Sensitivity of the shear wave speed-stress relationship to soft tissue material properties and fiber alignment

Gauging force by tapping tendons? Inaccurately in the human patellar tendon

Accurately estimating in vivo tendon load non-invasively remains a major challenge in biomechanics, which might be overcome by shear-wave tensiometry. Shear-wave tensiometry measures the speed of mechanically induced tendon shear waves by skin-mounted accelerometers. To gauge the feasibility and accuracy of this novel technique, we obtained patellar tendon shear wave speeds via shear-wave tensiometry during sustained or ramp voluntary contractions of the knee extensors in two experiments (n = 8 in both). In experiment one, participants produced a constant knee extension torque of ∼ 50 Nm at five different knee joint angles (i.e. variable tendon load), which resulted in estimated patellar tendon forces between 1005 ± 6N and 1182 ± 16 N. However, wave speed squared did not correlate with estimated tendon force within participants (rrm(31) = -0.19, p = 0.278). In experiment two, averaged correlation coefficients between normalized wave speed squared and torque of maximal and submaximal voluntary contractions across participants ranged between r = 0.43 and r = 0.94, while the time-varying correlation between these normalized signals ranged from r = -0.99 to r = 1.00. Further, the mean absolute errors (MAEs) between normalized wave speed squared and normalized torque across participants ranged between 0.03 and 0.54, which were larger than the MAEs between normalized torque and normalized summed EMG amplitude from the superficial quadriceps muscles (0.03-0.54 versus 0.06-0.26, respectively). In conclusion, there was no simple relation between shear wave speed squared and patellar tendon load, which severely limits the feasibility of shear-wave tensiometry for accurately estimating in vivo tendon load at the knee joint.

Shear wave elastography of transverse carpal ligament increased with simulated carpal tunnel pressure

BACKGROUND

Elevation of carpal tunnel pressure is known to be associated with carpal tunnel syndrome. This study aimed to correlate the shear wave elastography in the transverse carpal ligament (TCL) with carpal tunnel pressures using a cadaveric model.

METHODS

Eight human cadaveric hands were dissected to evacuate the tunnels. A medical balloon was inserted into each tunnel and connected to a pressure regulator to simulate tunnel pressure in the range of 0-210 mmHg with an increment of 30 mmHg. Shear wave velocity and modulus was measure in the middle of TCL.

RESULTS

SWV and SWE were significantly dependent on the pressure levels (p < 0.001), and positively correlated to the tunnel pressure (SWV: R = 0.997, p < 0.001; SWE: R = 0.996, p < 0.001). Regression analyses showed linear relationship SWV and pressure (SWV = 4.359 + 0.0263 * Pressure, R2 = 0.994) and between SWE and pressure (SWE = 48.927 + 1.248 * Pressure, R2 = 0.996).

CONCLUSION

The study indicated that SWV and SWE in the TCL increased linearly as the tunnel pressure increased within the current pressure range. The findings suggested that SWV/SWE in the TCL has the potential for prediction of tunnel pressure and diagnosis of carpal tunnel syndrome.

Regional shear wave speeds track regional axial stress in nonuniformly loaded fibrous soft tissues

Ligaments and tendons undergo nonuniform deformation during movement. While deformations can be imaged, it remains challenging to use such information to infer regional tissue loading. Shear wave tensiometry is a promising noninvasive technique to gauge axial stress and is premised on a tensioned beam model. However, it is unknown whether tensiometry can predict regional stress in a nonuniformly loaded structure. The objectives of this study were to (1) determine whether regional shear wave speed tracks regional axial stress in nonuniformly loaded fibrous soft tissues, and (2) determine the sensitivity of regional axial stress and shear wave speed to nonuniform load distribution and fiber alignment. We created a representative set of 12,000 dynamic finite element models of a fibrous soft tissue with probabilistic variations in fiber alignment, stiffness, and aspect ratio. In each model, we applied a randomly selected nonuniform load distribution, and then excited a shear wave and tracked its regional propagation. We found that regional shear wave speed was an excellent predictor of the regional axial stress (RMSE = 0.57 MPa) and that the nature of the regional shear wave speed-stress relationship was consistent with a tensioned beam model (R2 = 0.99). Variations in nonuniform load distribution and fiber alignment did not substantially alter the wave speed-stress relationship, particularly at higher loads. Thus, these findings suggests that shear wave tensiometry could provide a quantitative estimate of regional tissue stress in ligaments and tendons.

Tethered spinal cord tension assessed via ultrasound elastography in computational and intraoperative human studies

BACKGROUND

Tension in the spinal cord is a trademark of tethered cord syndrome. Unfortunately, existing tests cannot quantify tension across the bulk of the cord, making the diagnostic evaluation of stretch ambiguous. A potential non-destructive metric for spinal cord tension is ultrasound-derived shear wave velocity (SWV). The velocity is sensitive to tissue elasticity and boundary conditions including strain. We use the term Ultrasound Tensography to describe the acoustic evaluation of tension with SWV.

METHODS

Our solution Tethered cord Assessment with Ultrasound Tensography (TAUT) was utilized in three sub-studies: finite element simulations, a cadaveric benchtop validation, and a neurosurgical case series. The simulation computed SWV for given tensile forces. The cadaveric model with induced tension validated the SWV-tension relationship. Lastly, SWV was measured intraoperatively in patients diagnosed with tethered cords who underwent treatment (spinal column shortening). The surgery alleviates tension by decreasing the vertebral column length.

RESULTS

Here we observe a strong linear relationship between tension and squared SWV across the preclinical sub-studies. Higher tension induces faster shear waves in the simulation (R2 = 0.984) and cadaveric (R2 = 0.951) models. The SWV decreases in all neurosurgical procedures (p < 0.001). Moreover, TAUT has a c-statistic of 0.962 (0.92-1.00), detecting all tethered cords.

CONCLUSIONS

This study presents a physical, clinical metric of spinal cord tension. Strong agreement among computational, cadaveric, and clinical studies demonstrates the utility of ultrasound-induced SWV for quantitative intraoperative feedback. This technology is positioned to enhance tethered cord diagnosis, treatment, and postoperative monitoring as it differentiates stretched from healthy cords.

Residual force enhancement is affected more by quadriceps muscle length than stretch amplitude

Little is known about how muscle length affects residual force enhancement (rFE) in humans. We therefore investigated rFE at short, long, and very long muscle lengths within the human quadriceps and patellar tendon (PT) using conventional dynamometry with motion capture (rFE_TQ) and a new, non-invasive shear-wave tensiometry technique (rFE_WS). Eleven healthy male participants performed submaximal (50% max.) EMG-matched fixed-end reference and stretch-hold contractions across these muscle lengths while muscle fascicle length changes of the vastus lateralis (VL) were captured using B-mode ultrasound. We found significant rFE_TQ at long (7±5%) and very long (12±8%), but not short (2±5%) muscle lengths, whereas rFE_WS was only significant at the very long (38±27%), but not short (8±12%) or long (6±10%) muscle lengths. We also found significant relationships between VL fascicle length and rFE_TQ (r=0.63, p=0.001) and rFE_WS (r=0.52, p=0.017), but relationships were not significant between VL fascicle stretch amplitude and rFE_TQ (r=0.33, p=0.126) or rFE_WS (r=0.29, p=0.201). Squared PT shear-wave-speed-angle relationships did not agree with estimated PT force-angle relationships, which indicates that estimating PT loads from shear-wave tensiometry might be inaccurate. We conclude that increasing muscle length rather than stretch amplitude contributes more to rFE during submaximal voluntary contractions of the human quadriceps.

A Kalman Filter Approach for Estimating Tendon Wave Speed from Skin-Mounted Accelerometers

Shear wave tensiometry is a noninvasive approach for assessing in vivo tendon forces based on the speed of a propagating shear wave. Wave speed is measured by impulsively exciting a shear wave in a tendon and then assessing the wave travel time between skin-mounted accelerometers. Signal distortion with wave travel can cause errors in the estimated wave travel time. In this study, we investigated the use of a Kalman filter to fuse spatial and temporal accelerometer measurements of wave propagation. Spatial measurements consist of estimated wave travel times between accelerometers. Temporal measurements are the change in wave arrival at a fixed accelerometer between successive impulsive taps. The Kalman filter substantially improved the accuracy of estimated wave speeds when applied to simulated tensiometer data. The variability of estimated wave speed was reduced by ~55% in the presence of random sensor noise. It was found that increasing the number of accelerometers from two to three further reduced wave speed errors by 45%. The use of redundant accelerometers (>2) also improved the robustness of wave speed measures in the presence of uncertainty in accelerometer location. We conclude that the use of a Kalman filter and redundant accelerometers can enhance the fidelity of using shear wave tensiometers to track tendon wave speed and loading during movement.