1
|
Hojo E, Sui Y, Shan X, Zheng K, Rossman P, Manduca A, Powell GM, An KN, Zhao KD, Bauer BA, Ehman RL, Yin Z. MR elastography-based slip interface imaging (SII) for functional assessment of myofascial interfaces: A feasibility study. Magn Reson Med 2024; 92:676-687. [PMID: 38523575 PMCID: PMC11142878 DOI: 10.1002/mrm.30087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Abnormal adherence at functional myofascial interfaces is hypothesized as an important phenomenon in myofascial pain syndrome. This study aimed to investigate the feasibility of MR elastography (MRE)-based slip interface imaging (SII) to visualize and assess myofascial mobility in healthy volunteers. METHODS SII was used to assess local shear strain at functional myofascial interfaces in the flexor digitorum profundus (FDP) and thighs. In the FDP, MRE was performed at 90 Hz vibration to each index, middle, ring, and little finger. Two thigh MRE scans were performed at 40 Hz with knees flexed and extended. The normalized octahedral shear strain (NOSS) maps were calculated to visualize myofascial slip interfaces. The entropy of the probability distribution of the gradient NOSS was computed for the two knee positions at the intermuscular interface between vastus lateralis and vastus intermedius, around rectus femoris, and between vastus intermedius and vastus medialis. RESULTS NOSS map depicted distinct functional slip interfaces in the FDP for each finger. Compared to knee flexion, clearer slip interfaces and larger gradient NOSS entropy at the vastus lateralis-vastus intermedius interface were observed during knee extension, where the quadriceps are not passively stretched. This suggests the optimal position for using SII to visualize myofascial slip interface in skeletal muscles is when muscles are not subjected to any additional force. CONCLUSION The study demonstrated that MRE-based SII can visualize and assess myofascial interface mobility in extremities. The results provide a foundation for investigating the hypothesis that myofascial pain syndrome is characterized by changes in the mobility of myofascial interfaces.
Collapse
Affiliation(s)
- Emi Hojo
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Yi Sui
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Xiang Shan
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Keni Zheng
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Phillip Rossman
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Armando Manduca
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Garret M. Powell
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Kai-Nan An
- Orthopedics Research, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Kristin D. Zhao
- Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Brent A. Bauer
- General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Richard L. Ehman
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Ziying Yin
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| |
Collapse
|
2
|
Zheng K, Murphy MC, Camerucci E, Plitt AR, Shan X, Sui Y, Manduca A, Van Gompel JJ, Ehman RL, Huston J, Yin Z. Improved quantification of tumor adhesion in meningiomas using MR elastography-based slip interface imaging. PLoS One 2024; 19:e0305247. [PMID: 38917107 PMCID: PMC11198761 DOI: 10.1371/journal.pone.0305247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Meningiomas, the most prevalent primary benign intracranial tumors, often exhibit complicated levels of adhesion to adjacent normal tissues, significantly influencing resection and causing postoperative complications. Surgery remains the primary therapeutic approach, and when combined with adjuvant radiotherapy, it effectively controls residual tumors and reduces tumor recurrence when complete removal may cause a neurologic deficit. Previous studies have indicated that slip interface imaging (SII) techniques based on MR elastography (MRE) have promise as a method for sensitively determining the presence of tumor-brain adhesion. In this study, we developed and tested an improved algorithm for assessing tumor-brain adhesion, based on recognition of patterns in MRE-derived normalized octahedral shear strain (NOSS) images. The primary goal was to quantify the tumor interfaces at higher risk for adhesion, offering a precise and objective method to assess meningioma adhesions in 52 meningioma patients. We also investigated the predictive value of MRE-assessed tumor adhesion in meningioma recurrence. Our findings highlight the effectiveness of the improved SII technique in distinguishing the adhesion degrees, particularly complete adhesion. Statistical analysis revealed significant differences in adhesion percentages between complete and partial adherent tumors (p = 0.005), and complete and non-adherent tumors (p<0.001). The improved technique demonstrated superior discriminatory ability in identifying tumor adhesion patterns compared to the previously described algorithm, with an AUC of 0.86 vs. 0.72 for distinguishing complete adhesion from others (p = 0.037), and an AUC of 0.72 vs. 0.67 for non-adherent and others. Aggressive tumors exhibiting atypical features showed significantly higher adhesion percentages in recurrence group compared to non-recurrence group (p = 0.042). This study validates the efficacy of the improved SII technique in quantifying meningioma adhesions and demonstrates its potential to affect clinical decision-making. The reliability of the technique, coupled with potential to help predict meningioma recurrence, particularly in aggressive tumor subsets, highlights its promise in guiding treatment strategies.
Collapse
Affiliation(s)
- Keni Zheng
- Radiology, Mayo Clinic, Rochester, MN, United States of America
| | | | | | - Aaron R. Plitt
- Neurosurgery, Mayo Clinic, Rochester, MN, United States of America
| | - Xiang Shan
- Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Yi Sui
- Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Armando Manduca
- Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States of America
| | - Jamie J. Van Gompel
- Neurosurgery, Mayo Clinic, Rochester, MN, United States of America
- Otolaryngology, Mayo Clinic, Rochester, MN, United States of America
| | | | - John Huston
- Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Ziying Yin
- Radiology, Mayo Clinic, Rochester, MN, United States of America
| |
Collapse
|
3
|
Kumarapuram S, Yu R, Manchiraju P, Attard C, Escamilla J, Navin A, Khuroo M, Elmogazy O, Gupta G, Sun H, Roychowdhury S. Applying Shear Wave and Magnetic Resonance Elastography to Grade Brain Tumors: Systematic Review and Meta-Analysis. World Neurosurg 2023; 178:e147-e155. [PMID: 37442538 DOI: 10.1016/j.wneu.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Reports find that magnetic resonance elastography (MRE) and shear wave elastography (SWE) can classify intracranial tumors according to stiffness. However, systematic syntheses of these articles are lacking. In this report, a systematic review and meta-analysis was performed to evaluate whether SWE and MRE can predict meningioma and glioma grades. METHODS PubMed and Scopus were searched between February 10, 2022. and March 2, 2022. using manual search criteria. Eight out of 106 non-duplicate records were included, encompassing 84 patients with low-grade tumors (age 42 ± 13 years, 71% female) and 92 patients with high-grade tumors (age 50 ± 13 years, 42% female). Standardized mean difference in stiffness between high-grade and low-grade tumors were measured using a forest plot. The I2, χ2, and t tests were performed, and bubble plots were constructed to measure heterogeneity. An adapted QUADAS-2 scale evaluated study quality. Additionally, a funnel plot was constructed, and an Egger's intercept test determined study bias. RESULTS Low-grade tumors were stiffer than high-grade tumors (Cohen's D = -1.25; 95% CI -1.88, -0.62). Moderate heterogeneity was observed (I2 = 67%; P = 0.006) but controlling for publication year (I2 = 0.2%) and age (I2 = 0.0%-17%) reduced heterogeneity. Included studies revealed unclear or high bias for the reference standard and flow and timing (>50%). CONCLUSIONS Elastography techniques have potential to grade tumors intraoperatively and postoperatively. More studies are needed to evaluate the clinical utility of these technologies.
Collapse
Affiliation(s)
- Siddhant Kumarapuram
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
| | - Richard Yu
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Pranav Manchiraju
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Casey Attard
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jennifer Escamilla
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Apurva Navin
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Mohammad Khuroo
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Omar Elmogazy
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Gaurav Gupta
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Hai Sun
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Sudipta Roychowdhury
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| |
Collapse
|
4
|
Li M, Yin Z, Hu B, Guo N, Zhang L, Zhang L, Zhu J, Chen W, Yin M, Chen J, Ehman RL, Wang J. MR Elastography-Based Shear Strain Mapping for Assessment of Microvascular Invasion in Hepatocellular Carcinoma. Eur Radiol 2022; 32:5024-5032. [PMID: 35147777 DOI: 10.1007/s00330-022-08578-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the potential of MR elastography (MRE)-based shear strain mapping to noninvasively predict the presence of microvascular invasion (MVI) in hepatocellular carcinoma (HCC). METHODS Fifty-nine histopathology-proven HCC patients with conventional 60-Hz MRE examinations (+/-MVI, n = 34/25) were enrolled retrospectively between December 2016 and October 2019, with one subgroup comprising 29/59 patients (+/-MVI, n = 16/13) who also underwent 40- and 30-Hz MRE examinations. Octahedral shear strain (OSS) maps were calculated, and the percentage of peritumoral interface length with low shear strain (i.e., a low-shear-strain length, pLSL, %) was recorded. For OSS-pLSL, differences between the MVI (+) and MVI (-) groups and diagnostic performance at different MRE frequencies were analyzed using the Mann-Whitney test and area under the receiver operating characteristic curve (AUC), respectively. RESULTS The peritumor OSS-pLSL was significantly higher in the MVI (+) group than in the MVI (-) group at the three frequencies (all p < 0.01). The AUC of peritumor OSS-pLSL for predicting MVI was good/excellent in all frequency groups (60-Hz: 0.73 (n = 59)/0.80 (n = 29); 40-Hz: 0.84; 30-Hz: 0.90). On further analysis of the 29 cases with all frequencies, the AUCs were not significantly different. As the frequency decreased from 60-Hz, the specificity of OSS increased at 40-Hz (53.8-61.5%) and further increased at 30-Hz (53.8-76.9%), and the sensitivity remained high at lower frequencies (100.0-93.8%) (all p > 0.05). CONCLUSIONS MRE-based shear strain mapping is a promising technique for noninvasively predicting the presence of MVI in patients with HCC, and the most recommended frequency for OSS is 30-Hz. KEY POINTS • MR elastography (MRE)-based shear strain mapping has the potential to predict the presence of microvascular invasion (MVI) in hepatocellular carcinoma preoperatively. • The low interface shear strain identified at tumor-liver boundaries was highly correlated with the presence of MVI.
Collapse
Affiliation(s)
- Mengsi Li
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Ziying Yin
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bing Hu
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Ning Guo
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Linqi Zhang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Lina Zhang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Jie Zhu
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Wenying Chen
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Meng Yin
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jun Chen
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jin Wang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China.
| |
Collapse
|
5
|
Langevin HM. Fascia Mobility, Proprioception, and Myofascial Pain. Life (Basel) 2021; 11:life11070668. [PMID: 34357040 PMCID: PMC8304470 DOI: 10.3390/life11070668] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 12/19/2022] Open
Abstract
The network of fasciae is an important part of the musculoskeletal system that is often overlooked. Fascia mobility, especially along shear planes separating muscles, is critical for musculoskeletal function and may play an important, but little studied, role in proprioception. Fasciae, especially the deep epimysium and aponeuroses, have recently been recognized as highly innervated with small diameter fibers that can transmit nociceptive signals, especially in the presence of inflammation. Patients with connective tissue hyper- and hypo-mobility disorders suffer in large number from musculoskeletal pain, and many have abnormal proprioception. The relationships among fascia mobility, proprioception, and myofascial pain are largely unstudied, but a better understanding of these areas could result in improved care for many patients with musculoskeletal pain.
Collapse
Affiliation(s)
- Helene M Langevin
- National Center for Complementary and Integrative Health, National Institutes of Health, 31 Center Drive, Suite 2B11, Bethesda, MD 20892, USA
| |
Collapse
|
6
|
Pons-Escoda A. Editorial comment on "A new method for quantification and 3D visualization of brain tumor adhesion using slip interface imaging in patients with meningiomas". Eur Radiol 2021; 31:5552-5553. [PMID: 34041568 DOI: 10.1007/s00330-021-08055-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Albert Pons-Escoda
- Radiology Department, Neurooncology Unit, Hospital Universitari de Bellvitge, Insitut de Diagnostic per la Imatge, C/ Feixa Llarga SN L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| |
Collapse
|