Determination of reference ranges for normal upper trapezius elasticity during different shoulder abduction using shear wave elastography: a preliminary study

Bowel Stiffness Assessed by Shear-Wave Ultrasound Elastography Predicts Disease Behavior Progression in Patients With Crohn's Disease

INTRODUCTION

There is a lack of reliable predictors of disease behavior progression in patients with Crohn's disease (CD). Real-time shear-wave elastography (SWE) is a novel method for evaluating tissue stiffness. However, its value for assessing CD has not yet been investigated. We aimed to explore the value of SWE and other ultrasound parameters at diagnosis in predicting CD behavior progression.

METHODS

We retrospectively collected data from patients with CD with the nonstenotic nonpenetrating disease (B1 phenotype based on the Montreal classification). All patients underwent intestinal ultrasound at baseline and were followed up. The end point was defined as disease behavior progression to stricturing (B2) or penetrating (B3) disease. Cox regression analysis was performed for the association between baseline characteristics and subsequent end points. In addition, a multivariate nomogram was established to predict the risk of disease behavior progression quantitatively.

RESULTS

A total of 130 patients with CD with B1 phenotype were enrolled. Twenty-seven patients (20.8%) developed B2 or B3 disease, with a median follow-up of 33 months. Multivariate analysis identified that SWE was the only independent predictor of disease behavior progression (hazard ratio 1.08, 95% confidence interval 1.03-1.12, P = 0.001). A reverse of the HR appeared at the cutoff 12.75 kPa. The nomogram incorporating SWE and other clinical characteristics showed a good prediction performance (area under the curve = 0.792).

DISCUSSION

Intestinal stiffness assessed using SWE is an independent predictor of disease behavior progression in patients with CD. Patients with CD with SWE >12.75 kPa at diagnosis are prone to progress toward stricturing or penetrating diseases.

Providing safe and effective rehabilitation by assessing supraspinatus muscle elasticity using ultrasound real-time tissue elastography after rotator cuff repair: A case series

INTRODUCTION

Although surgical techniques have advanced to avoid a postoperative re-tear after rotator cuff surgery, it remains unclear how to directly evaluate the risk of a re-tear.

OBJECTIVE

To describe how muscle elasticity with real-time tissue elastography could be used to avoid re-tear in individual cases after rotator cuff repair.

CASE DESCRIPTION

This case series included four patients, two per tear size (small and large/massive), with contrasting changes in muscle elasticity of the supraspinatus muscle. All patients underwent primary arthroscopic or open rotator cuff repair. The elasticity of the supraspinatus muscle was evaluated at relaxed and elongated positions of 0° and 60° shoulder abduction angles, respectively. The change in muscle elasticity at 1 month after surgery was characteristically different, and we predicted that a greater elasticity in the elongated position indicated a higher risk of re-tear. The cases with high risk underwent careful rehabilitation to avoid re-tear, and no re-tears were recorded in this report.

CONCLUSION

Our findings suggested that evaluation of muscle elasticity using real-time tissue elastography, which provides an indication of the risk of re-tear, in the clinical setting might be useful for therapists, who could adjust the intensity of rehabilitation, and for patients.

Determination of the reference range for semi-quantified elasticity of healthy supraspinatus muscles using real-time tissue elastography and its clinical use in patients after rotator cuff repair

BACKGROUND

The quantitative assessment of healthy supraspinatus muscle elasticity may provide clinically useful preliminary information after rotator cuff repairs. We aimed to determine the reference range for supraspinatus muscle semi-quantified elasticity and describe how it can be used clinically after rotator cuff repair.

METHODS

The elasticity of healthy bilateral supraspinatus muscles in 43 participants aged between 24 and 75 years (categorized into two subgroups: <50 and ≥ 50 years) was measured as a strain ratio at 0° and 60° of shoulder abduction using real-time tissue elastography. The reference and modified reference ranges calculated by excluding outliers for elasticity were determined using normal distribution methods for logarithmically transformed data. The modified reference range was applied to eight cases of rotator cuff repair.

FINDINGS

Strain ratios under and over 50 years of age were 1.63 vs. 2.21 at 0° of shoulder abduction (P = 0.028) and 0.92 vs. 1.29 at 60° of shoulder abduction (P = 0.002), respectively. Modified reference ranges for under and over 50 years of age were 0.72-4.17 and 0.98-4.50 at 0° of shoulder abduction and 0.38-1.95 and 0.56-2.76 at 60° of shoulder abduction, respectively. Among eight cases, two showed strain ratios above the reference range at 1 month postoperatively, and rehabilitation protocols were adjusted.

INTERPRETATION

A strain ratio above the reference range, especially above the upper limit at 0° of shoulder abduction, may indicate increased passive stiffness of the musculotendinous unit. Clinically, the reference range has the potential to be used as a baseline after rotator cuff repairs.

Effects of Knee Joint Angle and Contraction Intensity on the Triceps Surae Stiffness

Purpose: Monitoring the contractility of muscles assists the clinician in understanding how muscle functions as part of the kinetic system. This study investigated the effect of knee joint angles under different resistance on the stiffness of the medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) muscles using the shear wave elastography (SWE) technique.

Methods: A total of 22 females were recruited. During isometric plantar flexion, at knee 0-degree (fully extended) and knee 90-degree (flexed 90°), the shear modulus on the MG, LG, and SOL was measured by shear wave elastography at no contraction and two intensities (40% and 80%) of maximal voluntary contraction (MVC). Shear modulus is a mechanical parameter to describe stiffness, and stiffness is a proxy for muscle contractility.

Results: There were moderate-to high-positive correlations between the active stiffness of triceps surae muscles and isometric contraction intensity (r: 0.57–0.91, p＜0.001). The active stiffness in MG and LG with extended knees was higher than that with flexed knees (p＜0.001). The active stiffness in SOL with flexed knee was higher than that with extended knee (p＜0.001).

Conclusion: Active stiffness can be considered a quantitative indicator generated by the force output of the triceps surae. Different knee joint angles cause three triceps surae muscles to exhibit non-uniform mechanical properties, which may explain part of the mechanism of soft tissue injury during physical exercise.

Determination of Reference Values of the Masseter Muscle Stiffness in Healthy Adults Using Shear Wave Elastography

Shear wave elastography (SWE) is an objective and reliable method for the assessment of muscles and internal organs. Every organ exhibits its own stiffness characteristics and hence requires individual reference values. We aimed to determine the reference values of stiffness of the masseter muscle in healthy adult individuals using SWE. We analyzed the data of 140 participants (74 men, 66 women) with a median age of 50 years. The overall mean elasticity was 10.67 ± 1.77 kPa. The average values were lower by 2.25 kPa (9.15%) in women compared to men (9.48 ± 1.47 kPa vs. 11.73 ± 1.27 kPa; p < 0.0001). The values of stiffness increased with age, with a correlation coefficient of about 0.35 and a p < 0.0001. Age was a significant influencing factor of masseter muscle stiffness. The left and right masseters had similar stiffness. We conclude that stiffness values are significantly lower in women than in men with a difference of 9%. Age significantly influences the stiffness of masseter muscle, and the values of stiffness increase significantly with age, particularly in men. However, further studies are required to determine the precise ranges of stiffness accounting for age and sex in healthy subjects and people with disorders and conditions of the masticatory system.

Quantitative assessment of normal middle deltoid muscle elasticity at various arm abduction using ultrasound shear wave elastography

The objective of this study is to assess the change in the normal MD elasticity using shear wave elastography (SWE) through measuring the middle deltoid (MD) elasticity in healthy participants at various arm abduction (with bilateral arms at 0 degrees abduction and 90 degrees active abduction) and analyzing the factors affecting normal MD elasticity. Mean shear wave velocity (SWV) of the MD in healthy right-handed participants were evaluated using SWE at different arm abduction, and potential factors (gender, MD thickness, age, body mass index) affecting MD elasticity were analyzed. Different arm abduction positions of each participant were as follows: (i) 0° abduction of bilateral arm (L0° and R0°), (ii) 90° active abduction of bilateral arm (L90° and R90°). Mean SWV was significantly higher at L90° than L0°, higher at R90° than R0°, higher at R0° than L0°, and higher at R90° than L90° (all P < 0.0001). SWV was significantly higher in males at both L0° (P < 0.05) and R0° (P < 0.01) than in females. Neither MD thickness, age nor body mass index influenced MD elasticity. Reference ranges of normal MD elasticity were 2.4–3.1 m/s in males and 2.2–2.9 m/s in females at L0° and 2.5–3.3 m/s in males and 2.4–3.2 m/s in females at R0°, and were 4.9–6.7 m/s at L90°, 5.2–7.1 m/s at R90° for both males and females. SWE is a feasible technique to assess normal MD elasticity at various arm abduction. Our results suggest that normal MD elasticity at L0°, R0°, L90°, and R90° with SWE are different. Moreover, these reference ranges may serve as quantitative baseline measurements for assessment of normal MD elasticity in the future.

Muscle shear wave elastography, conventional B mode and power doppler ultrasonography in healthy adults and patients with autoimmune inflammatory myopathies: a pilot cross-sectional study

Background

Before the role of shear wave elastography (SWE) and B mode ultrasound (US) in the diagnosis of different forms of idiopathic inflammatory myopathies (IIM) can be investigated, normative data is required. This study aimed to describe and then compare normative SWE and B mode ultrasound metrics of muscles in healthy controls and patients with IIM.

Methods

Twenty nine healthy adult controls and 10 IIM patients (5 with inclusion body myositis and 5 with necrotising autoimmune myopathy) underwent a full clinical examination, laboratory investigations, SWE and US measurements of selected proximal and distal limb muscles. Shear wave speed (SWS) and multiple US domains [echogenicity, fascial thickness, muscle bulk and power Doppler (PD)] were measured in both groups.

Results

In healthy controls (n = 29; mean age 46.60 ± 16.10; 44.8 % female), age was inversely correlated with SWS at the deltoid (stretch) (Rs. -0.40, p = 0.030) and PD score at the deltoid (rest) (Rs. -0.40, P = 0.032). Those ≥ 50 years old had a lower SWS at the deltoid (stretch) compared to the < 50 year group (2.92 m/s vs. 2.40 m/s, P = 0.032). Age correlated with increased echogenicity in the flexor digitorum profundus (Rs. 0.38, P = 0.045). Females had a smaller muscle bulk in the deltoid (P = 0.022). Body mass index (BMI) was inversely associated with SWS in the deltoid (stretch) (Rs – 0.45, P = 0.026), and positively correlated with echogenicity in the deltoid (Rs. 0.69, P = 0.026). In patients ≥50 years of age, patients with IIM (mean age 61.00 ± 8.18; females 20.0 %) had a higher proportion of abnormal echogenicity scores at the flexor digitorum profundus (FDP) (40.00 % vs. 14.30 %, P = 0.022) and tibialis anterior (TA) (80.00 % vs. 28.60 %, P = 0.004). Fascial thickness was lower in the FDP (0.63mm vs. 0.50mm, p = 0.012) and TA (0.58mm vs. 0.45mm, P = 0.001).

Conclusions

Our findings suggest there is scope for US techniques to be useful for diagnostic screening of affected muscles in patients with IIM, especially in those with suspected inclusion body myositis or necrotising autoimmune myopathy. We provide normative data for future studies into SWE and US techniques in skeletal muscle. The differences between IIM patients and controls warrant further study in a broader IIM patient cohort.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04424-0.