Assessment of the mechanical properties of the musculoskeletal system using 2-D and 3-D very high frame rate ultrasound

Deep Learning Model Coupling Wearable Bioelectric and Mechanical Sensors for Refined Muscle Strength Assessment

Muscle strength (MS) is related to our neural and muscle systems, essential for clinical diagnosis and rehabilitation evaluation. Although emerging wearable technology seems promising for MS assessment, problems still exist, including inaccuracy, spatiotemporal differences, and analyzing methods. In this study, we propose a wearable device consisting of myoelectric and strain sensors, synchronously acquiring surface electromyography and mechanical signals at the same spot during muscle activities, and then employ a deep learning model based on temporal convolutional network (TCN) + Transformer (Tcnformer), achieving accurate grading and prediction of MS. Moreover, by combining with deep clustering, named Tcnformer deep cluster (TDC), we further obtain a 25-level classification for MS assessment, refining the conventional 5 levels. Quantification and validation showcase a patient's postoperative recovery from level 3.2 to level 3.6 in the first few days after surgery. We anticipate that this system will importantly advance precise MS assessment, potentially improving relevant clinical diagnosis and rehabilitation outcomes.

Accurate Identification of Motoneuron Discharges From Ultrasound Images Across the Full Muscle Cross-Section

OBJECTIVE

Non-invasive identification of motoneuron (MN) activity commonly uses electromyography (EMG). However, surface EMG (sEMG) detects only superficial sources, at less than approximately 10-mm depth. Intramuscular EMG can detect deep sources, but it is limited to sources within a few mm of the detection site. Conversely, ultrasound (US) images have high spatial resolution across the whole muscle cross-section. The activity of MNs can be extracted from US images due to the movements that MN activation generates in the innervated muscle fibers. Current US-based decomposition methods can accurately identify the location and average twitch induced by MN activity. However, they cannot accurately detect MN discharge times.

METHODS

Here, we present a method based on the convolutive blind source separation of US images to estimate MN discharge times with high accuracy. The method was validated across Ten participants using concomitant sEMG decomposition as the ground truth.

RESULTS

140 unique MN spike trains were identified from US images, with a rate of agreement (RoA) with sEMG decomposition of 87.4 ± 10.3%. Over 50% of these MN spike trains had a RoA greater than 90%. Furthermore, with US, we identified additional MUs well beyond the sEMG detection volume, at up to >30 mm below the skin.

CONCLUSION

The proposed method can identify discharges of MNs innervating muscle fibers in a large range of depths within the muscle from US images.

SIGNIFICANCE

The proposed methodology can non-invasively interface with the outer layers of the central nervous system innervating muscles across the full cross-section.

A registration strategy to characterize DTI-observed changes in skeletal muscle architecture due to passive shortening

Skeletal muscle architecture is a key determinant of muscle function. Architectural properties such as fascicle length, pennation angle, and curvature can be characterized using Diffusion Tensor Imaging (DTI), but acquiring these data during a contraction is not currently feasible. However, an image registration-based strategy may be able to convert muscle architectural properties observed at rest to their contracted state. As an initial step toward this long-term objective, the aim of this study was to determine if an image registration strategy could be used to convert the whole-muscle average architectural properties observed in the extended joint position to those of a flexed position, following passive rotation. DTI and high-resolution fat/water scans were acquired in the lower leg of seven healthy participants on a 3T MR system in +20° (plantarflexion) and -10° (dorsiflexion) foot positions. The diffusion and anatomical images from the two positions were used to propagate DTI fiber-tracts from seed points along a mesh representation of the aponeurosis of fiber insertion. The -10° and +20° anatomical images were registered and the displacement fields were used to transform the mesh and fiber-tracts from the +20° to the -10° position. Student's paired t-tests were used to compare the mean architectural parameters between the original and transformed fiber-tracts. The whole-muscle average fiber-tract length, pennation angle, curvature, and physiological cross-sectional areas estimates did not differ significantly. DTI fiber-tracts in plantarflexion can be transformed to dorsiflexion position without significantly affecting the average architectural characteristics of the fiber-tracts. In the future, a similar approach could be used to evaluate muscle architecture in a contracted state.

Spatial decomposition of ultrafast ultrasound images to identify motor unit activity - A comparative study with intramuscular and surface EMG

The smallest voluntarily controlled structure of the human body is the motor unit (MU), comprised of a motoneuron and its innervated fibres. MUs have been investigated in neurophysiology research and clinical applications, primarily using electromyographic (EMG) techniques. Nonetheless, EMG (both surface and intramuscular) has a limited detection volume. A recent alternative approach to detect MUs is ultrafast ultrasound (UUS) imaging. The possibility of identifying MU activity from UUS has been shown by blind source separation (BSS) of UUS images, using optimal separation spatial filters. However, this approach has yet to be fully compared with EMG techniques for a large population of unique MU spike trains. Here we identify individual MU activity in UUS images using the BSS method for 401 MU spike trains from eleven participants based on concurrent recordings of either surface or intramuscular EMG from forces up to 30% of the maximum voluntary contraction (MVC) force. We assessed the BSS method's ability to identify MU spike trains from direct comparison with the EMG-derived spike trains as well as twitch areas and temporal profiles from comparison with the spike-triggered-averaged UUS images when using the EMG-derived spikes as triggers. We found a moderate rate of correctly identified spikes (53.0 ± 16.0%) with respect to the EMG-identified firings. However, the MU twitch areas and temporal profiles could still be identified accurately, including at 30% MVC force. These results suggest that the current BSS methods for UUS can accurately identify the location and average twitch of a large pool of MUs in UUS images, providing potential avenues for studying neuromechanics from a large cross-section of the muscle. On the other hand, more advanced methods are needed to address the convolutive and partly non-linear summation of velocities for recovering the full spike trains.

Contraction Velocity of the Elbow Flexors Assessed by Tensiomyography: A Comparison Between Formulas

ABSTRACT

Mesquita, RNO, Latella, C, Ruas, CV, Nosaka, K, and Taylor, JL. Contraction velocity of the elbow flexors assessed by tensiomyography: A comparison between formulas. J Strength Cond Res 37(10): 1969-1977, 2023-Muscle contraction velocity ( Vc ) assessed by tensiomyography is a promising measure for athlete profiling. Multiple formulas are used to estimate Vc , but the most suitable method is yet to be established. Fifteen adults (2 female subjects) underwent tensiomyography assessment of biceps brachii muscle at 10, 45 and 90° of elbow flexion on 2 separate days. Vc was calculated using 6 formulas. Formulas 1 and 2 are measures of the early phase of the twitch; Formulas 3-5 are measures over a wider time-window, with Formula 5 normalizing Vc to maximal displacement ( D m); and we proposed Formula 6 as a measure of peak Vc . Test-retest reliability, the required minimum number of trials, proportional bias, and effects of joint angle were investigated. Higher reliability (coefficient of variation: 2.8-6.9%) was found for Formula 1 (0-2 mm of displacement) and Formula 5 (normalized 10-90% of D m). Overall, a minimum of 6-7 trials was required to obtain reliable estimates. For 10° only, significant positive proportional bias ( r = 0.563-0.670) was found for all formulas except Formula 5. Vc was faster ( p < 0.001) at shorter muscle lengths for all formulas except Formula 5 ( p = 0.06). Vc in the early phase of the twitch was more reliable when calculated using absolute displacement (Formula 1) than a relative threshold (Formula 2). Over a larger time-window, Formulas 3 and 4 were similarly reliable. Because they are derived from different components of the twitch and different parameters, the different formulas should not be used interchangeably. Additionally, more precise nomenclature is required to describe the information obtained from each formula.

Non-Linearity in Motor Unit Velocity Twitch Dynamics: Implications for Ultrafast Ultrasound Source Separation

Ultrasound (US) muscle image series can be used for peripheral human-machine interfacing based on global features, or even on the decomposition of US images into the contributions of individual motor units (MUs). With respect to state-of-the-art surface electromyography (sEMG), US provides higher spatial resolution and deeper penetration depth. However, the accuracy of current methods for direct US decomposition, even at low forces, is relatively poor. These methods are based on linear mathematical models of the contributions of MUs to US images. Here, we test the hypothesis of linearity by comparing the average velocity twitch profiles of MUs when varying the number of other concomitantly active units. We observe that the velocity twitch profile has a decreasing peak-to-peak amplitude when tracking the same target motor unit at progressively increasing contraction force levels, thus with an increasing number of concomitantly active units. This observation indicates non-linear factors in the generation model. Furthermore, we directly studied the impact of one MU on a neighboring MU, finding that the effect of one source on the other is not symmetrical and may be related to unit size. We conclude that a linear approximation is partly limiting the decomposition methods to decompose full velocity twitch trains from velocity images, highlighting the need for more advanced models and methods for US decomposition than those currently employed.

Spatially repeatable components from ultrafast ultrasound are associated with motor unit activity in human isometric contractions. J Neural Eng 2023;20:046016. [PMID: 37437598 DOI: 10.1088/1741-2552/ace6fc]

Objective.Ultrafast ultrasound (UUS) imaging has been used to detect intramuscular mechanical dynamics associated with single motor units (MUs). Detecting MUs from ultrasound sequences requires decomposing a velocity field into components, each consisting of an image and a signal. These components can be associated with putative MU activity or spurious movements (noise). The differentiation between putative MUs and noise has been accomplished by comparing the signals with MU firings obtained from needle electromyography (EMG). Here, we examined whether the repeatability of the images over brief time intervals can serve as a criterion for distinguishing putative MUs from noise in low-force isometric contractions.Approach.UUS images and high-density surface EMG (HDsEMG) were recorded simultaneously from 99 MUs in the biceps brachii of five healthy subjects. The MUs identified through HDsEMG decomposition were used as a reference to assess the outcomes of the ultrasound-based components. For each contraction, velocity sequences from the same eight-second ultrasound recording were separated into consecutive two-second epochs and decomposed. To evaluate the repeatability of components' images across epochs, we calculated the Jaccard similarity coefficient (JSC). JSC compares the similarity between two images providing values between 0 and 1. Finally, the association between the components and the MUs from HDsEMG was assessed.Main results.All the MU-matched components had JSC > 0.38, indicating they were repeatable and accounted for about one-third of the HDsEMG-detected MUs (1.8 ± 1.6 matches over 4.9 ± 1.8 MUs). The repeatable components (JSC > 0.38) represented 14% of the total components (6.5 ± 3.3 components). These findings align with our hypothesis that intra-sequence repeatability can differentiate putative MUs from noise and can be used for data reduction.Significance.This study provides the foundation for developing stand-alone methods to identify MU in UUS sequences and towards real-time imaging of MUs. These methods are relevant for studying muscle neuromechanics and designing novel neural interfaces.

Estimation of contractile parameters of successive twitches in unfused tetanic contractions of single motor units - A proof-of-concept study using ultrafast ultrasound imaging in vivo

During a voluntary contraction, motor units (MUs) fire a train of action potentials, causing summation of the twitch forces, resulting in fused or unfused tetanus. Twitches have been important in studying whole-muscle contractile properties and differentiation between MU types. However, there are still knowledge gaps concerning the voluntary force generation mechanisms. Current methods rely on the spike-triggered averaging technique, which cannot track changes in successive twitches' properties in response to individual neural firings. This study proposes a method that estimates successive twitches contractile parameters of single MUs during low force voluntary isometric contractions in human biceps brachii. We used a previously developed ultrafast ultrasound imaging method to estimate unfused tetanic activity signals of single MUs. A twitch decomposition model was used to decompose unfused tetanic activity signals into individual twitches. This study found that the contractile parameters varied within and across MUs. There was an association between the inter-spike interval and the contraction time (r = 0.49,p < 0.001) and the half-relaxation time (r = 0.58,p < 0.001), respectively. The method shows the proof-of-concept to study MU contractile properties of individual twitches in vivo, which can provide further insights into the force generation mechanisms of voluntary contractions and response to individual neural discharges.

Optimization and comparison of two methods for spike train estimation in an unfused tetanic contraction of low threshold motor units

BACKGROUND

Recent findings have shown that imaging voluntarily activated motor units (MUs) by decomposing ultrasound-based displacement images provides estimates of unfused tetanic signals evoked by spinal motoneurons' neural discharges (spikes). Two methods have been suggested to estimate its spike trains: band-pass filter (BPM) and Haar wavelet transform (HWM). However, the methods' optimal parameters and which method performs the best are unknown. This study will answer these questions.

METHOD

HWM and BPM were optimized using simulations. Their performance was evaluated based on simulations and 21 experimental datasets, considering their rate of agreement, spike offset, and spike offset variability to the simulated or experimental spikes.

RESULTS

A range of parameter sets that resulted in the highest possible agreement with simulated spikes was provided. Both methods highly agreed with simulated and experimental spikes, but HWM was a better spike estimation method than BPM because it had a higher agreement, less bias, and less variation (p < 0.001).

CONCLUSIONS

The optimized HWM will be an important contributor to further developing the identification and analysis of MUs using imaging, providing indirect access to the neural drive of the spinal cord to the muscle by the unfused tetanic signals.

Kinematics of individual muscle units in natural contractions measured in vivo using ultrafast ultrasound

OBJECTIVE

The study of human neuromechanical control at the motor unit (MU) level has predominantly focussed on electrical activity and force generation, whilst the link between these, i.e., the muscle deformation, has not been widely studied. To address this gap, we analysed the kinematics of muscle units in natural contractions.

APPROACH

We combined high-density surface electromyography (HDsEMG) and ultrafast ultrasound (US) recordings, at 1000 frames per second, from the tibialis anterior muscle to measure the motion of the muscular tissue caused by individual MU contractions. The MU discharge times were identified online by decomposition of the HDsEMG and provided as biofeedback to 12 subjects who were instructed to keep the MU active at the minimum discharge rate (9.8 ± 4.7 pulses per second; force less than 10% of the maximum). The series of discharge times were used to identify the velocity maps associated with 51 single muscle unit movements with high spatio-temporal precision, by a novel processing method on the concurrently recorded US images. From the individual MU velocity maps, we estimated the region of movement, the duration of the motion, the contraction time, and the excitation-contraction (E-C) coupling delay.

MAIN RESULTS

Individual muscle unit motions could be reliably identified from the velocity maps in 10 out of 12 subjects. The duration of the motion, total contraction time, and E-C coupling were 17.9 ± 5.3 ms, 56.6 ± 8.4 ms, and 3.8 ± 3.0 ms (n = 390 across 10 participants). The experimental measures also provided the first evidence of muscle unit twisting during voluntary contractions and MU territories with distinct split regions.

SIGNIFICANCE

The proposed method allows for the study of kinematics of individual MU twitches during natural contractions. The described measurements and characterisations open new avenues for the study of neuromechanics in healthy and pathological conditions.

Modelling intra-muscular contraction dynamics using in silico to in vivo domain translation

BACKGROUND

Advances in sports medicine, rehabilitation applications and diagnostics of neuromuscular disorders are based on the analysis of skeletal muscle contractions. Recently, medical imaging techniques have transformed the study of muscle contractions, by allowing identification of individual motor units' activity, within the whole studied muscle. However, appropriate image-based simulation models, which would assist the continued development of these new imaging methods are missing. This is mainly due to a lack of models that describe the complex interaction between tissues within a muscle and its surroundings, e.g., muscle fibres, fascia, vasculature, bone, skin, and subcutaneous fat. Herein, we propose a new approach to overcome this limitation.

METHODS

In this work, we propose to use deep learning to model the authentic intra-muscular skeletal muscle contraction pattern using domain-to-domain translation between in silico (simulated) and in vivo (experimental) image sequences of skeletal muscle contraction dynamics. For this purpose, the 3D cycle generative adversarial network (cycleGAN) models were evaluated on several hyperparameter settings and modifications. The results show that there were large differences between the spatial features of in silico and in vivo data, and that a model could be trained to generate authentic spatio-temporal features similar to those obtained from in vivo experimental data. In addition, we used difference maps between input and output of the trained model generator to study the translated characteristics of in vivo data.

RESULTS

This work provides a model to generate authentic intra-muscular skeletal muscle contraction dynamics that could be used to gain further and much needed physiological and pathological insights and assess and overcome limitations within the newly developed research field of neuromuscular imaging.

Detecting anatomical characteristics of single motor units by combining high density electromyography and ultrafast ultrasound: a simulation study

Muscle force production is the result of a sequence of electromechanical events that translate the neural drive issued to the motor units (MUs) into tensile forces on the tendon. Current technology allows this phenomenon to be investigated non-invasively. Single MU excitation and its mechanical response can be studied through high-density surface electromyography (HDsEMG) and ultrafast ultrasound (US) imaging respectively. In this study, we propose a method to integrate these two techniques to identify anatomical characteristics of single MUs. Specifically, we tested two algorithms, combining the tissue velocity sequence (TVS, obtained from ultrafast US images), and the MU firings (extracted from HDsEMG decomposition). The first is the Spike Triggered Averaging (STA) of the TVS based on the occurrences of individual MU firings, while the second relies on the correlation between the MU firing patterns and the TVS spatio-temporal independent components (STICA). A simulation model of the muscle contraction was adapted to test the algorithms at different degrees of neural excitation (number of active MUs) and MU synchronization. The performances of the two algorithms were quantified through the comparison between the simulated and the estimated characteristics of MU territories (size, location). Results show that both approaches are negatively affected by the number of active MU and synchronization levels. However, STICA provides a more robust MU territory estimation, outperforming STA in all the tested conditions. Our results suggest that spatio-temporal independent component decomposition of TVS is a suitable approach for anatomical and mechanical characterization of single MUs using a combined HDsEMG and ultrafast US approach.

Physical and electrophysiological motor unit characteristics are revealed with simultaneous high-density electromyography and ultrafast ultrasound imaging

Electromyography and ultrasonography provide complementary information about electrophysiological and physical (i.e. anatomical and mechanical) muscle properties. In this study, we propose a method to assess the electrical and physical properties of single motor units (MUs) by combining High-Density surface Electromyography (HDsEMG) and ultrafast ultrasonography (US). Individual MU firings extracted from HDsEMG were used to identify the corresponding region of muscle tissue displacement in US videos. The time evolution of the tissue velocity in the identified region was regarded as the MU tissue displacement velocity. The method was tested in simulated conditions and applied to experimental signals to study the local association between the amplitude distribution of single MU action potentials and the identified displacement area. We were able to identify the location of simulated MUs in the muscle cross-section within a 2 mm error and to reconstruct the simulated MU displacement velocity (cc > 0.85). Multiple regression analysis of 180 experimental MUs detected during isometric contractions of the biceps brachii revealed a significant association between the identified location of MU displacement areas and the centroid of the EMG amplitude distribution. The proposed approach has the potential to enable non-invasive assessment of the electrical, anatomical, and mechanical properties of single MUs in voluntary contractions.

Acousto-elasticity of transversely isotropic incompressible soft tissues: characterization of skeletal striated muscle

Using shear wave elastography, we measure the changes in the wave speed with the stress produced by a striated muscle during isometric voluntary contraction. To isolate the behaviour of an individual muscle from complementary or antagonistic actions of adjacent muscles, we select theflexor digiti minimimuscle, whose sole function is to extend the little finger. To link the wave speed to the stiffness, we develop an acousto-elastic theory for shear waves in homogeneous, transversely isotropic, incompressible solids subject to an uniaxial stress. We then provide measurements of the apparent shear elastic modulus along, and transversely to, the fibre axis for six healthy human volunteers of different age and sex. The results display a great variety across the six subjects. We find that the slope of the apparent shear elastic modulus along the fibre direction changes inversely to the maximum voluntary contraction (MVC) produced by the volunteer. We propose an interpretation of our results by introducing the S (slow) or F (fast) nature of the fibres, which harden the muscle differently and accordingly, produce different MVCs. A natural follow-up on this study is to apply the method to patients with musculoskeletal disorders or neurodegenerative diseases.

MRI and muscle imaging for idiopathic inflammatory myopathies

Although idiopathic inflammatory myopathies (IIM) are a heterogeneous group of diseases nearly all patients display muscle inflammation. Originally, muscle biopsy was considered as the gold standard for IIM diagnosis. The development of muscle imaging led to revisiting not only the IIM diagnosis strategy but also the patients' follow-up. Different techniques have been tested or are in development for IIM including positron emission tomography, ultrasound imaging, ultrasound shear wave elastography, though magnetic resonance imaging (MRI) remains the most widely used technique in routine. Whereas guidelines on muscle imaging in myositis are lacking here we reviewed the relevance of muscle imaging for both diagnosis and myositis patients' follow-up. We propose recommendations about when and how to perform MRI on myositis patients, and we describe new techniques that are under development.

Assessment of muscle activity using electrical stimulation and mechanomyography: a systematic review

This research has proved that mechanomyographic (MMG) signals can be used for evaluating muscle performance. Stimulation of the lost physiological functions of a muscle using an electrical signal has been determined crucial in clinical and experimental settings in which voluntary contraction fails in stimulating specific muscles. Previous studies have already indicated that characterizing contractile properties of muscles using MMG through neuromuscular electrical stimulation (NMES) showed excellent reliability. Thus, this review highlights the use of MMG signals on evaluating skeletal muscles under electrical stimulation. In total, 336 original articles were identified from the Scopus and SpringerLink electronic databases using search keywords for studies published between 2000 and 2020, and their eligibility for inclusion in this review has been screened using various inclusion criteria. After screening, 62 studies remained for analysis, with two additional articles from the bibliography, were categorized into the following: (1) fatigue, (2) torque, (3) force, (4) stiffness, (5) electrode development, (6) reliability of MMG and NMES approaches, and (7) validation of these techniques in clinical monitoring. This review has found that MMG through NMES provides feature factors for muscle activity assessment, highlighting standardized electromyostimulation and MMG parameters from different experimental protocols. Despite the evidence of mathematical computations in quantifying MMG along with NMES, the requirement of the processing speed, and fluctuation of MMG signals influence the technique to be prone to errors. Interestingly, although this review does not focus on machine learning, there are only few studies that have adopted it as an alternative to statistical analysis in the assessment of muscle fatigue, torque, and force. The results confirm the need for further investigation on the use of sophisticated computations of features of MMG signals from electrically stimulated muscles in muscle function assessment and assistive technology such as prosthetics control.

Identification of single motor units in skeletal muscle under low force isometric voluntary contractions using ultrafast ultrasound

The central nervous system (CNS) controls skeletal muscles by the recruitment of motor units (MUs). Understanding MU function is critical in the diagnosis of neuromuscular diseases, exercise physiology and sports, and rehabilitation medicine. Recording and analyzing the MUs’ electrical depolarization is the basis for state-of-the-art methods. Ultrafast ultrasound is a method that has the potential to study MUs because of the electrical depolarizations and consequent mechanical twitches. In this study, we evaluate if single MUs and their mechanical twitches can be identified using ultrafast ultrasound imaging of voluntary contractions. We compared decomposed spatio-temporal components of ultrasound image sequences against the gold standard needle electromyography. We found that 31% of the MUs could be successfully located and their firing pattern extracted. This method allows new non-invasive opportunities to study mechanical properties of MUs and the CNS control in neuromuscular physiology.

Ultrafast ultrasound coupled with cervical magnetic stimulation for non-invasive and non-volitional assessment of diaphragm contractility

KEY POINTS

Twitch transdiaphragmatic pressure elicited by cervical magnetic stimulation of the phrenic nerves is a fully non-volitional method for assessing diaphragm contractility in humans, yet it requires invasive procedures such as oesophageal and gastric catheter balloons.  Ultrafast ultrasound enables a very high frame rate allowing the capture of transient events, such as muscle contraction elicited by nerve stimulation (twitch). Whether indices derived from ultrafast ultrasound can be used as an alternative to the invasive measurement of twitch transdiaphragmatic pressure is unknown.  Our findings demonstrate that maximal diaphragm tissue velocity assessed using ultrafast ultrasound following cervical magnetic stimulation is reliable, sensitive to change in cervical magnetic stimulation intensity, and correlates to twitch transdiaphragmatic pressure.  This approach provides a novel fully non-invasive and non-volitional tool for the assessment of diaphragm contractility in humans.

ABSTRACT

Measuring twitch transdiaphragmatic pressure (P_di,tw ) elicited by cervical magnetic stimulation (CMS) is considered as a reference method for the standardized evaluation of diaphragm function. Yet, the measurement of P_di requires invasive oesophageal and gastric catheter-balloons. Ultrafast ultrasound is a non-invasive imaging technique enabling frame rates high enough to capture transient events such as evoked muscle contractions. This study investigated relationships between indices derived from ultrafast ultrasound and P_di,tw , and how these indices might be used to estimate P_di,tw . CMS was performed in 13 healthy volunteers from 30% to 100% of maximal stimulator intensity in units of 10% in a randomized order. P_di,tw was measured and the right hemidiaphragm was imaged using a custom ultrafast ultrasound sequence with 1 kHz framerate. Maximal diaphragm axial velocity (V_di ,_max ) and diaphragm thickening fraction (TF_di,tw ) were computed. Intra-session reliability was assessed. Repeated-measures correlation (R) and Spearman correlation coefficients (ρ) were used to assess relationships between variables. Intra-session reliability was strong for P_di,tw and V_di,max and moderate for TF_di,tw . V_di,max correlated with P_di,tw in all subjects (0.64 < ρ < 1.00, R = 0.75; all P < 0.05). TF_di,tw correlated with P_di,tw in eight subjects only (0.85 < ρ < 0.93, R = 0.69; all P < 0.05). Coupling ultrafast ultrasound and CMS shows promise for the non-invasive and fully non-volitional assessment of diaphragm contractility. This approach opens up the prospect of both diagnosis and follow-up of diaphragm contractility in clinical populations.

From Anatomy to Functional and Molecular Biomarker Imaging and Therapy: Ultrasound Is Safe, Ultrafast, Portable, and Inexpensive

Ultrasound is the most widely used medical imaging modality worldwide. It is abundant, extremely safe, portable, and inexpensive. In this review, we consider some of the current development trends for ultrasound imaging, which build upon its current strength and the popularity it experiences among medical imaging professional users.Ultrasound has rapidly expanded beyond traditional radiology departments and cardiology practices. Computing power and data processing capabilities of commonly available electronics put ultrasound systems in a lab coat pocket or on a user's mobile phone. Taking advantage of new contributions and discoveries in ultrasound physics, signal processing algorithms, and electronics, the performance of ultrasound systems and transducers have progressed in terms of them becoming smaller, with higher imaging performance, and having lower cost. Ultrasound operates in real time, now at ultrafast speeds; kilohertz frame rates are already achieved by many systems.Ultrasound has progressed beyond anatomical imaging and monitoring blood flow in large vessels. With clinical approval of ultrasound contrast agents (gas-filled microbubbles) that are administered in the bloodstream, tissue perfusion studies are now routine. Through the use of modern ultrasound pulse sequences, individual microbubbles, with subpicogram mass, can be detected and observed in real time, many centimeters deep in the body. Ultrasound imaging has broken the wavelength barrier; by tracking positions of microbubbles within the vasculature, superresolution imaging has been made possible. Ultrasound can now trace the smallest vessels and capillaries, and obtain blood velocity data in those vessels.Molecular ultrasound imaging has now moved closer to clinic; the use of microbubbles with a specific affinity to endothelial biomarkers allows selective accumulation and retention of ultrasound contrast in the areas of ischemic injury, inflammation, or neoangiogenesis. This will aid in noninvasive molecular imaging and may provide additional help with real-time guidance of biopsy, surgery, and ablation procedures.The ultrasound field can be tightly focused inside the body, many centimeters deep, with millimeter precision, and ablate lesions by energy deposition, with thermal or mechanical bioeffects. Some of such treatments are already in clinical use, with more indications progressing through the clinical trial stage. In conjunction with intravascular microbubbles, focused ultrasound can be used for tissue-specific drug delivery; localized triggered release of sequestered drugs from particles in the bloodstream may take time to get to clinic. A combination of intravascular microbubbles with circulating drug and low-power ultrasound allows transient opening of vascular endothelial barriers, including blood-brain barrier; this approach has reached clinical trial stage. Therefore, the drugs that normally would not be getting to the target tissue in the brain will now have an opportunity to produce therapeutic efficacy.Overall, medical ultrasound is developing at a brisk rate, even in an environment where other imaging modalities are also advancing rapidly and may be considered more lucrative. With all the current advances that we discuss, and many more to come, ultrasound may help solve many problems that modern medicine is facing.

Changes in the Viscoelastic Properties of the Vastus Lateralis Muscle With Fatigue

We investigated the in vivo effects of voluntary fatiguing isometric contractions of the knee extensor muscles on the viscoelastic properties of the vastus lateralis (VL). Twelve young males (29.0 ± 4.5 years) performed an intermittent voluntary fatigue protocol consisting of 6 sets × 10 repetitions of 5-s voluntary maximal isometric contractions with 5-s passive recovery periods between repetitions. Voluntary and evoked torque were assessed before, immediately after, and 20 min after exercise. The shear modulus (μ) of the VL muscle was estimated at rest and during a ramped isometric contraction using a conventional elastography technique. An index of active muscle stiffness was then calculated (slope from the relationship between shear modulus and absolute torque). Resting muscle viscosity (η) was quantified using a shear-wave spectroscopy sequence to measure the shear-wave dispersion. Voluntary and evoked torque decreased by ∼37% (P < 0.01) immediately after exercise. The resting VL μ was lower at the end of the fatigue protocol (-57.9 ± 5.4%, P < 0.001), whereas the resting VL η increased (179.0 ± 123%, P < 0.01). The active muscle stiffness index also decreased with fatigue (P < 0.05). By 20 min post-fatigue, there were no significant differences from the pre-exercise values for VL η and the active muscle stiffness index, contrary to the resting VL μ. We show that the VL μ is greatly reduced and η greatly enhanced by fatigue, reflecting a more compliant and viscous muscle. The quantification of both shear μ and η moduli in vivo may contribute to a better understanding of the mechanical behavior of muscles during fatigue in sports medicine, as well as in clinical situations.

Shear wave sonoelastography of skeletal muscle: basic principles, biomechanical concepts, clinical applications, and future perspectives

Imaging plays an important role in the diagnosis and therapeutic response evaluation of muscular diseases. However, one important limitation is its incapacity to assess the in vivo biomechanical properties of the muscles. The emerging shear wave sonoelastography technique offers a quantifiable spatial representation of the viscoelastic characteristics of skeletal muscle. Elastography is a non-invasive tool used to analyze the physiologic and biomechanical properties of muscles in healthy and pathologic conditions. However, radiologists need to familiarize themselves with the muscular biomechanical concepts and technical challenges of shear wave elastography. This review introduces the basic principles of muscle shear wave elastography, analyzes the factors that can influence measurements and provides an overview of its potential clinical applications in the field of muscular diseases.

Precontractile optical response during excitation-contraction in human muscle revealed by non-invasive high-speed spatiotemporal NIR measurement

During muscle contraction the excitation-contraction process mediates the neural input and mechanical output. Proper muscle function and body locomotion depends on the status of the elements in the same process. However, non-invasive and in-vivo methods to study this are not available. Here we show the existence of an optical response occurring during the excitation-contraction process in human biceps brachii muscle. We developed a non-invasive instrument from a photodiode array and light emitting diodes to detect spatially propagating (~5 m/s) and precontractile (~6 ms onset) optical signals closely related to the action potential during electrostimulation. Although this phenomenon was observed 60 years ago on isolated frog muscle cells in the lab, it has not been shown in-vivo before now. We anticipate our results to be a starting point for a new category in-vivo studies, characterising alterations in the excitation-contraction process in patients with neuromuscular disease and to monitor effects of therapy.

Comparison of calf muscle architecture between Asian children with spastic cerebral palsy and typically developing peers

OBJECTIVE

To compare the muscle thickness, fascicle length, and pennation angle of the gastrocnemius, soleus, and tibialis anterior between Asian children with spastic cerebral palsy (CP) and typically developing (TD) peers.

METHODS

This cross-sectional study involved a total of 72 children with hemiplegic CP (n = 24), and diplegic CP (n = 24) and their TD peers (n = 24). Muscle architecture was measured at rest using ultrasound. Clinical measures included gross motor function and a modified Ashworth scale.

RESULTS

The thicknesses of the tibialis anterior and medial gastrocnemius muscles were smaller in the affected calf of children with CP (p<0.05) than in those of their TD peers. Additionally, the lengths of the lateral gastrocnemius and soleus fascicle were shorter (p<0.05) in children with diplegic CP than in their TD peers. The fascicle length was shorter in the affected calf of children with CP (p<0.05) than in the calves of their TD peers or the unaffected calf of children with hemiplegic CP. However, the length of the lateral gastrocnemius fascicle was similar between the two legs of children with hemiplegic CP. The pennation angles of the medial gastrocnemius and soleus muscles were larger (p<0.05) in the affected calf in children with hemiplegic CP than in the calves of their TD peers. The fascicle length of the lateral gastrocnemius and the thickness of the soleus muscle were positively correlated with gross motor function scores in children with CP (p<0.05).

CONCLUSIONS

Muscle thickness and fascicle length were lower in the affected tibialis anterior, gastrocnemius, and soleus in children with spastic CP. These changes may limit the ability to stand and walk, and indicate a need to strengthen the affected muscle.

Noninvasive measurement of wave speed of porcine cornea in ex vivo porcine eyes for various intraocular pressures

The objective of this study was to extend an ultrasound surface wave elastography (USWE) technique for noninvasive measurement of ocular tissue elastic properties. In particular, we aim to establish the relationship between the wave speed of cornea and the intraocular pressure (IOP). Normal ranges of IOP are between 12 and 22mmHg. Ex vivo porcine eye balls were used in this research. The porcine eye ball was supported by the gelatin phantom in a testing container. Some water was pour into the container for the ultrasound measurement. A local harmonic vibration was generated on the side of the eye ball. An ultrasound probe was used to measure the wave propagation in the cornea noninvasively. A 25 gauge butterfly needle was inserted into the vitreous humor of the eye ball under the ultrasound imaging guidance. The needle was connected to a syringe. The IOP was obtained by the water height difference between the water level in the syringe and the water level in the testing container. The IOP was adjusted between 5mmHg and 30mmHg with a 5mmHg interval. The wave speed was measured at each IOP for three frequencies of 100, 150 and 200Hz. Finite element method (FEM) was used to simulate the wave propagation in the corneal according to our experimental setup. A linear viscoelastic FEM model was used to compare the experimental data. Both the experiments and the FEM analyses showed that the wave speed of cornea increased with IOP.

Ultrasound Imaging of Muscle Contraction of the Tibialis Anterior in Patients with Facioscapulohumeral Dystrophy

A need exists for biomarkers to diagnose, quantify and longitudinally follow facioscapulohumeral muscular dystrophy (FSHD) and many other neuromuscular disorders. Furthermore, the pathophysiological mechanisms leading to muscle weakness in most neuromuscular disorders are not completely understood. Dynamic ultrasound imaging (B-mode image sequences) in combination with speckle tracking is an easy, applicable and patient-friendly imaging tool to visualize and quantify muscle deformation. This dynamic information provides insight in the pathophysiological mechanisms and may help to distinguish the various stages of diseased muscle in FSHD. In this proof-of-principle study, we applied a speckle tracking technique to 2-D ultrasound image sequences to quantify the deformation of the tibialis anterior muscle in patients with FSHD and in healthy controls. The resulting deformation patterns were compared with muscle ultrasound echo intensity analysis (a measure of fat infiltration and dystrophy) and clinical outcome measures. Of the four FSHD patients, two patients had severe peroneal weakness and two patients had mild peroneal weakness on clinical examination. We found a markedly varied muscle deformation pattern between these groups: patients with severe peroneal weakness showed a different motion pattern of the tibialis anterior, with overall less displacement of the central tendon region, while healthy patients showed a non-uniform displacement pattern, with the central aponeurosis showing the largest displacement. Hence, dynamic muscle ultrasound of the tibialis anterior muscle in patients with FSHD revealed a distinctively different tissue deformation pattern among persons with and without tibialis anterior weakness. These findings could clarify the understanding of the pathophysiology of muscle weakness in FSHD patients. In addition, the change in muscle deformation shows good correlation with clinical measures and quantitative muscle ultrasound measurements. In conclusion, dynamic ultrasound in combination with speckle tracking allows the study of the effects of muscle pathology in relation to strength, force transmission and movement generation. Although further research is required, this technique can develop into a biomarker to quantify muscle disease severity.

Semianalytical Solution for the Deformation of an Elastic Layer under an Axisymmetrically Distributed Power-Form Load: Application to Fluid-Jet-Induced Indentation of Biological Soft Tissues

Fluid-jet-based indentation is used as a noncontact excitation technique by systems measuring the mechanical properties of soft tissues. However, the application of these devices has been hindered by the lack of theoretical solutions. This study developed a mathematical model for testing the indentation induced by a fluid jet and determined a semianalytical solution. The soft tissue was modeled as an elastic layer bonded to a rigid base. The pressure of the fluid jet impinging on the soft tissue was assumed to have a power-form function. The semianalytical solution was verified in detail using finite-element modeling, with excellent agreement being achieved. The effects of several parameters on the solution behaviors are reported, and a method for applying the solution to determine the mechanical properties of soft tissues is suggested.

Wideband 2-D Array Design Optimization With Fabrication Constraints for 3-D US Imaging

Ultrasound (US) 2-D arrays are of increasing interest due to their electronic steering capability to investigate 3-D regions without requiring any probe movement. These arrays are typically populated by thousands of elements that, ideally, should be individually driven by the companion scanner. Since this is not convenient, the so-called microbeamforming methods, yielding a prebeamforming stage performed in the probe handle by suitable custom integrated circuits, have so far been implemented in a few commercial high-end scanners. A possible approach to implement relatively cheap and efficient 3-D US imaging systems is using 2-D sparse arrays in which a limited number of elements can be coupled to an equal number of independent transmit/receive channels. In order to obtain US beams with adequate characteristics all over the investigated volume, the layout of such arrays must be carefully designed. This paper provides guidelines to design, by using simulated annealing optimization, 2-D sparse arrays capable of fitting specific applications or fabrication/implementation constraints. In particular, an original energy function based on multidepth 3-D analysis of the beam pattern is also exploited. A tutorial example is given, addressed to find the N _e elements that should be activated in a 2-D fully populated array to yield efficient acoustic radiating performance over the entire volume. The proposed method is applied to a 32 ×32 array centered at 3 MHz to select the 128, 192, and 256 elements that provide the best acoustic performance. It is shown that the 256-element optimized array yields sidelobe levels even lower (by 5.7 dB) than that of the reference 716-element circular and (by 10.3 dB) than that of the reference 1024-element array.

2-D Ultrasound Sparse Arrays Multidepth Radiation Optimization Using Simulated Annealing and Spiral-Array Inspired Energy Functions

Full matrix arrays are excellent tools for 3-D ultrasound imaging, but the required number of active elements is too high to be individually controlled by an equal number of scanner channels. The number of active elements is significantly reduced by the sparse array techniques, but the position of the remaining elements must be carefully optimized. This issue is faced here by introducing novel energy functions in the simulated annealing (SA) algorithm. At each iteration step of the optimization process, one element is freely translated and the associated radiated pattern is simulated. To control the pressure field behavior at multiple depths, three energy functions inspired by the pressure field radiated by a Blackman-tapered spiral array are introduced. Such energy functions aim at limiting the main lobe width while lowering the side lobe and grating lobe levels at multiple depths. Numerical optimization results illustrate the influence of the number of iterations, pressure measurement points, and depths, as well as the influence of the energy function definition on the optimized layout. It is also shown that performance close to or even better than the one provided by a spiral array, here assumed as reference, may be obtained. The finite-time convergence properties of SA allow the duration of the optimization process to be set in advance.

In vivo maximal fascicle-shortening velocity during plantar flexion in humans

Interindividual variability in performance of fast movements is commonly explained by a difference in maximal muscle-shortening velocity due to differences in the proportion of fast-twitch fibers. To provide a better understanding of the capacity to generate fast motion, this study aimed to 1) measure for the first time in vivo the maximal fascicle-shortening velocity of human muscle; 2) evaluate the relationship between angular velocity and fascicle-shortening velocity from low to maximal angular velocities; and 3) investigate the influence of musculo-articular features (moment arm, tendinous tissues stiffness, and muscle architecture) on maximal angular velocity. Ultrafast ultrasound images of the gastrocnemius medialis were obtained from 31 participants during maximal isokinetic and light-loaded plantar flexions. A strong linear relationship between fascicle-shortening velocity and angular velocity was reported for all subjects (mean R2 = 0.97). The maximal shortening velocity (VFmax) obtained during the no-load condition (NLc) ranged between 18.8 and 43.3 cm/s. VFmax values were very close to those of the maximal shortening velocity (Vmax), which was extrapolated from the F-V curve (the Hill model). Angular velocity reached during the NLc was significantly correlated with this VFmax ( r = 0.57; P < 0.001). This finding was in agreement with assumptions about the role of muscle fiber type, whereas interindividual comparisons clearly support the fact that other parameters may also contribute to performance during fast movements. Nevertheless, none of the biomechanical features considered in the present study were found to be directly related to the highest angular velocity, highlighting the complexity of the upstream mechanics that lead to maximal-velocity muscle contraction.

Quantification of elasticity changes in the myometrium during labor using Supersonic Shear Imaging: a feasibility study

Very little is known about the myometrium's physiology in terms of its elasticity but shear wave elastography could be an efficient tool to better understand it. This could considerably help the prevention of difficult births, the consequences of which are tremendous for neonate morbidity and pathologies. The purpose of this paper is to show the feasibility of the in vivo monitoring of myometrial stiffness changes in contraction and relaxation during pregnancy. In this study, Supersonic Shear Wave Imaging, a real-time and quantitative imaging technique that has been proven efficient for the investigation of tissue elasticity, was used to quantify the uterus shear-wave speed and stiffness in 6 patients, through the abdomen, using an 8-MHz linear ultrasound probe. Changes in shear wave speed were tracked in real time during the uterine contraction and were well correlated with the uterine pressure, which is currently considered to be a gold standard. These results open a new way to better understand the myometrium contraction during labour.

Detection of the electromechanical delay and its components during voluntary isometric contraction of the quadriceps femoris muscle

Electromechanical delay (EMD) was described as a time elapsed between first trigger and force output. Various results have been reported based on the measurement method with observed inconsistent results when the trigger is elicited by voluntary contraction. However, mechanomyographic (MMG) sensor placed far away on the skin from the contracting muscle was used to detect muscle fiber motion and excitation-contraction (EC) coupling which may give unreliable results. On this basis, the purpose of this study was to detect EMD during active muscle contraction whilst introducing an ultrafast ultrasound (US) method to detect muscle fiber motion from a certain depth of the muscle. Time delays between onsets of EMG-MMG, EMG-US, MMG-FORCE, US-FORCE, and EMG-FORCE were calculated as 20.5 ± 4.73, 28.63 ± 6.31, 19.21 ± 6.79, 30.52 ± 8.85, and 49.73 ± 6.99 ms, respectively. Intrarater correlation coefficient (ICC) was higher than MMG when ultrafast US was used for detecton of the Δt EMG-US and Δt US-FORCE, ICC values of 0.75 and 0.70, respectively. Synchronization of the ultrafast ultrasound with EMG and FORCE sensors can reveal reliable and clinically useful results related to the EMD and its components when muscle is voluntarily contracted. With ultrafast US, we detect onset from the certain depth of the muscle excluding the tissues above the muscle acting as a low-pass filter which can lead to inaccurate time detection about the onset of the contracting muscle fibers. With this non-invasive technique, understanding of the muscle dynamics can be facilitated.

Interaction between gastrocnemius medialis fascicle and Achilles tendon compliance: a new insight on the quick-release method

The insufficient temporal resolution of imaging devices has made the analysis of very fast movements, such as those required to measure active muscle-tendon unit stiffness, difficult. Thus the relative contributions of tendon, aponeurosis, and fascicle to muscle-tendon unit compliance remain to be determined. The present study analyzed the dynamic interactions of fascicle, tendon, and aponeurosis in human gastrocnemius medialis during the first milliseconds of an ankle quick-release movement, using high-frame-rate ultrasonography (2,000 frames/s). Nine subjects performed the tests in random order at six levels of maximal voluntary contraction (MVC) (30% to 80% of MVC). These tests were carried out with the ultrasound probe placed on the muscle belly and on the myotendinous junction. Tendon, muscle fascicle, and aponeurosis length changes were quantified in relation to shortening of the muscle-tendon unit during the first few milliseconds following the release. The tendon was the main contributor (around 72%) to the shortening of the muscle-tendon unit, whereas the muscle fascicle and aponeurosis contributions were 18% and 10%, respectively. Because these structures can be considered in series, the quantified contributions can be regarded as relative contributions to muscle-tendon compliance. These contributions were not modified with the level of MVC or the time range used for the analysis between 10 and 25 ms. The constant contribution of tendon, muscle fascicle, and aponeurosis to muscle-tendon unit compliance may help to simplify the mechanism of compliance regulation and to maintain the important role of tendons in enhancing work output and movement efficiency.

Ultrafast imaging in biomedical ultrasound

Although the use of ultrasonic plane-wave transmissions rather than line-per-line focused beam transmissions has been long studied in research, clinical application of this technology was only recently made possible through developments in graphical processing unit (GPU)-based platforms. Far beyond a technological breakthrough, the use of plane or diverging wave transmissions enables attainment of ultrafast frame rates (typically faster than 1000 frames per second) over a large field of view. This concept has also inspired the emergence of completely novel imaging modes which are valuable for ultrasound-based screening, diagnosis, and therapeutic monitoring. In this review article, we present the basic principles and implementation of ultrafast imaging. In particular, present and future applications of ultrafast imaging in biomedical ultrasound are illustrated and discussed.

Shortening behavior of the different components of muscle-tendon unit during isokinetic plantar flexions

The torque-velocity relationship has been widely considered as reflecting the mechanical properties of the contractile apparatus, and the influence of tendinous tissues on this relationship obtained during in vivo experiments remains to be determined. This study describes the pattern of shortening of various muscle-tendon unit elements of the triceps surae at different constant angular velocities and quantifies the contributions of fascicles, tendon, and aponeurosis to the global muscle-tendon unit shortening. Ten subjects performed isokinetic plantar flexions at different preset angular velocities (i.e., 30, 90, 150, 210, 270, and 330°/s). Ultrafast ultrasound measurements were performed on the muscle belly and on the myotendinous junction of the medial and lateral gastrocnemius muscles. The contributions of fascicles, tendon, and aponeurosis to global muscle-tendon unit shortening velocity were calculated for velocity conditions for four parts of the total range of motion. For both muscles, the fascicles' contribution decreased throughout the motion (73.5 ± 21.5% for 100–90° angular range to 33.7 ± 20.2% for 80–70°), whereas the tendon contribution increased (25.8 ± 15.4 to 55.6 ± 16.8%). In conclusion, the tendon contribution to the global muscle-tendon unit shortening is significant even during a concentric contraction. However, this contribution depends on the range of motion analyzed. The intersubject variability found in the maximal fascicle shortening velocity, for a given angular velocity, suggests that some subjects might possess a more efficient musculoarticular complex to produce the movement velocity. These findings are of great interest for understanding the ability of muscle-tendon shortening velocity.

A novel system of electrodes transparent to ultrasound for simultaneous detection of myoelectric activity and B-mode ultrasound images of skeletal muscles

Application of two-dimensional surface electrode arrays can provide a means of mapping motor unit action potentials on the skin surface above a muscle. The resulting muscle tissue displacement can be quantified, in a single plane, using ultrasound (US) imaging. Currently, however, it is not possible to simultaneously map spatio-temporal propagation of activation and resulting tissue strain. In this paper, we developed and tested a material that will enable concurrent measurement of two-dimensional surface electromyograms (EMGs) with US images. Specific protocols were designed to test the compatibility of this new electrode material, both with EMG recording and with US analysis. Key results indicate that, for this new electrode material, 1) the electrode-skin impedance is similar to that of arrays of electrodes reported in literature; 2) the reflection of US at the electrode-skin interface is negligible; 3) the likelihood of observing missing contacts, short-circuits, and artifacts in EMGs is not affected by the US probe; 4) movement of tissues sampled by US can be tracked accurately. We, therefore, conclude this approach will facilitate multimodal imaging of muscle to provide new spatio-temporal information regarding electromechanical function of muscle. This is relevant to basic physiology-biomechanics of active and passive force transmission through and between muscles, of motor unit spatio-temporal activity patterns, of their variation with architecture and task-related function, and of their adaptation with aging, training-exercise-disuse, neurological disease, and injury.

Length and activation dependent variations in muscle shear wave speed

Muscle stiffness is known to vary as a result of a variety of disease states, yet current clinical methods for quantifying muscle stiffness have limitations including cost and availability. We investigated the capability of shear wave elastography (SWE) to measure variations in gastrocnemius shear wave speed induced via active contraction and passive stretch. Ten healthy young adults were tested. Shear wave speeds were measured using a SWE transducer positioned over the medial gastrocnemius at ankle angles ranging from maximum dorsiflexion to maximum plantarflexion. Shear wave speeds were also measured during voluntary plantarflexor contractions at a fixed ankle angle. Average shear wave speed increased significantly from 2.6 to 5.6 m s(-1) with passive dorsiflexion and the knee in an extended posture, but did not vary with dorsiflexion when the gastrocnemius was shortened in a flexed knee posture. During active contractions, shear wave speed monotonically varied with the net ankle moment generated, reaching 8.3 m s(-1) in the maximally contracted condition. There was a linear correlation between shear wave speed and net ankle moment in both the active and passive conditions; however, the slope of this linear relationship was significantly steeper for the data collected during passive loading conditions. The results show that SWE is a promising approach for quantitatively assessing changes in mechanical muscle loading. However, the differential effect of active and passive loading on shear wave speed makes it important to carefully consider the relevant loading conditions in which to use SWE to characterize in vivo muscle properties.

Acoustic radiation force elasticity imaging in diagnostic ultrasound

The development of ultrasound-based elasticity imaging methods has been the focus of intense research activity since the mid-1990s. In characterizing the mechanical properties of soft tissues, these techniques image an entirely new subset of tissue properties that cannot be derived with conventional ultrasound techniques. Clinically, tissue elasticity is known to be associated with pathological condition and with the ability to image these features in vivo; elasticity imaging methods may prove to be invaluable tools for the diagnosis and/or monitoring of disease. This review focuses on ultrasound-based elasticity imaging methods that generate an acoustic radiation force to induce tissue displacements. These methods can be performed noninvasively during routine exams to provide either qualitative or quantitative metrics of tissue elasticity. A brief overview of soft tissue mechanics relevant to elasticity imaging is provided, including a derivation of acoustic radiation force, and an overview of the various acoustic radiation force elasticity imaging methods.

Reliability and validity of ultrasound measurements of muscle fascicle length and pennation in humans: a systematic review

Ultrasound imaging is widely used to measure architectural features of human skeletal muscles in vivo. We systematically reviewed studies of the reliability and validity of two-dimensional ultrasound measurement of muscle fascicle lengths or pennation angles in human skeletal muscles. A comprehensive search was conducted in June 2011. Thirty-six reliability studies and six validity studies met the inclusion criteria. Data from these studies indicate that ultrasound measurements of muscle fascicle lengths are reliable across a broad range of experimental conditions [intraclass correlation coefficient (ICC) and r values were always > 0.6, and coefficient of variation values were always < 10%]. The reliability of measurements of pennation angles is broadly similar (ICC and r values were always > 0.5 and coefficient of variation values were always < 14%). Data on validity are less extensive and probably less robust, but suggest that measurement of fascicle lengths and pennation angles are accurate (ICC > 0.7) under certain conditions, such as when large limb muscles are imaged in a relaxed state and the limb or joint remains stationary. Future studies on validity should consider ways to test for the validity of two-dimensional ultrasound imaging in contracted or moving muscles and the best method of probe alignment.

Impact of the defect size, the mesh overlap and the fixation depth on ventral hernia repairs: a combined experimental and numerical approach

BACKGROUND

Ventral hernia repairs (VHRs) still exhibit clinical complications in terms of recurrence, pain, and discomfort. Factors such as surgical technique or mesh features are thought to be highly influent. The aim was to evaluate the impact of the defect size, the mesh overlap and the fixation depth on VHR using both physical and numerical models.

METHODS

The physical model was developed to mimic a passive abdominal wall. Healthy, damaged, and repaired configurations were evaluated using a spherical plunger. The associated numerical (Finite Elements) model was first loaded by a plunger for validation. A parametric study was then conducted with the numerical model loaded by a uniform pressure. Two defect sizes (3.5 × 5 cm and 8.25 × 12 cm elliptic shape), two overlaps (2 and 5 cm), and two fixation depths (peritoneum or muscle) were investigated for both passive and active abdominal walls.

RESULTS

With the physical model, the repaired configuration was 22 % stiffer than the damaged configuration. The statistical analysis of the parametric study showed that the defect size was the most influential parameter regarding the stress in the mesh, the bulging and the pull-out force at the fixation points. The overlap was influential in terms of stress in the mesh. The fixation depth was not influential. These trends increased with the abdominal wall activity.

CONCLUSION

Increase of the defect size and decrease of the overlap affected significantly the VHR mechanical performances. Such numerical models could help to better understand the behavior of the repaired abdominal wall and finally to reduce the clinical complications.

Surface wave measurements using a single continuously scanning laser Doppler vibrometer: application to elastography

A continuous scanning laser Doppler vibrometry (CSLDV) obtained sweeping a single laser beam along a periodic scan pattern allows measuring surface vibrations at many points simultaneously by demultiplexing the CSLDV signal. This known method fundamentally differs from conventional scanning laser vibrometry techniques in which the laser beam is kept at a fixed point during each measurement and then moved to a new position prior to the next measurement. This article demonstrates the use of a CSLDV for measuring in a non-contact fashion the velocity of low-frequency surface waves (f < 100 Hz) propagating over soft materials, namely here gel surfaces-mimicking human body soft tissues-and skeletal muscles, to develop an affordable and noninvasive elastography modality. The CSLDV vibration measurements obtained with a single laser beam, linearly scanned over the test surface at 200 Hz over lengths up to 6 cm, were validated using an array of three fixed laser Doppler vibrometers distributed along the same scan line. Furthermore, this CSLDV setup was used to measure the increase in surface wave velocity over the biceps brachii muscle which was directly correlated to the actual stiffening of the biceps occurring while a subject was performing voluntary contractions at an increasing level.

Imaging two-dimensional mechanical waves of skeletal muscle contraction

Skeletal muscle contraction is related to rapid mechanical shortening and thickening. Recently, specialized ultrasound systems have been applied to demonstrate and quantify transient tissue velocities and one-dimensional (1-D) propagation of mechanical waves during muscle contraction. Such waves could potentially provide novel information on musculoskeletal characteristics, function and disorders. In this work, we demonstrate two-dimensional (2-D) mechanical wave imaging following the skeletal muscle contraction. B-mode image acquisition during multiple consecutive electrostimulations, speckle-tracking and a time-stamp sorting protocol were used to obtain 1.4 kHz frame rate 2-D tissue velocity imaging of the biceps brachii muscle contraction. The results present novel information on tissue velocity profiles and mechanical wave propagation. In particular, counter-propagating compressional and shear waves in the longitudinal direction were observed in the contracting tissue (speed 2.8-4.4 m/s) and a compressional wave in the transverse direction of the non-contracting muscle tissue (1.2-1.9 m/s). In conclusion, analysing transient 2-D tissue velocity allows simultaneous assessment of both active and passive muscle tissue properties.