check on how to write
hypothesis…hypothesis is something yg u predict from the result.
Eg: u predict metabolite of NAA akan increase after the exercise

Xperlu HA and HO..just mestion as below

7.0 LITERATURE REVIEW…just buat on 1H MRS…other type of MRS kita xleh buat Hypothesis 1 (for obj 1):
snn xde coil The NAA metabolite exhibit an increment reading after the exercise

7.1 Introduction
Magnetic resonance spectroscopy (MRS) is an expert technique which is
more familiar with magnetic resonance imaging (MRI) scan. MRI dealing with
water and lipid protons across a scanning area. MRI gives information about soft
tissues and evaluate chemical and structural changes non-invasively (Psatha et al.,
2015). Therefore, it is high possible to study of evolution imaging biomarkers of
physiological processes or pathology (Psatha et al., 2015). In fact, the ratio of fat
to water is major key of muscle classification since a muscle with a high
5
 proportion of fat has less contractile tissue than an amout of same sized muscle
with a lower proportion of fat (Psatha et al., 2015). T2 values are also the
classification of muscle classification since they connect to many features of the
muscle such as fiber type water content and fat content (Psatha et al., 2015).
Muscle atrophy relate with lengthening T2 relaxation times. Non-active lifestyle
has been found relate with less in strength and escalate in fat in people.
Nevertheless, exercise training lessens the amount of intramuscular fat (Psatha et
al., 2015).

Meanwhile, MRS calculate the chemical content of MR-visible nuclei

such as the metabolic applicable component of hydrogen (1H), carbon (13C), and
phosphorus (31P) (Befroy & Shulman, 2011). MRS have superior technique for
evaluating metabolism (Befroy & Shulman, 2011). This is because, In MRS the
chemical properties and environment of each nucleus control the frequency at
which conclude at MR spectrum cause it rise the specific metabolites and nuclei
of each metabolite (Befroy & Shulman, 2011). MRS is noninvasive technique that
can study a large scope of biological elements over many types tissues. This
technique suitable for vivo studies of human metabolism (Befroy & Shulman,
2011). Other than that, MRI has benefit in give advance in study of structural and
anatomical details that can escort data acquisition and give assistant in data
analysis and interpretation. MRS can study metabolic disorders (Hwang & Choi,
2015). Numerous clinical and bio-medical examination have been organize by
MRS technique such as the quantification of hepatic lipid and glycogen content
as well as tricarboxylic acid (TCA) cycle or adenosine triphosphate (ATP)
synthesis rates in vivo by applying 1H, 31P and 13C MRS (Hwang & Choi, 2015).
This technique is very hard to determine by other modalities.

7.2 Phosphorus Magnetic Resonance Spectroscopy (31P MRS)

31
P MRS qualify in vivo quantification of phosphorus metabolites that are
reflected on membrane turnover and energy metabolism (Yuksel et al., 2015) . As
example, in chronic brain disorder called schizophrenia (SZ), 31P MRS research
discover variety malformation in different brain area propose that adjustment in
these pathways may be contributing to the pathophysiology (Yuksel et al., 2015).
This specialized neuroimaging technique enables in vivo measurement of multiple
functionally important phosphorus-containing metabolites. For brain studies,
these fall into one of two broad groups cell membrane related phospholipids and
energy related metabolites.

6
8.0 METHODOLOGY

. Commented [U11]: Xperlu intro

8.2 Study design Commented [U12]: Check study design..ur study melibatkan
pre and post scanning..
This study is an experimental study design. This study will conduct at For tis subheading, Cerita secara ringkas what your study all about
Clinical Training Centre (CTC) Faculty of Medicine, Universiti Teknologi Mara
(UiTM) Sungai Buloh. It will be performed on non-active subjects with the age
between 18 to 75 years old with no history of any diseases. The experimental will
started with testing the protocol for suitable MRS. This MRS were acquired at
baseline (rest) and after exercise to investigate the differences of muscle
structures and metabolism changes.

8.3 Research Setting

This study will be done at gymnasium center in UiTM Sungai Buloh for
exercise protocols and CTC for MR spectroscopy scanning. Most of the Commented [U13]: Proper name please

equipment that will be required for this research are available at both centers.

8.4 Scope of Research Commented [U14]: Scope of reseach is something yg u nk cari

frm ur study
This study will be mainly focused to the lower limb muscles assessment
on healthy non-active subjects pre and posy exercise by using MR spectroscopy. Commented [U15]: Refer above; non active ni very general.

Furthermore, the findings of this research study would provide effective protocol
design for MR spectroscopy which can detect the metabolism and muscle
structures changes before and after appling exercises.

8.5 Sampling Population

8.5.1 inclusion criteria

8.5.2 exclusion criteria

This study will involve the subjects that following to the following criteria. Commented [U16]: Below are the inclusion criterias…

1. 10 control non-active male in sports Commented [U17]: Better categorize based on activity..either
1.Sedentary – little or no exercise
2.Lightly active – exercise/sporty 1-3 rimes/week
2. The age is between 18 to 75 years old with no history of any 3.Moderately active – exercise/sport 3-5times/week
diseases. Or pilih subjek yg jenis mcm mana u nk pilih as ur subjek
Commented [U18]: 75? Students?

7
 3. Body mass index (BMI) is normal

Each volunteer will provide written informed consent and all studies were
conducted in in fulfilment of UiTM research ethics board as this study involves
human as subjects.

8.6 Determining Sample Size

Sample size will be decided by using Statistical Test Selector v4 at the
95% of confidence level and 5% of error margin. The suggest sample size for this
study will be 10. The formula of sample size is:

𝑁𝑧 2 𝑝𝑞
𝑛 =
(𝐸 2 (𝑁 − 1) + 𝑧^2 𝑝𝑞

Where,

n is the requires sample size

N is the population size

p and q are population proportion which are set them each to 0.5

z is the value that specifies the level of confidence. Confidence interval

planned for this survey is 95%, therefore, Z = 1.96

E is the accuracy of sample proportions, which is set to 0.05

Calculation of the sample size is as below:

(10) (1.96)2 (0.5)(0.5)

𝑛=
((0.05)2 (10 − 1) + (1.962 )(0.5)(0.5))

n=9.604/0.9629

n=10

8.7 Data Collection

8.7.1 Anthropometry
Height of the subjects will be measured using a stadiometer.
Stadiometers can be either portable or permanently affixed to a wall which
is scales nearest to 0.1 cm. But, it is advice to use portable digital scales
8
 stadiometers to avoid problems relating to proper installation of wall-
mounted models. In addition, the digital scales are more precise and easy
to reading the digital read-out. For the measurement of weight, the
subjects will stand still over the center of the with body weight evenly
distributed between both feet. The scale will be measured nearest 0.1 kg
by using digital scale. Body mass index of each subjects will be calculated
by using (kg/m2) by dividing the weight in kilograms (kg) by heights in
meter squared (m2) to estimate the body fat. The measurement of the
human individual will be done prior to the procedure.

8.7.2 MR Imaging Setting

3.0T MRI scanner with 8-channel phased array radiofrequency Commented [U19]: 1.5T..siemens? Toshiba??

(RF) knee coil at CTC will be used were use for scanning. Each subject Commented [U20]: Kne coil? Confirm?

will be positioned in supine with knees extended and both feet

immobilized during 20-30 minutes scanning. on the scanner by the
researchers and the positioning techniques will standardized. Each subject
will supine. Fish oil capsule will used as fiducial marker taped onto the Commented [U21]: Purpose??if no purpose, don’t mention,
and letak kat mana..kn specific
subjects. The left leg will be used in this study. Subjects will be study into
Commented [U22]: Why left leg??if suggested fm article, then
the gantry feet first. Subjects stay still in the MRI scanner bed with their metion it by whom
feet immobilized during the 35-minute scanning protocol.

Toshiba 1.5 Tesla Human MRI scanner equipped with 8-channel

phased array radiofrequency (RF) coil available at Clinical Training
Center (CTC), UiTM Sg Buloh will be used for this study. Each subject
will be screened for MRI safety and; risk, MR procedure and duration of
the scanning will be explain to the subject. Consent form sign..(tulis in
proper sentence)…

The subject will be positioned in supine with knees extended and

both feet immobilized during 20-30 minutes scanning. Fish oil..left leg… Commented [U23]: Contoh apa yg u perlu mention under MR
imaging setting
8.7.3 MR Imaging protocol
The study will include gluteus maximus, hamstring and quadriceps
muscle. The scan will be performed before and after exercises. Before the
study started the conventional MR, imaging will be performed on subjects.
This examination will done to control the suggest outline of anatomy and
layout of the preferred muscles.

8.7.4 Basic Anatomical Protocol

8.7.4.1 Localizer

9
 8.7.4.2 T2 Short Tau Inversion Recovery (STIR) 5mm 460-470
FOV

8.7.4.3 T1 Turbo Spin Echo (TSE) coronal 5mm 460-470 FOV

8.7.4.4 T1 TSE axial 6mm 450-470 FOV

8.7.4.5 T2 STIR axial 6mm 450-470FOV

8.7.4.6 T2 TSE sagittal 5mm right

8.7.4.7 T2 TSE sagittal 5mm left

Table 1.MRI Thigh

T2 Short Tau Inversion Recovery TR: 4000-5000

(STIR) Coronal
TE: 110

Slice: 5mm

FLIP:130

Matrix: 384 x 384

FOV: 460-480

TI: 130

T1 Turbo Spin Echo (TSE) Coronal TR: 400-600

TE: 15-25

Slice: 5mm

FLIP:130

Matrix: 512 x 384

10
 FOV: 460-480

T1 Turbo Spin Echo (TSE) Axial TR: 400-600

TE: 15-25

Slice: 6mm

FLIP: 130

Matrix: 512 x 384

FOV: 460-480

T2 Short Tau Inversion Recovery TR: 4000-5000

(STIR) Axial
TE: 110

Slice: 6mm

Matrix: 448 x 384

FOV: 460-480

TI:130

T2 Turbo Spin Echo (TSE) Sagittal TR: 4000-5000

including right and left sides)
TE: 100-120

Slice: 5mm

FLIP: 130-150

Matrix: 512 x 384

11
 FOV: 460-480

(George, Dela Cruz, Singh, & Ilangovan, n.d.)

8.7.5 Proton MR Spectroscopy (1H Spectroscopy)

Subjects still supine in the bore of the magnet. The region of
interest will include from the upper and lower regions of the left leg. T2-
weighted multi-slice spin echo (SE) axial images will obtain. The
refocusing pulse width will set and make sure it is 1.5 times the excitation
pulse width on all scanners. Single voxel 1H-MRS data will set for study
of lipid fraction using stimulated-echo acquisition mode (STEAM) from
the soleus (Sol) and vastus lateralis. Finally, 1H spectroscopic relaxometry
was performed using STEAM.

Table 2.Proton MR Spectroscopy (1H Spectroscopy)

T2-weighted multi-slice spin echo (SE) Number of slices:4–6 slices

axial images
Slice: 7 mm

Gap: 3.5 mm

TE: 16

Space: 20 – 320mm

TR: 3s

Single voxel 1H-MRS data TE:108 ms

12
 TR:3 s

NA: 64

1
H spectroscopic relaxometry Soleus muscle

16: TE

Non-linearly spaced from 11–288 ms

TR: 9 s

NA:4

Vastus Lateralis muscle:

4 TE

non-linearly spaced from 11–243 ms

TR: 9 s

NA:4

(Forbes et al., 2014)

8.7.6 Sodium Spectroscopy (23Na Spectroscopy)

Sequence involve of a repetition time of 20 msec, a TE of 5 msec,
and a flip angle of 40°, with 32 excitations and a 128 (X, readout) x 40 (Y,
phase encoding) x 32 (Z, phase encoding) matrix size over a field of view
of 600 (X) X 600 (Y) x 480mm(Z) (Bansal, Szczepaniak, Ternullo,
Fleckenstein, & Malloy, 2000). The times taken for the procedure will
takes 14 minutes. 23Na spectra will composed of nominal 90° excitation
pulse width of 90–115 µsec.

8.7.7 Phosphorus MR Spectroscopy (31P Spectroscopy).

MR data will obtain through the systematics rest-exercise-recovery
protocol with the follow-ing parameters (radio frequency [RF] hard pulse
duration = 500 µs, repetition time = 2 s, sweep width =32 kHz, data points
= 4096, dwell time = 128 ms, flip angle = 60°).

13
 8.7.8 Muscle Exercise Protocol
Each subject will ongoing lower limbs muscle exercise outside of
the magnet. The exercise will be involving gluteus maximus, hamstring
and quadriceps muscle. Each exercise will contribute to each muscle as
stated. Each exercise takes about 5 to 10 minutes each. After that, the
subject immediately positioned in the magnet for evaluation.

8.8 Data analysis

Data will analyses using SPPS version 21.0. This will calculate based on
mean values of metabolite spectrum in the entire muscle tissue volume and the
segmented muscles were calculated by fitting the parameter distribution of each
volume with a skew of normal distribution. Each variable will be try out Mauchly
test of sphericity.

9.0 ETHICAL CONSIDERATION

Ethical approval will obtain from ethical committee of Universiti Teknologi Mara
(UiTM). For this study, it will need ethical approval because it involved subject’s private
information that will be study. The entire letter such as approval letter, will submitted to
the director of CTC during clinical practice. The permission letter also will be submit to
do this research study to obtain the approval usage of required instrumentations and
patient data permission

14
 Here are the subheadings for METHODOLOGY part:

1. Study design: mention wat are the design u used for tis study…ur study is pre and post
exercise data..here also u shud mention yg subject kn undergone exercise protocol
tu…then letak flow chart after study design explanation

Not expose to 30 minutes 45 minutes 1 hour exposure /

MRI exposure / day exposure / day day

Sample of flow chart of the study…edit accordingly

2. Research setting: refer comments above

3. Scope of research : refer comments above
4. Sampling population: refer comments above
5. Sample size : refer comments above

15
6. Data collection:
6.1 Patient screening/ subject selection:
- MR screening (such as no metal, no implant, claustrophobia?)
- Subject meets the inclusion and exclusion criteria
- Explanation of the procedure, risk of the MRI, consent form sign
6.2 Anthropometry
Good, as u mention above
but mskkn kn juga yg u akan ukur the physical size (circumference0 of the
tight/lower limb..nk tgk ada perubahan dari segi physical or not….how to
measure kn refer staff PT
6.3 MR Imaging Setting and Scanning protocol
6.3.1 Patient preparation..(MR safety screening again, remove metal
item & change to hospital gown*if applicable*, explanation of the
procedure..etc)
6.3.2 MR scanning protocols
- MRI protocol
- MRS protocol
**both just list dlm table
6.3.3 MRI and MRS data analysis
- Muscle structures data analysis
- Metabolite data analysis
**both explain how u r going to measure the size of the muscle and metabolit
(graph…)

7. Statistical analysis
- Wat test u r going to use…selalunya 1 spss test utk test 1 objektive
8. Ethics

16
 11.0 PROPOSED TIME FRAME FOR THE PROJECT

SEPT-
JANUARY FEBRUARY
JUNE 2017 DISEMBE MARCH 2018 APRIL MAY 2019 JUNE 2019
TASKS 2018 2018
R 2017 2018
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
Draft proposal / /
Submission of
/
proposal
Ethical
/ / /
approval DISCUSSI

Data collection ON WITH / / / / / / / / /

Data analysis SUPERVIS / / / / / / / / / /
Report writing OR / / / / / / / /
1st draft report / / / / /
2nd draft report / / / /
Final /
presentation

17
12.0 PROPOSED BUDGET

NO. ITEMS UNIT TOTAL (RM)

1.
Printing of the interview schedule
RM 2 X 30 Unit 60.00

Printing and photocopy for project

 Paper (Double A 100 sheets per
RM 11.00 11.00
rim)
RM 10.00 10.00
 Journals
2. RM 10.00 10.00
 Proposal
RM 20.00 20.00
 1st draft report
RM 20.00 20.00
 2nd draft report
RM 20.00 20.00
 Final report

Stationeries:
3. RM 5.00 x 2 Box 10.00
 Pen
Travel to Hospital RM 5.00 x 16
4. 80.00
 Petrol weeks
Use of telephone
5. RM 10 x 16 weeks 160.00
 Celcom

GRAND TOTAL RM 401.00

18
13.0 REFERENCES
Anwer, S., & Alghadir, A. (2014). Effect of Isometric Quadriceps Exercise on Muscle Strength,
Pain, and Function in Patients with Knee Osteoarthritis: A Randomized Controlled Study.
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Forbes, S. C., Willcocks, R. J., Triplett, W. T., Rooney, W. D., Lott, D. J., Wang, D. J., …
Vandenborne, K. (2014). Magnetic resonance imaging and spectroscopy assessment of
lower extremity skeletal muscles in boys with duchenne muscular dystrophy: A multicenter
cross sectional study. PLoS ONE, 9(9), 1–8. https://doi.org/10.1371/journal.pone.0106435

George, R., Dela Cruz, J., Singh, R., & Ilangovan, R. (n.d.). MRI Thigh. Retrieved January 1,
2018, from https://mrimaster.com/PLAN THIGH.html

Resonance, M., Imaging, M. R., Mri, T., N-acetyl, L. L. A., & Myoinositol, C. C. (2016).
Magnetic Resonance ( MR ) Spectroscopy, 1–2. Retrieved from
http://www.mayfieldclinic.com/PE-MRspectroscopy.htm

Vagal Achala. (2017). No Title. Retrieved from https://www.mayfieldclinic.com/PE-

MRspectroscopy.HTM

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