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Embriano K, Holland M, Corriveau KM, Hofmeister E, McCarthy J. Shear-wave elastography of canine patellar tendons in healthy dogs and the influence of stifle joint angle. Vet Radiol Ultrasound 2024. [PMID: 39360389 DOI: 10.1111/vru.13447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/29/2024] [Accepted: 09/14/2024] [Indexed: 10/04/2024] Open
Abstract
Elastography is a sonographic modality that measures tissue stiffness, a mechanical property of tissues, and a biomarker for disease. Canine musculoskeletal application to the patellar tendon has been limited to semiqualitative strain elastography. This prospective study aimed to quantitatively evaluate patellar tendon stiffness using shear-wave elastography with a color map superimposed over the tendon, a propagation map for quality control, and measurements at specific regions of interest in 16 clinically normal sedated dogs weighing 25 kg or greater. Tendon stiffness using shear-wave elastography (SWE) was assessed at different stifle angles and in three regions to determine if angle and location affected stiffness. All dogs were screened with general and orthopedic exams, lateral stifle radiographs, and patellar tendon 2D ultrasound. Shear-wave elastography was performed from a long axis at various stifle angles at the proximal, middle, and distal tendon segments. Quality diagnostic SWE results varied significantly with stifle angle, and 150° of extension was the only angle found to be clinically useful based on the ease of obtaining measurable results and a quality control propagation wave. Patellar tendons were primarily stiff with a red color elastogram. The proximal and middle segments, measured at various angles, had a mean SWE velocity of 7.32 ± 0.90 m/s. Tendon stiffness did not differ along tendon length when measured in greater extension. However, stiffness decreased in the middle segment of the tendon at 150° when compared with 120°. This study establishes a quantitative baseline of normal patellar tendon stiffness to compare with pathologic states.
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Affiliation(s)
| | - Merrilee Holland
- Department of Clinical Science, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Kayla M Corriveau
- Department of Clinical Science, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Eric Hofmeister
- Department of Clinical Science, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Jess McCarthy
- Department of Surgical Sciences, University of Wisconsin-Madison College of Veterinary Medicine, Madison, Wisconsin, USA
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Mannina D, Kulkarni A, van der Pol CB, Al Mazroui R, Abdullah P, Joshi S, Alabousi A. Utilization of Texture Analysis in Differentiating Benign and Malignant Breast Masses: Comparison of Grayscale Ultrasound, Shear Wave Elastography, and Radiomic Features. JOURNAL OF BREAST IMAGING 2024; 6:513-519. [PMID: 39027926 DOI: 10.1093/jbi/wbae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Indexed: 07/20/2024]
Abstract
OBJECTIVE This study aims to determine which qualitative and quantitative US features are independently associated with malignancy, including those derived from grayscale imaging morphology, shear wave elastography (SWE), and texture analysis. METHODS This single-center retrospective study was approved by the institutional research ethics board. Consecutive breast US studies performed between January and December 2020 were included. Images were acquired using a Canon Aplio i800 US unit (Canon Medical Systems, Inc., CA) and i18LX5 wideband linear matrix transducer. Grayscale US features, SWE mean, and median elasticity were obtained. Single representative grayscale images were analyzed using dedicated software (LIFEx, version 6.30). First-order and gray-level co-occurrence matrix second-order texture features were extracted. Multivariate logistic regression was performed to assess for predictors of malignancy (STATA v16.1). RESULTS One hundred forty-seven cases with complete SWE data were selected for analysis (mean age 54.3, range 21-92). The following variables were found to be independently associated with malignancy: age (P <.001), family history (P = .013), irregular mass shape (P = .024), and stiffness on SWE (mean SWE ≥40 kPa; P <.001). Remaining variables (including texture features) were not found to be independently associated with malignancy (P >.05). CONCLUSION US texture analysis features were not associated with malignancy independent of other qualitative and quantitative US characteristics currently utilized in clinical practice. This suggests texture analysis may not be warranted when differentiating benign and malignant breast masses on US. In contrast, irregular mass shape on grayscale imaging and increased stiffness on SWE were found to be independent predictors of malignancy.
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Affiliation(s)
- Daniel Mannina
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Ameya Kulkarni
- Department of Radiology, McMaster University, Juravinski Hospital, Hamilton, ON, Canada
| | | | - Reem Al Mazroui
- Department of Radiology, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
| | - Peri Abdullah
- Department of Kinesiology, York University, Toronto, ON, Canada
| | - Sayali Joshi
- Hospital for Sick Children, IMS-University of Toronto, Toronto, ON, Canada
| | - Abdullah Alabousi
- Department of Radiology, McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada
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Yoon D, Eckstein KN, Ruding M, Bayly PV. Structural tuning of anisotropic mechanical properties in 3D-Printed hydrogel lattices. J Mech Behav Biomed Mater 2024; 157:106625. [PMID: 38924921 DOI: 10.1016/j.jmbbm.2024.106625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
We investigated the ability to tune the anisotropic mechanical properties of 3D-printed hydrogel lattices by modifying their geometry (lattice strut diameter, unit cell size, and unit cell scaling factor). Many soft tissues are anisotropic and the ability to mimic natural anisotropy would be valuable for developing tissue-surrogate "phantoms" for elasticity imaging (shear wave elastography or magnetic resonance elastography). Vintile lattices were 3D-printed in polyethylene glycol di-acrylate (PEGDA) using digital light projection printing. Two mechanical benchtop tests, dynamic shear testing and unconfined compression, were used to measure the apparent shear storage moduli (G') and apparent Young's moduli (E) of lattice samples. Increasing the unit cell size from 1.25 mm to 2.00 mm reduced the Young's and shear moduli of the lattices by 91% and 85%, respectively. Decreasing the strut diameter from 300 μm to 200 μm reduced the apparent shear moduli of the lattices by 95%. Increasing the geometric scaling ratio of the lattice unit cells from 1.00 × to 2.00 × increased mechanical anisotropy in shear (by a factor of 3.1) and in compression (by a factor of 2.9). Both simulations and experiments show that the effects of unit cell size and strut diameter are consistent with power law relationships between volume fraction and apparent elastic moduli. In particular, experimental measurements of apparent Young's moduli agree well with predictions of the theoretical Gibson-Ashby model. Thus, the anisotropic mechanical properties of a lattice can be tuned by the unit cell size, the strut diameter, and scaling factors. This approach will be valuable in designing tissue-mimicking hydrogel lattice-based composite materials for elastography phantoms and tissue engineered scaffolds.
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Affiliation(s)
- Daniel Yoon
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, Missouri, USA
| | - Kevin N Eckstein
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, Missouri, USA
| | - Margrethe Ruding
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, Missouri, USA
| | - Philip V Bayly
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, Missouri, USA; Department of Biomedical Engineering, Washington University in St. Louis, Missouri, USA.
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Zhang J, Duan K, Wei J, Zhang W, Zhou H, Sang L, Sun Y, Gong X, Guan H, Yu M. Quantitative diagnosis of early acute compartment syndrome using two-dimensional shear wave elastography in a rabbit model. Ultrasonography 2024; 43:345-353. [PMID: 39112093 PMCID: PMC11374589 DOI: 10.14366/usg.24067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/07/2024] [Indexed: 09/04/2024] Open
Abstract
PURPOSE This study explored the association of the elasticity modulus and shear wave velocity (SWV) of the tibialis anterior muscle, as measured by two-dimensional shear wave elastography (2D-SWE), with the intracompartmental pressure (ICP) determined using the Whitesides method in a New Zealand rabbit model of acute compartment syndrome (ACS). Additionally, it evaluated the viability of 2D-SWE as a noninvasive, quantitative tool for the early detection of ACS. METHODS An ACS model was established through direct external compression by applying pressure bandaging to the lower legs of 15 New Zealand rabbits using neonatal blood pressure cuffs. Another five animals represented a non-modeled control group. To measure the elasticity modulus and SWV of the tibialis anterior muscles, 2D-SWE was employed. Blood oxygen saturation, serum creatine kinase (CK), and myoglobin levels were monitored. Subsequently, the anterior tibial compartment was dissected, and the tibialis anterior was removed for hematoxylin and eosin staining to assess muscle injury. RESULTS The elasticity modulus and SWV of the tibialis anterior muscle increased with compression duration, as did serum CK and myoglobin levels. ICP was strongly positively correlated with these parameters, particularly mean velocity (r=0.942, P<0.001) and CK (r=0.942, P<0.001). Blood oxygen saturation was negatively correlated with ICP (r=-0.887, P<0.001). Histological analysis indicated progressive muscle cell swelling over time, with damage transitioning from reversible to irreversible and culminating in necrosis. CONCLUSION In a rabbit ACS model, ICP was strongly positively correlated with muscle elasticity modulus/SWV. Consequently, 2D-SWE may represent a novel tool for assessing early-phase ACS.
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Affiliation(s)
- Jun Zhang
- Department of Ultrasound, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Kunlong Duan
- Department of Ultrasound, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Junci Wei
- Department of Ultrasound, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Wanfu Zhang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Huihui Zhou
- Department of Ultrasound, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Lin Sang
- Department of Ultrasound, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Yuanyuan Sun
- Department of Ultrasound, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Xue Gong
- Department of Ultrasound, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Hao Guan
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Ming Yu
- Department of Ultrasound, Xijing Hospital, Air Force Medical University, Xi'an, China
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Pelea MA, Serban O, Badarinza M, Gutiu R, Fodor D. Shear-Wave Elastography of the Achilles tendon: reliability analysis and impact of parameters modulating elasticity values. J Ultrasound 2024; 27:559-566. [PMID: 38613661 PMCID: PMC11333681 DOI: 10.1007/s40477-024-00877-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/31/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE Shear wave elastography (SWE) has seen many advancements in Achilles tendon evaluation in recent years, yet standardization of this technique is still problematic due to the lack of knowledge regarding the optimal way to perform the examination. The purpose of this study was to evaluate the effects of ankle position, probe frequency and physical effort on the shear modulus of the Achilles tendon, but also to determine the intra and inter-observer reliability of the technique. METHODS 37 healthy volunteers were included; SWE protocol was performed by two examiners. We analyzed the shear modulus of the tendon with the ankle in neutral, maximum dorsiflexion and maximum plantar flexion using two different high frequency probes. Afterwards, the subjects performed a brief physical exercise and SWE measurements were repeated. RESULTS The L18-5 probe showed the highest ICC values (ICC = 0.798, 95% CI 0.660-0.880, p < 0.001) when positioned at 2 cm from the calcaneal insertion with the ankle in a neutral state. Conversely, utilizing the same L18-5 probe at 1 cm from the insertion during maximum plantar flexion of the ankle resulted in the lowest ICC (ICC = 0.422, 95% CI 0.032-0.655, p = 0.019). Significant variations in elasticity values were noted among different ankle positions and probe types, while no significant changes in elasticity were observed post-physical exercise. CONCLUSION Ankle position and probe frequency are factors that influence elasticity values of the Achilles tendon. An ankle position between 10 and 20 degrees of plantar flexion is the most suitable for SWE evaluation. However, more research focusing on Achilles tendon SWE is essential due to the challenges encountered in standardizing this region.
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Affiliation(s)
- Michael-Andrei Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 2-4 Clinicilor Street, 400006, Cluj-Napoca Napoca, Romania
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 2-4 Clinicilor Street, 400006, Cluj-Napoca Napoca, Romania
| | - Maria Badarinza
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 2-4 Clinicilor Street, 400006, Cluj-Napoca Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 2-4 Clinicilor Street, 400006, Cluj-Napoca Napoca, Romania
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 2-4 Clinicilor Street, 400006, Cluj-Napoca Napoca, Romania.
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Jelen A, Javornik E, Meh SG, Kozinc Ž. The effect of a 5-week therapeutic massage on erector spinae and upper trapezius muscle stiffness as determined by shear-wave elastography: a randomized controlled trial. Front Sports Act Living 2024; 6:1428301. [PMID: 39253625 PMCID: PMC11381258 DOI: 10.3389/fspor.2024.1428301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/13/2024] [Indexed: 09/11/2024] Open
Abstract
Introduction Massage is an effective treatment for reducing pain, swelling, stiffness, and improving muscle mobility. Although self-reported benefits on muscle stiffness and pain are well-known, studies measuring muscle stiffness objectively are scarce. Methods A randomized controlled trial involving 30 recreationally active young women (22.3 ± 0.4 years) was conducted. The participants were randomly assigned to either the control group or the intervention group which received a series of five 30-min whole back therapeutic massage sessions over 5 weeks. Shear wave elastography was used to assess muscle stiffness (erector spinae (ESp) and upper trapezius (UT) muscles) before and after the intervention and at 3-week follow-up. Results For ESp, there was no statistically significant time × group interaction (F = 2.908; p = 0.063). However, there was a statistically significant and large time × group interaction for UT (F = 13.533; p = 0.006; η 2 = 0.19). Post-hoc testing for time indicated that the shear modulus in the intervention group was reduced at follow-up (p = 0.005; d = 1.02), while the difference between baseline and post-intervention measurements were not statistically significant (p = 0.053; d = 0.75). Conclusion In conclusion, massage significantly reduced proximal UT stiffness both 3 days and 3 weeks after the intervention. However, it had no significant effect on the distal part of UT or the ESp muscle.
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Affiliation(s)
- Amadej Jelen
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Erina Javornik
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Sara Gloria Meh
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
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Qiao N, Dumas V, Bergheau A, Ouillon L, Laroche N, Privet-Thieulin C, Perrot JL, Zahouani H. Contactless mechanical stimulation of the skin using shear waves. J Mech Behav Biomed Mater 2024; 156:106597. [PMID: 38810542 DOI: 10.1016/j.jmbbm.2024.106597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/12/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
The skin, the outermost organ of the human body, is vital for sensing and responding to stimuli through mechanotransduction. It is constantly exposed to mechanical stress. Consequently, various mechanical therapies, including compression, massage, and microneedling, have become routine practices for skin healing and regeneration. However, these traditional methods require direct skin contact, restricting their applicability. To address this constraint, we developed shear wave stimulation (SWS), a contactless mechanical stimulation technique. The effectiveness of SWS was compared with that of a commercial compression bioreactor used on reconstructed skin at various stages of maturity. Despite the distinct stimulus conditions applied by the two methods, SWS yielded remarkable outcomes, similar to the effects of the compression bioreactor. It significantly increased the shear modulus of tissue-engineered skin, heightened the density of collagen and elastin fibers, and resulted in an augmentation of fibroblasts in terms of their number and length. Notably, SWS exhibited diverse effects in the low- and high-frequency modes, highlighting the importance of fine-tuning the stimulus intensity. These results unequivocally demonstrated the capability of SWS to enhance the mechanical functions of the skin in vitro, making it a promising option for addressing wound healing and stretch mark recovery.
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Affiliation(s)
- Na Qiao
- Univ Lyon, Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR5513, 69130, Ecully, France.
| | - Virginie Dumas
- Univ Lyon, Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR5513, ENISE, 42023, Saint Etienne, France
| | - Alexandre Bergheau
- Univ Lyon, Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR5513, 69130, Ecully, France
| | - Lucas Ouillon
- Univ Lyon, Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR5513, 69130, Ecully, France
| | - Norbert Laroche
- INSERM U1059-SAINBIOSE, University of Lyon, Jean Monnet University, 42270 Saint Priest en Jarez, France
| | | | - Jean-Luc Perrot
- Département de Dermatologie, Centre Hospitalier Universitaire de Saint-Etienne, 42055, Saint-Etienne, France
| | - Hassan Zahouani
- Univ Lyon, Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR5513, 69130, Ecully, France.
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Haueise A, Le Sant G, Eisele-Metzger A, Dieterich AV. Is musculoskeletal pain associated with increased muscle stiffness? Evidence map and critical appraisal of muscle measurements using shear wave elastography. Clin Physiol Funct Imaging 2024; 44:187-204. [PMID: 38155545 DOI: 10.1111/cpf.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION AND AIMS Approximately 21% of the world's population suffers from musculoskeletal conditions, often associated with sensations of stiff muscles. Targeted therapy requires knowing whether typically involved muscles are objectively stiffer compared to asymptomatic individuals. Muscle stiffness is quantified using ultrasound shear wave elastography (SWE). Publications on SWE-based comparisons of muscle stiffness between individuals with and without musculoskeletal pain are increasing rapidly. This work reviewed and mapped the existing evidence regarding objectively measured muscle stiffness in musculoskeletal pain conditions and surveyed current methods of applying SWE to measure muscle stiffness. METHODS A systematic search was conducted in PubMed and CINAHL using the keywords "muscle stiffness", "shear wave elastography", "pain", "asymptomatic controls" and synonyms. The search was supplemented by a hand search using Google Scholar. Included articles were critically appraised with the AXIS tool, supplemented by items related to SWE methods. Results were visually mapped and narratively described. RESULTS Thirty of 137 identified articles were included. High-quality evidence was missing. The results comprise studies reporting lower stiffness in symptomatic participants, no differences between groups and higher stiffness in symptomatic individuals. Results differed between pain conditions and muscles, and also between studies that examined the same muscle(s) and pathology. The methods of the application of SWE were inconsistent and the reporting was often incomplete. CONCLUSIONS Existing evidence regarding the objective stiffness of muscles in musculoskeletal pain conditions is conflicting. Methodological differences may explain most of the inconsistencies between findings. Methodological standards for SWE measurements of muscles are urgently required.
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Affiliation(s)
- Andreas Haueise
- Faculty of Health, Security, Society, Furtwangen University, Furtwangen, Germany
| | - Guillaume Le Sant
- CHU Nantes, Movement-Interactions-Performance, MIP, Nantes Université, Nantes, France
- School of Physiotherapy, IFM3R, St-Sebastien/Loire, France
| | - Angelika Eisele-Metzger
- Institute for Evidence in Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Angela V Dieterich
- Faculty of Health, Security, Society, Furtwangen University, Furtwangen, Germany
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Chen Q, Li Z, Deng M, Peng J, Zhu X, Zhang C. Quantitative Evaluation of the Lumbar Multifidus Muscle by Shear Wave Dispersion in Healthy Adults: A Preliminary Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:863-872. [PMID: 38240408 DOI: 10.1002/jum.16416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVES To investigate the application value of shear wave dispersion (SWD) in healthy adults with the lumbar multifidus muscle (LMM), to determine the range of normal reference values, and to analyze the influences of factors on the parameter. METHODS Ninety-five healthy volunteers participated in the study, from whom 2-dimensional, shear wave elastography (SWE), and SWD images of the bilateral LMM were acquired in three positions (prone, standing, and anterior flexion). Subcutaneous fat thickness (SFH), SWE velocity, and SWD slope were measured accordingly for analyses. RESULTS The mean SWD slope of the bilateral LMM in the prone position was as follows: left: 14.8 ± 3.1 (m/second)/kHz (female) and 13.0 ± 2.5 (m/second)/kHz (male); right: 14.8 ± 3.7 (m/second)/kHz (female) and 14.2 ± 3.4 (m/second)/kHz (male). In the prone position, there was a weak negative correlation between the bilateral LMM SWD slope of activity level 2 and level 1 (β = -1.5 (2 versus 1, left), -1.9 (2 versus 1, right), all P < .05), and between the left SWD slope of activity level 3 and level 1 (β = -2.3 [3 versus 1, left], P < .05). The correlation between SWE velocity and SWD slope value changed with the position: there was a weak positive correlation in the prone position (r = 0.3 [left], 0.37 [right], both P < .05), and a moderate positive correlation in the standing and anterior flexed positions (r = 0.49-0.74, both P < .001). SFH was moderately negatively correlated with bilateral SWD slope values in the anterior flexion (left: r = -0.4, P = .01; right: r = -0.7, P < .01). CONCLUSIONS SWD imaging can be used as an adjunct tool to aid in the assessment of viscosity in LMM. Further, activity level, and position are influencing factors that should be considered in clinical practice.
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Affiliation(s)
- Qiuxiang Chen
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhenzhou Li
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Meifang Deng
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jiayu Peng
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiangming Zhu
- Department of Ultrasound, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Chaoxue Zhang
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, Hefei, China
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Chowdhary K, Raum G, Visco C. Diagnostic utility of shear wave elastography in musculoskeletal injuries: A narrative review. PM R 2024; 16:384-397. [PMID: 38607311 DOI: 10.1002/pmrj.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 04/13/2024]
Abstract
Shear wave elastography (SWE) is an emerging and promising ultrasound modality, and is more recently employed in the diagnosis of musculoskeletal (MSK) pathologies. SWE evaluates tissue stiffness by measuring the speed of propagating acoustic waves through body tissue structures. Knowing the variations in stiffness of MSK soft tissue can provide helpful diagnostic insight for the evaluation of pathology in muscles, tendons, ligaments, nerves, and other soft tissues. The goal of this review is to synthesize recent literature on the utility of SWE for MSK pathology diagnosis. This review reveals that SWE adds important diagnostic data for the evaluation of several pathologies, such as median mononeuropathy at the wrist, Achilles tendinopathy, and plantar fasciitis. The review also reveals a lack of evidence pertaining to appropriate standardization of use and the connection to reliable and valid diagnostic benefit in the clinical setting.
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Affiliation(s)
- Kuntal Chowdhary
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - George Raum
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christopher Visco
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Alapati R, Bon Nieves A, Wagoner S, Lawrence A, Jones J, Bur AM. Quantitative measurements of radiation-induced fibrosis for head and neck cancer: A narrative review. Laryngoscope Investig Otolaryngol 2024; 9:e1249. [PMID: 38651078 PMCID: PMC11034491 DOI: 10.1002/lio2.1249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/23/2024] [Accepted: 03/30/2024] [Indexed: 04/25/2024] Open
Abstract
Objectives To provide a comprehensive summary of the different modalities available to measure soft tissue fibrosis after radiotherapy in head and neck cancer patients. Data Sources PubMed, Scopus, and Web of Sciences. Review Methods A search was conducted using a list of medical subject headings and terms related to head and neck oncology, radiation fibrosis, and quantitative measurements, including bioimpedance, MRI, and ultrasound. Original research related to quantitative measurement of neck fibrosis post-radiotherapy was included without time constraints, while reviews, case reports, non-English texts, and inaccessible studies were excluded. Discrepancies during the review were resolved by discussing with the senior author until consensus was reached. Results A total of 284 articles were identified and underwent title and abstract screening. Seventeen articles had met our criteria for full-text review based on relevance, of which nine had met our inclusion criteria. Young's modulus (YM) and viscoelasticity measures have demonstrated efficacy in quantifying neck fibrosis, with fibrotic tissues displaying significantly higher YM values and altered viscoelastic properties such as increased stiffness rate-sensitivity and prolonged stress-relaxation post-radiation. Intravoxel incoherent motion offers detailed insights into tissue changes by assessing the diffusion of water molecules and blood perfusion, thereby differentiating fibrosed from healthy tissues. Shear wave elastography has proven to be an effective technique for quantifying radiation-induced fibrosis in the head and neck region by measuring shear wave velocity. Conclusion There are various modalities to measure radiation-induced fibrosis, each with its unique strengths and limitations. Providers should be aware of these implications and decide on methodologies based on their specific clinical workflow. Level of Evidence Step 5.
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Affiliation(s)
- Rahul Alapati
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Antonio Bon Nieves
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Sarah Wagoner
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Amelia Lawrence
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Jill Jones
- Department of RadiologyUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Andrés M. Bur
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
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12
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Fan Y, Zheng H, Feng L, To MKT, Kuang GM, Yeung EHK, Cheung KMC, Liu L, Cheung JPY. Elasticity and cross-sectional thickness of paraspinal muscles in progressive adolescent idiopathic scoliosis. Front Pediatr 2024; 12:1323756. [PMID: 38516354 PMCID: PMC10954774 DOI: 10.3389/fped.2024.1323756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
Objectives (1) Compare the cross-sectional thickness (CST) and shear wave speed (SWS) of paraspinal muscles (PSM) in adolescent idiopathic scoliosis (AIS) with and without curve progression; (2) investigate the relationship between CST/SWS and radiographic characteristics in AIS with curve progression; (3) compare the CST/SWS between AIS and non-scoliosis controls. Methods This cross-sectional study analyzed the CST and SWS of PSM in 48 AIS with mild to moderate curvature and 24 non-scoliosis participants. Participants with scoliosis greater than 45° of Cobb angles were excluded. The Change of Cobb angles within the last 6-months was retrieved to allocate AIS into progression and non-progression groups. The SWS and CST of multifidus; longissimus and iliocostalis of the major curve were measured using B-mode ultrasound image with an elastography mode. Discrepancies of the SWS (SWS-ratio: SWS on the convex side divided by SWS on the concave side) and CST (CST-ratio: CST on the convex side divided by CST on the concave side) at the upper/lower end and apical vertebrae were studied. Results A higher SWS at the apical vertebrae on the concave side of the major curve (multifidus: 3.9 ± 1.0 m/s vs. 3.1 ± 0.6 m/s; p < 0.01, longissimus: 3.3 ± 1.0 m/s vs. 3.0 ± 0.9 m/s; p < 0.01, iliocostalis: 2.8 ± 1.0 m/s vs. 2.5 ± 0.8 m/s; p < 0.01) was observed in AIS with curve progression. A lower SWS-ratio at apical vertebrae was detected with a greater vertebral rotation in participants with curve progression (multifidus [grade II]: 0.7 ± 0.1 vs. grade I: 0.9 ± 0.2; p = 0.03, longissimus [grade II]: 0.8 ± 0.2 vs. grade I: 1.1 ± 0.2; p < 0.01). CST was not different among the progressive, non-progressive AIS and non-scoliosis controls. Conclusions Increased SWS of PSM without change of CST was observed on the concave side of the major curve in participants with progressive AIS.
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Affiliation(s)
- Yunli Fan
- Department of Physiotherapy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Haiping Zheng
- Department of Medical Imaging-Ultrasound Division, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Lin Feng
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Michael K T To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Guan-Ming Kuang
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Eric H K Yeung
- Department of Physiotherapy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Li Liu
- Department of Medical Imaging-Ultrasound Division, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
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13
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Çelik AO, Günay B, Çoker GB, Ustabaşıoğlu FE, Ateş S, Tunçbilek N. Evaluation of placenta in patients with gestational diabetes using shear wave elastography and superb microvascular imaging. Acta Radiol 2024; 65:318-323. [PMID: 38111238 DOI: 10.1177/02841851231217201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a common disease, and the placenta shows various functional and morphological changes in these patients. Superb microvascular imaging (SMI) and shear wave elastography (SWE) are innovative ultrasound (US) methods that provide detailed information about tissue vascularization and elasticity. PURPOSE To evaluate placental changes in patients with GDM with SMI and SWE methods. MATERIAL AND METHODS For this case-control study, 20 healthy and 20 women with GDM were included. Women at >21 weeks of pregnancy were evaluated with SMI and SWE by two independent radiologists. Mean SMI values and mean SWE values from three different region of interest-based measurements were compared between the two groups. RESULTS We identified that the mean SMI and SWE value of the GDM group was found to be significantly higher than that of the control group (P = 0.002, P = 0.001 respectively). Using a receiver operating characteristic curve, the cutoff value of the SMI ratio, which maximizes the prediction of the presence of GDM, was 0.1234279750 (95% confidence interval [CI] = 0.625-0.920), the SWE cut-off value was 15.5 kPa (95% CI = 0.794-0.989). CONCLUSION We have demonstrated that evaluation with SMI and SWE might allow quantitative assessment of the morphological changes of placentas in women with GDM. We believe that the use of innovative methods such as SMI and SWE in addition to conventional US examinations in daily practice and studies will provide significant clinical benefits to patient management.
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Affiliation(s)
- Ahmet Onur Çelik
- Department of Radiology, Çanakkale Mehmet Akif Ersoy State Hospital, Çanakkale, Turkey
| | - Burak Günay
- Department of Radiology, Trakya University Faculty of Medicine, Turkey
| | - Gonca Büşra Çoker
- Department of Gynecology and Obstetrics, Trakya University Faculty of Medicine, Turkey
| | | | - Sinan Ateş
- Department of Gynecology and Obstetrics, Trakya University Faculty of Medicine, Turkey
| | - Nermin Tunçbilek
- Department of Radiology, Trakya University Faculty of Medicine, Turkey
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Day JM, Merriman H. Common Wrist-Extensor Tendon and Pectoralis Muscle Stiffness in Healthy Recreational Tennis Players. J Sport Rehabil 2024; 33:174-180. [PMID: 38377986 DOI: 10.1123/jsr.2023-0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/21/2023] [Accepted: 01/06/2024] [Indexed: 02/22/2024]
Abstract
CONTEXT Imbalances in upper-extremity soft tissue stiffness may play a role in the development of shoulder and elbow musculoskeletal injuries in tennis players. Ultrasound shear wave elastography provides quantifiable and specific data regarding muscle stiffness. The purpose of this study was to compare tendon and muscle stiffness in healthy tennis players to nontennis players. DESIGN Cross-sectional study. METHODS The shear wave modulus, measured in kilopascals, was obtained for the dominant pectoralis major, pectoralis minor, and common wrist-extensor tendon using 2-dimensional shear wave elastography ultrasound imaging (GE Logiq S8, L9 linear transducer). Independent t test was run to compare age, body mass index, and the activity index score between both groups. Within-day intrarater reliability was assessed using a within-examiner intraclass correlation coefficients (ICC [3, 1]) with 95% confidence intervals. A multivariate general linear model was run to compare the mean differences between the tennis and nontennis players for each of the soft tissues. RESULTS Twenty-six individuals (13 tennis players and 13 nontennis players) were recruited. Within-day ICCs were very good (ICC > .78 for the pectoralis musculature) and excellent (ICC > .94 for the common wrist extensor). Common extensor tendon stiffness was significantly higher in tennis players compared to nontennis players (mean difference = 114.8 [61.8], confidence interval, -22.8 to 252.5 kPa for the dominant arm [P = .039]). Mean pectoralis major and minor stiffness differences were not significant (P > .214). CONCLUSIONS Common wrist-extensor stiffness in healthy recreational tennis players is higher than those who do not play tennis. Therefore, clinicians may need to facilitate a greater soft tissue stiffness response with resistance training when rehabilitating recreational tennis players as compared to those not playing tennis. Additional normative data on a larger sample of recreational tennis players should be collected.
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Affiliation(s)
- Joseph M Day
- Department of Physical Therapy, University of Dayton, Dayton, OH, USA
| | - Harold Merriman
- Department of Physical Therapy, University of Dayton, Dayton, OH, USA
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Fu C, Xia Y, Wang B, Zeng Q, Pan S. MRI T2 mapping and shear wave elastography for identifying main pain generator in delayed-onset muscle soreness: muscle or fascia? Insights Imaging 2024; 15:67. [PMID: 38424366 PMCID: PMC10904698 DOI: 10.1186/s13244-024-01619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/06/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION The main generator of delayed onset muscle soreness (DOMS) is still unknown. This study aimed to clarify the main generator of DOMS. METHODS Twelve participants performed eccentric exercise (EE) on lower legs. MRI and ultrasound were used to assess changes of calf muscle and deep fascia before and after EE. These results were then compared to the muscle pain level. RESULTS Compared to baseline, muscle pain peaked at 24-48 h after EE (downstairs 22.25 ± 6.196, 57.917 ± 9.298, F = 291.168, p < 0.01; resting 5.833 ± 1.899, 5.083 ± 2.429, F = 51.678, p < 0.01). Shear wave speed (SWE) of the deep fascia and T2 values of the gastrocnemius muscle and deep fascia all increased and peaked at 48 h after EE (1.960 ± 0.130, F = 22.293; 50.237 ± 2.963, F = 73.172; 66.328 ± 2.968, F = 231.719, respectively, p < 0.01). These measurements were positively correlated with DOMS (downstairs: r = 0.46, 0.76, 0.87, respectively, p < 0.001; resting: r = 0.42, 0.70, 0.77, respectively, p < 0.001). There was a significant positive correlation between SWE and T2 values of deep fascia (r = 0.54, p < 0.01). CONCLUSION DOMS is a common result of muscle and fascia injuries. Deep fascia edema and stiffness play a crucial role in DOMS, which can be effectively evaluated MR-T2 and SWE. CRITICAL RELEVANCE STATEMENT Delayed-onset muscle soreness is a common result of muscle and deep fascia injuries, in which the edema and stiffness of the deep fascia play a crucial role. Both MRI and shear wave elastography can be effectively used to evaluate soft tissue injuries. KEY POINTS • The deep fascia is the major pain generator of delayed-onset muscle soreness. • There is a significant correlation between fascia injury and delayed-onset muscle soreness. • MRI and shear wave elastography are preferred methods for assessing fascia injuries.
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Affiliation(s)
- Congcong Fu
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Yu Xia
- Department of Medical Ultrasonic, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Bingshan Wang
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Qiang Zeng
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China.
| | - Shinong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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Zhu J, Qiu L, Ta D, Hua X, Liu H, Zhang H, Li J, Wang Y, Xi Z, Zheng Y, Shan Y, Liu B, Huang W, Liu W, Hao S, Cui L, Cai J, Zhang W, Zhang C, Chen S, Wei A, Dong F. Chinese Ultrasound Doctors Association Guideline on Operational Standards for 2-D Shear Wave Elastography Examination of Musculoskeletal Tissues. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:175-183. [PMID: 37949764 DOI: 10.1016/j.ultrasmedbio.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/19/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
The Ultrasound Physician Branch of the Chinese Medical Doctor Association sought to develop evidence-based recommendations on the operational standards for 2-D shear wave elastography examination of musculoskeletal tissues. A consensus panel of 22 Chinese musculoskeletal ultrasound experts reviewed current scientific evidence and proposed a set of 12 recommendations for 13 key issues, including instruments, operating methods, influencing factors and image interpretation. A final consensus was reached through discussion and voting. On the basis of research evidence and expert opinions, the strength of recommendation for each proposition was assessed using a visual analog scale, while further emphasizing the best available evidence during the question-and-answer session. These expert consensus guidelines encourage facilitation of the standardization of clinical practices for collecting and reporting shear wave elastography data.
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Affiliation(s)
- Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China.
| | - Li Qiu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Dean Ta
- Center for Biomedical Engineering, Fudan University, Shanghai, China
| | - Xing Hua
- Department of Ultrasound, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Hongmei Liu
- Department of Ultrasound, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Huabin Zhang
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital Affiliated with Tsinghua University, Beijing, China
| | - Jia Li
- Department of Ultrasound, Southeast University Zhongda Hospital, Nanjing, China
| | - Yuexiang Wang
- Department of Ultrasound, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhanguo Xi
- Department of Functional Examination, Henan Provincial Orthopedic Hospital Zhengzhou Campus, Zhengzhou, China
| | - Yuanyi Zheng
- Department of Ultrasound, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yong Shan
- Department of Ultrasound, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bingyan Liu
- Department of Ultrasound, Hainan General Hospital, Haikou, China
| | - Weijun Huang
- Department of Interventional Ultrasound, First People's Hospital of Foshan, Foshan, China
| | - Weiyong Liu
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Shaoyun Hao
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Guangzhou, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Jin Cai
- Department of Ultrasound, Zhejiang Chinese Medical University Affiliated Third Hospital, Hangzhou, China
| | - Wei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Medical Ultrasound, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Shuqiang Chen
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - An Wei
- Department of Ultrasound, Hunan Provincial People's Hospital, Changsha, China
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People's Hospital, Shenzhen, China
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17
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Pimenta R, Coelho F, Correia JP, Vaz JR. Influence of transducer pressure and examiner experience on muscle active shear modulus measured by shear wave elastography. Radiography (Lond) 2024; 30:185-192. [PMID: 38035432 DOI: 10.1016/j.radi.2023.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/19/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION This study examined the effects of ultrasound transducer pressure and examiner experience on the biceps femoris long head and semitendinosus muscle active shear modulus in healthy individuals (n = 28). METHODS Active shear modulus was assessed using shear wave elastography at 20% of knee flexor maximal voluntary isometric contraction. Examiners with different experience levels measured the muscles' shear modulus with three pressure levels: mild, moderate, and hard. RESULTS A main effect of transducer pressure was found for both biceps femoris long head (p < 0.001; η2p = 0.314) and semitendinosus muscles (p < 0.001; η2p = 0.280), whereas differences were found between mild-moderate (biceps femoris long head: p = 0.013, d = 0.23; semitendinosus: p = 0.024, d = 0.25), and mild-hard pressures (biceps femoris long head: p = 0.001, d = 0.47; semitendinosus: p = 0.002, d = 0.47). Examiners performed similar shear modulus measurements in the biceps femoris long head (p = 0.299; η2p = 0.041) and semitendinosus (p = 0.177; η2p = 0.066), although the experienced examiner showed a higher measurement repeatability (biceps femoris long head: ICC = 0.86-0.95, semitendinosus: ICC = 0.89-0.96; vs. biceps femoris long head: ICC = 0.78-0.87, semitendinosus: ICC = 0.66-0.87). CONCLUSION Transducer pressure influences the active shear modulus measurement between mild and moderate or hard pressures. Additionally, examiner experience seems to have no influence on muscle active shear modulus measurement when assessed at the same site (using casts). IMPLICATIONS FOR PRACTICE Future studies assessing active muscle shear modulus should use mild transducer pressure and having experienced examiners in order to improve measurement reliability.
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Affiliation(s)
- R Pimenta
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal; Research Center of the Polytechnic Institute of Maia (N2i), Maia Polytechnic Institute (IPMAIA), Castêlo da Maia, 4475-690 Maia, Portugal; Futebol Clube Famalicão - Futebol SAD, Department of Rehabilitation and Performance, Famalicão, Portugal.
| | - F Coelho
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal
| | - J P Correia
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal
| | - J R Vaz
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, Portugal; Egas Moniz - Cooperativa de Ensino Superior, Monte da Caparica, Portugal
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Kempfert DJ, Mitchell K, Brewer W, Bickley C, Mandel G. Reliability of lower leg muscle elasticity using shear wave elastography in non-weight-bearing and weight-bearing. J Electromyogr Kinesiol 2023; 73:102813. [PMID: 37666036 DOI: 10.1016/j.jelekin.2023.102813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/10/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023] Open
Abstract
PURPOSE Muscle elasticity can be quantified with shear wave elastography (SWE) and has been used as an estimate of muscle force but reliability has not been established for lower leg muscles. The purpose of this study was to examine the intra-rater and inter-rater reliability of elasticity measures in non-weight-bearing (NWB) and weight-bearing (WB) for the tibialis anterior (TA), tibialis posterior (TP), peroneal longus (PL), and peroneal brevis (PB) muscles using SWE. METHODS A total of 109 recreationally active healthy adults participated. The study employed a single-cohort, same-day repeated-measures test-retest design. Elasticity, measured in kilopascals as the Young's modulus, was converted to the shear modulus. All four muscles were measured in NWB and at 90% WB. RESULTS Intra-rater reliability estimates were good to excellent for NWB (ICC = 0.930-0.988) and WB (ICC = 0.877-0.978) measures. Inter-rater reliability estimates were moderate to good (ICC = 0.500-0.795) for NWB measures and poor to good (ICC = 0.346-0.910) for WB measures. CONCLUSION Despite the studies poor to good inter-rater variability, the intra-rater reproducibility represents the potential benefit of SWE in NWB and WB. Establishing the reliability of SWE with clinical and biomechanical approaches may aid in improved understanding of the mechanical properties of muscle.
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Affiliation(s)
- David J Kempfert
- College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, St. Augustine, FL, United States.
| | - Katy Mitchell
- College of Health Sciences, Texas Woman's University, Houston, TX, United States
| | - Wayne Brewer
- College of Health Sciences, Texas Woman's University, Houston, TX, United States
| | - Christina Bickley
- College of Health Sciences, Texas Woman's University, Houston, TX, United States
| | - Garrett Mandel
- College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, St. Augustine, FL, United States
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Günay B, Uslu B, Çelik AO, Korkmaz S, Ustabaşıoğlu FE, Solak S, Kula O, Tunçbilek N. The Role of Superb Microvascular Imaging and Shear Wave Elastography in the Prediction of Hemorrhage Complications After Renal Parenchyma Biopsy. Ultrasound Q 2023; 39:242-249. [PMID: 37918031 DOI: 10.1097/ruq.0000000000000656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVES The aim of study was to evaluate the diagnostic utility of the renal parenchyma elasticity with the shear wave elastography (SWE) and microvascularization with the superb microvascular imaging (SMI) technique before kidney biopsy and to predict the complication of hemorrhage before kidney biopsy. METHODS A total of 75 patients were included in the prospective study. Before the biopsy, vascularity features of the kidney parenchyma in the area to be biopsied were assessed by SMI and parenchymal stiffness by SWE and were examined by 2 independent radiologists. RESULTS A statistically significant difference was found in the SMI and SWE values between the groups with and without hematoma and hematuria when compared with the Student t test and Mann-Whitney U test ( P < 0.05). The SWE hardness cutoff value, which maximizes the prediction of the development of hematuria, was found to be 18.40 kPa, and the sensitivity and specificity values were 84.4% and 62.8%, respectively. In SMI vascularity index values, the cutoff value was found to be 0.247410800 kPa, and sensitivity and specificity values were 81.3% and 83.7%, respectively. The cutoff value of the SMI vascularity index values that maximized the prediction of hematoma development was 0.297009650, and the sensitivity and specificity values were 87% and 87%, respectively. CONCLUSIONS We believe that evaluating and standardizing the microvascularization and elasticity of the kidney parenchyma before a percutaneous kidney biopsy will be potentially useful as a guiding method in the prediction of postbiopsy hemorrhage development.
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Affiliation(s)
- Burak Günay
- Department of Radiology, Trakya University Faculty of Medicine, Edirne
| | - Burak Uslu
- Department of Radiology, Yüksekova State Hospital, Hakkari
| | | | - Selçuk Korkmaz
- Department of Biostatistics and Medical Informatics, Trakya University Faculty of Medicine, Edirne, Turkey
| | | | - Serdar Solak
- Department of Radiology, Trakya University Faculty of Medicine, Edirne
| | - Osman Kula
- Department of Radiology, Trakya University Faculty of Medicine, Edirne
| | - Nermin Tunçbilek
- Department of Radiology, Trakya University Faculty of Medicine, Edirne
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Shembel AC, Morrison RA, Fetzer DT, Patterson-Lachowicz A, McDowell S, Comstock Smeltzer JC, Mau T. Extrinsic Laryngeal Muscle Tension in Primary Muscle Tension Dysphonia with Shear Wave Elastography. Laryngoscope 2023; 133:3482-3491. [PMID: 37334857 PMCID: PMC10728340 DOI: 10.1002/lary.30830] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES It has been assumed that patients with primary muscle tension dysphonia (pMTD) have more extrinsic laryngeal muscle (ELM) tension, but tools to study this phenomenon lack. Shear wave elastography (SWE) is a potential method to address these shortcomings. The objectives of this study were to apply SWE to the ELMs, compare SWE measures to standard clinical metrics, and determine group differences in pMTD and typical voice users before and after vocal load. METHODS SWE measurements of the ELMs from ultrasound examinations of the anterior neck, supraglottic compression severities from laryngoscopic images, cepstral peak prominences (CPP) from voice recordings, and self-perceptual ratings of vocal effort and discomfort were obtained in voice users with (N = 30) and without (N = 35) pMTD, before and after a vocal load challenge. RESULTS ELM tension significantly increased from rest-to-voiced conditions in both groups. However, the groups were similar in their ELM stiffness levels at SWE at baseline, during vocalization, and post-vocal load. Levels of vocal effort and discomfort and supraglottic compression were significantly higher and CPP was significantly lower in the pMTD group. Vocal load had a significant effect on vocal effort and discomfort but not on laryngeal or acoustic patterns. CONCLUSION SWE can be used to quantify ELM tension with voicing. Although the pMTD group reported significantly higher levels of vocal effort and vocal tract discomfort and, on average, exhibited significantly more severe supraglottic compression and lower CPP values, there were no group differences in levels of ELM tension using SWE. LEVEL OF EVIDENCE 2 Laryngoscope, 133:3482-3491, 2023.
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Affiliation(s)
- Adrianna C. Shembel
- Department of Otolaryngology-Head and Neck, Voice Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Robert A. Morrison
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - David T. Fetzer
- Department of Radiology, CACTUS Lab, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Amber Patterson-Lachowicz
- Department of Radiology, CACTUS Lab, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sarah McDowell
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Julianna C. Comstock Smeltzer
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Ted Mau
- Department of Otolaryngology-Head and Neck, Voice Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Wang X, Xu L, Hu X, Zhao H, Yin J. Musculoskeletal Ultrasound for the Diagnosis of Plantar Fasciitis: An Accuracy and Diagnostic Yield Study. Int J Gen Med 2023; 16:4765-4771. [PMID: 37904905 PMCID: PMC10613412 DOI: 10.2147/ijgm.s434182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/16/2023] [Indexed: 11/01/2023] Open
Abstract
Objective To evaluate the accuracy of musculoskeletal ultrasound measurement of plantar fascia thickness and shear wave elastography (SWE) calculation of Young's modulus in the diagnosis of plantar fasciitis (PFis), and to explore whether it will have any impact on clinical decision-making, rather than just using established diagnostic methods of clinical symptoms and signs. Methods A diagnostic single-center study was conducted in 60 patients with PFis and 64 patients with other types of heel pain. The sensitivity and specificity of musculoskeletal ultrasound in the diagnosis of PFis were calculated according to the diagnostic criteria for PFis recommended by the Clinical Practice Guide for PFis of the American Physical Therapy Association (APTA) Orthopaedic Branch. The analysis of the receiver operating characteristic curve of the subjects was used to study the accuracy of the diagnosis of PFis by two indicators alone and two indicators jointly. Results The thickness of plantar fascia measured by musculoskeletal ultrasound and the area under the curve (AUCs) calculated by shear wave elastography for diagnosing PFis were 0.925 and 0.917, respectively, and the optimal cutoff values were 3.15 mm (sensitivity: 100.0%, specificity: 81.3%) and 63.24 kPa (sensitivity: 78.3%, specificity: 92.2%), respectively. The area under the curve (AUCs) for the combined diagnosis of the two is 0.973 (sensitivity: 93.3%, specificity: 93.8%). Conclusion The thickness of plantar fascia measured by musculoskeletal ultrasound and Young's modulus calculated by SWE have high accuracy in diagnosing PFis, and the combined diagnosis of the two can improve the diagnostic accuracy of patients with PFis.
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Affiliation(s)
- Xuan Wang
- First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, People’s Republic of China
- Foot and Ankle Surgery Department, Honghui Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Lei Xu
- Functional Department, Xi’an Hospital of Traditional Chinese Medicine, Xi’an, People’s Republic of China
| | - Xinglu Hu
- Spine Surgery Department, Xi’an Hospital of Traditional Chinese Medicine, Xi’an, People’s Republic of China
| | - Hongmou Zhao
- Foot and Ankle Surgery Department, Honghui Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Jichao Yin
- First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, People’s Republic of China
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22
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Shao TY, Wang JX, Shou ST, Fidimanantsoa OL. Wet cupping with rehabilitation training for upper-limb poststroke spasticity: A systematic review and meta-analysis of randomized controlled trials. Heliyon 2023; 9:e20623. [PMID: 37829814 PMCID: PMC10565697 DOI: 10.1016/j.heliyon.2023.e20623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/01/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
Background Upper-limb poststroke spasticity (PSS) negatively impacts on patients' quality of life. An increasing number of clinical trials have indicated that wet cupping with rehabilitation training is conductive to alleviate spastic muscle tone, thereby to improve upper-limb function. However, related evidence base is insufficient. This study systematically investigates the efficacy and safety of wet cupping with rehabilitation training on stroke patients with upper-limb spasticity. Methods Eight separate databases and two clinical trial registries were searched from their inception to December 6, 2022. Two reviewers extracted the data and assessed the quality of the literature, independently. The mean difference (MD) or risk ratio (RR) were used as measure of effect size in meta-analysis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used for the certainty of evidence. Results Eight randomized controlled trials (RCTs) were quantified for meta-analysis. The results indicated that in comparison with the control group, wet cupping with rehabilitation training was more effective in reducing modified Ashworth scale score (MD = -0.60, 95% CI: -0.74, -0.46; P < 0.00001) and the integral electromyography value of biceps muscle (MD = -4.71, 95% CI: -6.74, -2.67; P < 0.00001), but improving effective rate (RR = 1.28, 95% CI: 1.15, 1.41; P < 0.00001), Fugl-Myer Assessment score (MD = 4.84, 95% CI: 3.05, 6.64; P < 0.00001) as well as Barthel Index score (MD = 6.38, 95% CI: 2.20, 10.57; P = 0.003). However, no significant difference was found regarding the integral electromyography value of triceps muscle between groups (MD = 1.72, 95% CI: -2.05, 5.48; P = 0.37). Conclusion Wet cupping with rehabilitation training should be included in a comprehensive therapeutic regimen for stroke patients with upper-limb spasticity. However, these results need to be further verified by more RCTs with rigorous design and large sample size.
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Affiliation(s)
- Tian-Yi Shao
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Jun-Xiang Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Song-Ting Shou
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Almotairi FS, Basalamah AA, Amir A, Al-Habib AF. Intraoperative demonstration of reduced distal spinal cord stiffness following untethering of the spinal cord using ultrasound shear wave elastography (SWE). World Neurosurg X 2023; 20:100225. [PMID: 37456688 PMCID: PMC10344799 DOI: 10.1016/j.wnsx.2023.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
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Holmgren JG, Kottapalli V, Ngo T, Tran A, Roberts T, Johnson T, Gao J. Anisotropy and reproducibility of ultrasound shear wave elastography in patella tendons with and without tendinopathy. Clin Imaging 2023; 102:71-77. [PMID: 37633230 DOI: 10.1016/j.clinimag.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Ultrasound shear wave elastography (SWE) is a tool that can be utilized to assess biomechanical properties of tendons. Anisotropy, an ultrasound imaging artifact has been commonly cited as a potential source of error in the accuracy and reproducibility of SWE. The aim of the study was to assess reproducibility in performing SWE of patella tendons and differences in SWE and anisotropy between normal patella tendons and patellar tendinopathy. METHODS After obtaining the Institutional Review Board approval and written informed consent, we prospectively measured the shear wave velocity (SWV) of patella tendons with and without tendinopathy in 25 volunteers. SWVs were measured in three anatomic planes: longitudinal, perpendicular transverse, and tilted transverse with the probe tilted 15-30° from the perpendicular transverse plane by three operators with varied levels of experience. Anisotropy coefficient (A) was calculated by formula of A = (SWVLongitudinal - SWVTransverse) / SWVTransverse. RESULTS Differences in SWV and anisotropy coefficient between normal tendons and tendons with tendinopathy were significant (p < 0.05). The intra- and inter-observer reproducibility in performing SWE were moderate to good (intraclass correlation coefficient: 0.81-0.95). The mean difference of 95% Bland-Altman limits of agreement for measuring tendon SWV ranged -0.08 to 0.41 (upper 0.08 to 1.14, lower -1.22 to -0.22) between senior and junior operators. CONCLUSION The results of this study suggest that SWE and anisotropy coefficient are feasible tools to differentiate patellar tendinopathy from normal patella tendons. The reproducibility of performing SWE of patella tendons is moderate to good.
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Affiliation(s)
| | | | - Thien Ngo
- Rocky Vista University, Ivins, UT, USA
| | | | | | | | - Jing Gao
- Rocky Vista University, Ivins, UT, USA.
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Miller T, Bello UM, Tsang CSL, Winser SJ, Ying MTC, Pang MYC. Using ultrasound elastography to assess non-invasive, non-pharmacological interventions for musculoskeletal stiffness: a systematic review and meta-analysis. Disabil Rehabil 2023:1-15. [PMID: 37668241 DOI: 10.1080/09638288.2023.2252744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To evaluate the current evidence regarding the use of ultrasound elastography for assessing non-invasive, non-pharmacological interventions for eliciting changes in musculoskeletal stiffness. METHODS A systematic search of MEDLINE, CINAHL, EMBASE, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Information on measurement and intervention procedures was extracted. Bias was assessed using Cochrane Risk of Bias or Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I) tools for studies with true or quasi-experimental designs, respectively. Analyses were conducted for adequately powered subgroups based on intervention type, measurement site, and population assessed. RESULTS Twenty-one studies were included in the review. Overall risk of bias was low for true experimental studies and moderate for quasi-experimental studies. Subgroup analyses indicated a large overall effect for interventions involving manual physiotherapy and taping/splinting for reducing masseter muscle stiffness in patients with masticatory muscle disorders (g = 1.488, 95% CI = 0.320-2.655, p = 0.013). Analyses for other intervention types and patient groups were underpowered. CONCLUSION Ultrasound elastography demonstrates clinical applicability for assessing non-invasive, non-pharmacological interventions for musculoskeletal stiffness. However, the comparative efficacy of these interventions for modulating tissue stiffness remains inconclusive.
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Affiliation(s)
- Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Umar M Bello
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Charlotte S L Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Stanley J Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Michael T C Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Turk CB, Baykara Ulusan M, Döş YM, Manav Baş V, Sarikaya Tellal E, Koku Aksu AE. The Effects of Oral Isotretinoin on Atrophic Acne Scars Measured by Shear-wave Elastography: An Observational, Single-center Study. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2023; 16:46-51. [PMID: 37720196 PMCID: PMC10503936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background Although the effects of oral isotretinoin (OI) on acne vulgaris and preventing further acne scars have been well-documented, the specific impact of OI alone on pre-existing atrophic acne scars (AAS) remains unclear. No clinical study has objectively evaluated the effect of OI on AAS yet. Objective We sought to investigate the OI effect on AAS quantitatively and reliably by shear-wave elastography (SWE). Methods This work is a single-center, prospective and observational study. Thirty patients with moderate and severe acne vulgaris accompanied by AAS were included. We started the OI with a standard dose regime. On Days 0 and 90 of treatment, patients' global acne grading system (GAGS) and the Goodman and Baron's Qualitative Global Scar Rating System (GSRS) were evaluated. The dermal thickness, subcutaneous tissue thickness, scar size, and scar and subcutaneous tissue's elastic modules were measured on both cheeks of each patient by SWE. Results The improvement in GSRS stages and GAGS scores in 90 days were statistically significant (respectively; p=0.029, <0.001). Scar size and dermal thickness decreased, while the subcutaneous tissue thickness and the elastic modulus of scar and subcutaneous tissue increased in bilateral cheeks. The thickness changes in the right side dermis, and subcutaneous tissue on both sides were noteworthy (p<0.05). Conclusion Besides its well-known effect on acne vulgaris, OI also could be an effective treatment option for reducing scar size and severity while improving skin elasticity. SWE may help follow skin and scar properties.
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Affiliation(s)
- Cemre Busra Turk
- Dr. Turk is with the Wellman Center for Photomedicine at Massachusetts General Hospital in Boston, Massachusetts
- Additionally, Dr. Turk is with the Department of Dermatology at Harvard Medical School in Boston, Massachusetts
| | - Melis Baykara Ulusan
- Dr. Baykara Ulusan is with the University of Health Sciences Istanbul Training and Research Hospital's Radiology Clinic in Istanbul, Turkey
| | - Yusuf Mert Döş
- Drs. Döş, Manav Baş, Sarıkaya Tellal, and Koku Aksu are with the University of Health Sciences Istanbul Training and Research Hospital's Dermatology Clinic in Istanbul, Turkey
| | - Vildan Manav Baş
- Drs. Döş, Manav Baş, Sarıkaya Tellal, and Koku Aksu are with the University of Health Sciences Istanbul Training and Research Hospital's Dermatology Clinic in Istanbul, Turkey
| | - Ebru Sarikaya Tellal
- Drs. Döş, Manav Baş, Sarıkaya Tellal, and Koku Aksu are with the University of Health Sciences Istanbul Training and Research Hospital's Dermatology Clinic in Istanbul, Turkey
| | - Ayse Esra Koku Aksu
- Drs. Döş, Manav Baş, Sarıkaya Tellal, and Koku Aksu are with the University of Health Sciences Istanbul Training and Research Hospital's Dermatology Clinic in Istanbul, Turkey
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Schytz HW, Hvedstrup J. Evaluating Headache and Facial Pain in a Headache Diagnostic Laboratory: Experiences from the Danish Headache Center. Diagnostics (Basel) 2023; 13:2671. [PMID: 37627930 PMCID: PMC10452981 DOI: 10.3390/diagnostics13162671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Diagnostic tests are not routinely used for the diagnosis of primary headaches. It is possible that laboratory tests could be developed and implemented at tertiary headache centers to be an integrated part of the diagnosis and management of headache patients, and laboratory tests that can be used on-site at headache centers could help in evaluating patients with secondary headache disorders. METHODS In this narrative review, we present some of the studies that have been made so far at the Headache Diagnostic Laboratory at the Danish Headache Center that aim to investigate and phenotype primary headaches and investigate secondary headaches as well as improve management. RESULTS Semi-structured interviews and deep phenotyping, quantitative sensory testing, and provocation studies have been shown to be valuable in categorizing primary and secondary headache subtypes, possible pathophysiology, and defining needs for further research. In patients suspected of increased intracranial pressure, transorbital ultrasound with measurement of the optic sheath diameter may be useful in monitoring patients. The management of headache patients needs to be critically evaluated to optimize treatment continuously. CONCLUSION A Headache Diagnostic Laboratory is very useful and should be an integrated part of headache care and management at tertiary headache centers.
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Affiliation(s)
- Henrik Winter Schytz
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, DK-2600 Glostrup, Denmark;
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark
| | - Jeppe Hvedstrup
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, DK-2600 Glostrup, Denmark;
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Yancey M, Rbil N, Chatterjee A, Lin H, Wyles HL, Ko LM, Nwawka OK, Khormaee S. Ultrasound Shear Wave Elastography Quantitatively Assesses Tension Changes of Supraspinous/Interspinous Ligament Complex Under Varied Loads. Int J Spine Surg 2023; 17:502-510. [PMID: 37402508 PMCID: PMC10478687 DOI: 10.14444/8479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Although interspinous and supraspinous ligaments of the lumbar spine are thought to contribute to spinal stability, little is known about their dynamic biomechanics. We demonstrate that shear wave elastography (SWE) offers a novel technique to noninvasively and quantitatively evaluate posterior spinous ligament complex functional loading and stiffness in different physiologic positions. METHODS We performed SWE and measured the length of the interspinous/supraspinous ligament complex in cadaveric torsos (N = 5), isolated ligaments (N = 10), and healthy volunteers (N = 9) to obtain length and shear wave velocity measurements. For cadavers and volunteers, SWE was utilized in 2 lumbar positions: lumbar spine flexion and extension. In addition, SWE was performed on isolated ligaments undergoing uniaxial tension to correlate shear wave velocities with experienced load. RESULTS Average shear wave velocity in cadaveric supraspinous/interspinous ligament complexes increased for lumbar levels (23%-43%) and most thoracic levels (0%-50%). This corresponded to an average increase in interspinous distance from extension to flexion for the lumbar spine (19%-63%) and thoracic spine (3%-8%). Volunteer spines also demonstrated an average increase in shear wave velocity from extension to flexion for both the lumbar spine (195% at L2-L3 to 200% at L4-L5) and thoracic spine (31% at T10-T11). There was an average increase in interspinous distance from extension to flexion for the lumbar spine (93% at L2-L3 to 127% at L4-L5) and thoracic spine (11% at T10-T11). In isolated ligaments, there was a positive correlation between applied tensile load and average shear wave velocity. CONCLUSION This study creates a foundation to apply SWE as a noninvasive tool for assessing the mechanical stiffness of posterior ligamentous structures and has potential applications in augmenting or evaluating these ligaments in patients with spine pathology. CLINICAL RELEVANCE The interspinous and supraspinous ligaments are critical soft tissue supports of the posterior lumbar spine. Disruption of these structures is thought to have a negative impact on spinal stability in trauma and spine deformities. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Nada Rbil
- Hospital for Special Surgery, New York, NY, USA
| | | | - Hannah Lin
- Hospital for Special Surgery, New York, NY, USA
| | | | - Lydia M Ko
- Hospital for Special Surgery, New York, NY, USA
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29
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Jia F, Zhu XR, Kong LY, Fan JC, Zhu ZJ, Lin LZ, Zhang SY, Yuan XZ. Stiffness changes in internal rotation muscles of the shoulder and its influence on hemiplegic shoulder pain. Front Neurol 2023; 14:1195915. [PMID: 37332999 PMCID: PMC10272777 DOI: 10.3389/fneur.2023.1195915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/10/2023] [Indexed: 06/20/2023] Open
Abstract
Background Hemiplegic shoulder pain (HSP) is a common complication in patients with stroke. The pathogenesis of HSP is complex, and muscle hypertonia, especially the hypertonia of internal rotation muscles of the shoulder, may be one of the important causes of shoulder pain. However, the relationship between muscle stiffness and HSP has not been well studied. The purpose of this study is to explore the correlations between the stiffness of internal rotation muscles and clinical symptoms in patients with HSP. Methods A total of 20 HSP patients and 20 healthy controls were recruited for this study. The stiffness of internal rotation muscles was quantified using shear wave elastography, and Young's modulus (YM) of the pectoralis major (PM), anterior deltoid (AD), teres major ™, and latissimus dorsi (LD) were measured. Muscle hypertonia and pain intensity were evaluated using the Modified Ashworth Scale (MAS) and Visual Analog Scale (VAS), respectively. The mobility of the shoulder was evaluated using the Neer score. The correlations between muscle stiffness and the clinical scales were analyzed. Results YM of internal rotation muscles on the paretic side was higher than that of the control group in the resting and passive stretching positions (P < 0.05). YM of internal rotation muscles on the paretic side during passive stretching was significantly higher than that at rest (P < 0.05). YM of PM, TM, and LD during passive stretching were correlated with MAS (P < 0.05). In addition, the YM of TM during passive stretching was positively correlated with VAS and negatively correlated with the Neer score (P < 0.05). Conclusion Increased stiffness of PM, TM, and LD was observed in patients with HSP. The stiffness of TM was associated with pain intensity of the shoulder and shoulder mobility.
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Affiliation(s)
- Fan Jia
- Faculty of Rehabilitation Medicine, Weifang Medical University, Weifang, Shandong, China
| | - Xin-Rui Zhu
- Faculty of Rehabilitation Medicine, Weifang Medical University, Weifang, Shandong, China
| | - Ling-Yu Kong
- Physical Education and Sports School, Soochow University, Suzhou, Jiangsu, China
| | - Jie-Cheng Fan
- Department of Rehabilitation Medicine, Weifang People's Hospital, Weifang, Shandong, China
| | - Zong-Jing Zhu
- Department of Rehabilitation Medicine, Weifang People's Hospital, Weifang, Shandong, China
| | - Li-Zhen Lin
- Department of Rehabilitation Medicine, Weifang People's Hospital, Weifang, Shandong, China
| | - Shu-Yun Zhang
- Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China
| | - Xiang-Zhen Yuan
- Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China
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Stiver ML, Mirjalili SA, Agur AMR. Measuring Shear Wave Velocity in Adult Skeletal Muscle with Ultrasound 2-D Shear Wave Elastography: A Scoping Review. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1353-1362. [PMID: 36958957 DOI: 10.1016/j.ultrasmedbio.2023.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 05/11/2023]
Abstract
Ultrasound 2-D shear wave elastography (US 2D-SWE) is a non-invasive, cost-effective tool for quantifying tissue stiffness. Amidst growing interest in US 2D-SWE for musculoskeletal research, it has been recommended that shear wave velocity (SWV) should be reported instead of elastic moduli to avoid introducing unwanted error into the data. This scoping review examined the evolving use of US 2D-SWE to measure SWV in skeletal muscle and identified strengths and weaknesses to guide future research. We searched electronic databases and key review reference lists to identify articles published between January 2000 and May 2021. Two reviewers assessed the eligibility of records during title/abstract and full-text screening, and one reviewer extracted and coded the data. Sixty-six studies met the eligibility criteria, of which 58 were published in 2017 or later. We found a striking lack of consensus regarding the effects of age and sex on skeletal muscle SWV, and widely variable reliability values. Substantial differences in methodology between studies suggest a pressing need for developing standardized, validated scanning protocols. This scoping review illustrates the breadth of application for US 2D-SWE in musculoskeletal research, and the data synthesis exposed several notable inconsistencies and gaps in current literature that warrant consideration in future studies.
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Affiliation(s)
- Mikaela L Stiver
- Division of Anatomy, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Anatomical Sciences, Department of Anatomy and Cell Biology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
| | - Seyed Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anne M R Agur
- Division of Anatomy, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Wang JX, Fidimanantsoa OL, Ma LX. New insights into acupuncture techniques for poststroke spasticity. Front Public Health 2023; 11:1155372. [PMID: 37089473 PMCID: PMC10117862 DOI: 10.3389/fpubh.2023.1155372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/15/2023] [Indexed: 04/25/2023] Open
Abstract
With the trend of aging population getting more obvious, stroke has already been a major public health problem worldwide. As a main disabling motor impairment after stroke, spasticity has unexpected negative impacts on the quality of life and social participation in patients. Moreover, it brings heavy economic burden to the family and society. Previous researches indicated that abnormality of neural modulation and muscle property corelates with the pathogenesis of poststroke spasticity (PSS). So far, there still lacks golden standardized treatment regimen for PSS; furthermore, certain potential adverse-events of the mainstream therapy, for example, drug-induced generalized muscle weakness or high risk related surgery somehow decrease patient preference and compliance, which brings challenges to disease treatment and follow-up care. As an essential non-pharmacological therapy, acupuncture has long been used for PSS in China and shows favorable effects on improvements of spastic hypertonia and motor function. Notably, previous studies focused mainly on the research of antispastic acupoints. In comparison, few studies lay special stress on the other significant factor impacting on acupuncture efficacy, that is acupuncture technique. Based on current evidences from the clinic and laboratory, we will discuss certain new insights into acupuncture technique, in particular the antispastic needling technique, for PSS management in light of its potential effects on central modulations as well as peripheral adjustments, and attempt to provide some suggestions for future studies with respect to the intervention timing and course, application of acupuncture techniques, acupoint selection, predictive and aggravating factors of PSS, aiming at optimization of antispastic acupuncture regimen and improvement of quality of life in stroke patients. More innovations including rigorous study design, valid objective assessments for spasticity, and related experimental studies are worthy to be expected in the years ahead.
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Affiliation(s)
- Jun-Xiang Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Jun-Xiang Wang,
| | | | - Liang-Xiao Ma
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
- The Key Unit of State Administration of Traditional Chinese Medicine, Evaluation of Characteristic Acupuncture Therapy, Beijing, China
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32
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Xiao Y, Jin J, Yuan Y, Zhao Y, Li D. A New Estimation Scheme for Improving the Performance of Shear Wave Elasticity Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:289-308. [PMID: 36283938 DOI: 10.1016/j.ultrasmedbio.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/09/2022] [Accepted: 09/04/2022] [Indexed: 06/16/2023]
Abstract
Shear wave velocity (SWV) reconstruction based on time-of-flight (TOF) is widely adopted to realize shear wave elasticity imaging (SWEI). It typically breaks down the reconstruction of a SWV image into many kernels and treats them independently. We hypothesized that information exchange among kernels improves the performance of SWEI. Therefore, we propose the approach of iterative re-weighted least squares based on inter-kernel communication (IKC-IRLS). We also hypothesized that time-to-peak (TTP) is superior to cross-correlation (CC) in visualizing small targets because TTP uses higher shear wave frequencies than CC. To examine the hypotheses, IKC-IRLS was combined with TTP data and compared with four established methods. The five methods were tested by imaging several small-size stiff targets (2.5, 4.0 and 6.4 mm in diameter) using different kernel sizes in the simulation and real experiments. The results indicate that the IKC-IRLS approach can mitigate speckle noise and is robust to TTP outliers. Consequently, the proposed method achieves the highest contrast-to-noise ratio and the lowest mean absolute percentage error of target in almost all tested cases.
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Affiliation(s)
- Yang Xiao
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, Heilongjiang Province, China
| | - Jing Jin
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, Heilongjiang Province, China.
| | - Yu Yuan
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, Heilongjiang Province, China
| | - Yue Zhao
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, Heilongjiang Province, China
| | - Dandan Li
- Department of Control Science and Engineering, Harbin Institute of Technology, Harbin, Heilongjiang Province, China
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Hong S, Hahn S, Yi J, Park EJ, Bang JY. Comparing the clinical application of strain elastography and shear wave elastography for the evaluation of lateral epicondylitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:123-130. [PMID: 36169174 DOI: 10.1002/jcu.23356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE This study aimed to compare the diagnostic performance of gray-scale ultrasound (GSU), strain elastography (SE), and shear wave elastography (SWE) for lateral epicondylitis (LE). METHODS From November 2018 to March 2021, 87 common extensor tendons (CETs) of 70 patients were evaluated using elbow ultrasound. Patients were divided into two groups: patients with LE and those without lateral elbow pain. GSU, SE, and SWE findings from the two groups were compared, and the diagnostic performance was compared for significant variables. RESULTS Among the 70 patients, 41 with 44 CETs were clinically diagnosed with LE, and 29 with 43 CETs had no lateral elbow pain. Hypoechogenicity, calcification, and hyperemia were significantly different. Strain ratio (SR), stiffness, and shear wave velocity (SWV) were also significantly different. The diagnostic accuracy of stiffness and SWV was better than that of other significant findings. Furthermore, there were no superiorities in SR, stiffness, or SWV. CONCLUSION Both SE and SWE can be valuable diagnostic tools for diagnosing LE. The diagnostic performances of both SE and SWE were similar in the detection of LE.
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Affiliation(s)
- Sujin Hong
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seok Hahn
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jisook Yi
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Eun Joo Park
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jin-Young Bang
- Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
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Gülsaran U, Ustabaşıoğlu F, Günay B, Ustabaşıoğlu FE. Evaluation of Accuracy of Shear Wave Elastography and Superb Microvascular Imaging Methods in Diagnosis of Piriformis Syndrome: A Preliminary Study. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2521-2529. [PMID: 36123220 DOI: 10.1016/j.ultrasmedbio.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Piriformis syndrome is a neuromuscular disease resulting from sciatic nerve compression caused by an abnormal condition in the piriformis muscle. Superb microvascular imaging (SMI) is a new ultrasound imaging technique that visualizes low-velocity and small-diameter blood vessel flow. In our prospectively designed study, we aimed to evaluate the accuracy of diagnosis of piriformis syndrome with innovative methods such as shear wave elastography (SWE) and SMI. Thirty-two patients diagnosed with unilateral piriformis syndrome were accepted to the statistical stage. The side without symptoms was considered the "unaffected side." Bilateral piriformis muscles were examined by ultrasonography. Muscle thickness was determined on gray scale, stiffness on SWE and vascularity characteristics on power Doppler and SMI by two independent radiologists. Piriformis muscle stiffness on the non-pathological (unaffected) side was measured by SWE as 18.27 ± 7.301 kPa, and the mean stiffness on the pathological side was 29.70 ± 10.095 kPa. Pathological side muscle stiffness was significantly higher (p < 0.05). Using innovative methods such as SWE and SMI in addition to conventional ultrasonography as much as possible in our daily practice and research helps us in making the correct diagnosis in piriformis syndrome.
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Affiliation(s)
- Uğur Gülsaran
- Department of Radiology, Edirne Sultan First Murat State Hospital, Edirne, Turkey.
| | - Fatma Ustabaşıoğlu
- Department of Physical Medicine and Rehabilitation, Edirne Sultan First Murat State Hospital, Edirne, Turkey.
| | - Burak Günay
- Department of Radiology, Faculty of Medicine, Trakya University, Edirne, Turkey.
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Liu Y, Zhu Y, Jiang L, Lu C, Xiao L, Wang T, Chen J, Sun L, Deng L, Gu M, Zheng T, Feng M, Shi Y. Efficacy of electro-acupuncture in postpartum with diastasis recti abdominis: A randomized controlled clinical trial. Front Public Health 2022; 10:1003361. [PMID: 36483239 PMCID: PMC9724647 DOI: 10.3389/fpubh.2022.1003361] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Electro-acupuncture (EA) has promising effects on diastasis rectus abdominis (DRA), defined as a separation of the two muscle bellies of rectus abdominis. To study, there is scant knowledge or scarce high-quality evidence. Objective We aimed to evaluate the long-term efficacy and safety of EA in treating DRA during postpartum. It was assumed that the improvement of DRA was more obvious in the EA group than in the control group. Design Randomized, controlled, blinded trial (Clinical Trial Registration: ChiCTR2100041891). Setting Hangzhou Hospital of Traditional Chinese Medicine in China. Participants Females aged 20-45 years without a past medical history of pathological rectus abdominal dissection were recruited from DRA inclusion criteria from 42 days to 1 year postpartum. Intervention 110 participants were randomly assigned in a 1:1 ratio to a control group with no EA intervention (n = 55), and EA group (n = 55). The EA group received ten sessions of EA combined with physical exercise or only physical exercise for 2 weeks with a 26-week follow-up. Measurements Outcomes were assessed at baseline, week 2, and week 26. The primary outcome was the change of the inter recti distance (IRD) and electromyographic evaluation of the pelvic floor. Secondary outcomes included elasticity of linea alba (LA), paraumbilical subcutaneous adipose tissue (SAT) measurement, body mass index (BMI), percentage body fat (F%), dyspepsia symptoms, menstrual symptoms, quality of life (QoL), pain performance of patients with lower back pain, postnatal depression symptoms (PDS), postpartum self-image, and DRA-related symptom assessment including urine leakage, frequency, and urgency, constipation, sexual dysfunction, and chronic pelvic pain. Results A total of 110 maternal (55 in each group) were recruited. The mean difference in IRD from baseline to week 2 and week 26 in all states of the two groups were reduced compared with those before treatment, with statistical significance (P < 0.05). The mean of IRD at the horizontal line of the umbilicus in the end-expiratory state was smaller in the EA group than in the control group, but the difference was not statistically significant (P > 0.05) at week 2. The mean of IRD at the horizontal line of the umbilicus in head-up and flexed knee state was smaller in the EA group than in the control group, and the difference was statistically significant (P < 0.05) at week 26. Five (9.1%) and thirteen (23.64%) adverse events were reported in EA and control groups, respectively. No serious adverse events were reported. Limitation The frequency intensity of EA parameters was selected between 4 and 6 because of individual tolerance differences. Conclusion EA is an effective approach to improve IRD, electromyographic evaluation of the pelvic floor, BMI, the elasticity of LA, paraumbilical SAT, and symptoms of DRA, with durable effects at 26 weeks. Primary funding source The Construction Fund of Medical Key Disciplines of Hangzhou (Project Number: OO20200097), Hangzhou Medical and Health Science and Technology Project No. A20200483, and Zhejiang Traditional Chinese Medicine Science and Technology Plan Project (Project Number: 2021ZQ065). Clinical trial registration http://www.chictr.org.cn/index.aspx, identifier: ChiCTR2100041891.
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Affiliation(s)
- Yan Liu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ying Zhu
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Liyuan Jiang
- Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China,*Correspondence: Liyuan Jiang
| | - Chao Lu
- Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Lijuan Xiao
- Chun'an County Hospital of Traditional Chinese Medicine, Chun'an, China
| | - Ting Wang
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiayu Chen
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Li Sun
- Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Lujun Deng
- Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Meiyu Gu
- Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Tingting Zheng
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Min Feng
- Department of Maternal Health Care, Maternity and Child Health Care Centers of Hechi, Hechi, China
| | - Yingying Shi
- Dingqiao Hospital of Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
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Evaluating Different Quantitative Shear Wave Parameters of Ultrasound Elastography in the Diagnosis of Lymph Node Malignancies: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14225568. [PMID: 36428661 PMCID: PMC9688428 DOI: 10.3390/cancers14225568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Shear wave elastography (SWE) has shown promise in distinguishing lymph node malignancies. However, the diagnostic accuracies of various SWE parameters that quantify tissue stiffness are yet to be demonstrated. To evaluate the pooled diagnostic accuracy of different SWE parameters for differentiating lymph node malignancies, we conducted a systematic screening of four databases using the PRISMA guidelines. Lymph node biopsy was adopted as the reference standard. Emax (maximum stiffness), Emean (mean stiffness), Emin (minimum stiffness), and Esd (standard deviation) SWE parameters were subjected to separate meta-analyses. A sub-group analysis comparing the use of Emax in cervical (including thyroid) and axillary lymph node malignancies was also conducted. Sixteen studies were included in this meta-analysis. Emax and Esd demonstrated the highest pooled sensitivity (0.78 (95% CI: 0.69-0.87); 0.78 (95% CI: 0.68-0.87)), while Emean demonstrated the highest pooled specificity (0.93 (95% CI: 0.88-0.98)). From the sub-group analysis, the diagnostic performance did not differ significantly in cervical and axillary LN malignancies. In conclusion, SWE is a promising adjunct imaging technique to conventional ultrasonography in the diagnosis of lymph node malignancy. SWE parameters of Emax and Esd have been identified as better choices of parameters for screening clinical purposes.
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The Role of Ultrasound in the Evaluation of Elbow Medial Ulnar Collateral Ligament Injuries in Throwing Athletes. Curr Rev Musculoskelet Med 2022; 15:535-546. [PMID: 36370301 PMCID: PMC9789266 DOI: 10.1007/s12178-022-09793-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Although ultrasound (US) imaging is commonly used to evaluate the elbow medial ulnar collateral ligament (mUCL) in throwing athletes, significant technical heterogeneity exists in the published literature and in practice. This has resulted in variable and often ambiguous US diagnostic criteria for mUCL injury. This review summarizes the literature on sonographic evaluation of the mUCL and outlines recommendations for consistent descriptive terminology, as well as future clinical and research applications. RECENT FINDINGS Both acute and chronic throwing loads in overhead athletes cause the mUCL to become thicker and more lax on stress testing, and these changes tend to revert after a period of prolonged rest. Stress US (SUS) can aid in the diagnosis of mUCL tears and may help identify athletes at risk of mUCL injury. Variability exists in terminology, elbow flexion angle, amount of stress applied, and technique of stress testing. Recent studies have suggested an injured elbow stress delta (SD-change in ulnohumeral joint (UHJ) space with valgus stress) of 2.4 mm and a stress delta difference (SDD-side-side difference in SD) of 1 mm each denote abnormal UHJ laxity due to mUCL injury. US imaging is a powerful and widely accessible tool in the evaluation elbow mUCL injuries. Sonologists should consider how their US techniques compare with published methods and use caution when applying diagnostic criteria outside of those circumstances. Currently, an SD of 2.4 mm and an SDD of 1 mm provide the best diagnostic accuracy for mUCL tears requiring surgery. Finally, preliminary work suggests that shear wave elastography may be helpful in evaluating the biomechanical properties of the mUCL, but additional research is needed.
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García González P, Escoda Menéndez S, Meana Morís A. Elastography in musculoskeletal imaging: A tool or a toy? RADIOLOGIA 2022; 64:566-572. [DOI: 10.1016/j.rxeng.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/30/2021] [Indexed: 11/18/2022]
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Yentes JM, Liu WY, Zhang K, Markvicka E, Rennard SI. Updated Perspectives on the Role of Biomechanics in COPD: Considerations for the Clinician. Int J Chron Obstruct Pulmon Dis 2022; 17:2653-2675. [PMID: 36274993 PMCID: PMC9585958 DOI: 10.2147/copd.s339195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) demonstrate extra-pulmonary functional decline such as an increased prevalence of falls. Biomechanics offers insight into functional decline by examining mechanics of abnormal movement patterns. This review discusses biomechanics of functional outcomes, muscle mechanics, and breathing mechanics in patients with COPD as well as future directions and clinical perspectives. Patients with COPD demonstrate changes in their postural sway during quiet standing compared to controls, and these deficits are exacerbated when sensory information (eg, eyes closed) is manipulated. If standing balance is disrupted with a perturbation, patients with COPD are slower to return to baseline and their muscle activity is differential from controls. When walking, patients with COPD appear to adopt a gait pattern that may increase stability (eg, shorter and wider steps, decreased gait speed) in addition to altered gait variability. Biomechanical muscle mechanics (ie, tension, extensibility, elasticity, and irritability) alterations with COPD are not well documented, with relatively few articles investigating these properties. On the other hand, dyssynchronous motion of the abdomen and rib cage while breathing is well documented in patients with COPD. Newer biomechanical technologies have allowed for estimation of regional, compartmental, lung volumes during activity such as exercise, as well as respiratory muscle activation during breathing. Future directions of biomechanical analyses in COPD are trending toward wearable sensors, big data, and cloud computing. Each of these offers unique opportunities as well as challenges. Advanced analytics of sensor data can offer insight into the health of a system by quantifying complexity or fluctuations in patterns of movement, as healthy systems demonstrate flexibility and are thus adaptable to changing conditions. Biomechanics may offer clinical utility in prediction of 30-day readmissions, identifying disease severity, and patient monitoring. Biomechanics is complementary to other assessments, capturing what patients do, as well as their capability.
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Affiliation(s)
- Jennifer M Yentes
- Department of Kinesiology & Sport Management, Texas A&M University, College Station, TX, USA
| | - Wai-Yan Liu
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, the Netherlands
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital, Eindhoven, the Netherlands
| | - Kuan Zhang
- Department of Electrical & Computer Engineering, University of Nebraska at Lincoln, Lincoln, NE, USA
| | - Eric Markvicka
- Department of Electrical & Computer Engineering, University of Nebraska at Lincoln, Lincoln, NE, USA
- Department of Mechanical & Materials Engineering, University of Nebraska at Lincoln, Lincoln, NE, USA
| | - Stephen I Rennard
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Xin Y, Liu F, Li D, Zhu J. Viscoelasticity assessment for in vivo quantification of muscle contusion injury in rats using shear wave elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2019-2028. [PMID: 35868906 DOI: 10.1016/j.ultrasmedbio.2022.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
The aim of the study described here was to investigate the role of viscoelasticity in assessing muscle fibrosis and inflammation in a rat model of contusion using quantitative shear wave elastography (SWE). Unilateral gastrocnemius muscle contusion was induced in 32 male rats using an impactor apparatus. The contralateral muscles served as the control group. SWE was applied to the control group and rats 1, 3, 14 and 21 d after successful modeling (each time point group, n = 8). Histologic features were used as reference standards. The degree of fibrosis was moderately correlated with shear wave speed (r = 0.53), whereas the degree of inflammation was well correlated with shear wave dispersion (SWD) slope (r = 0.74). The area under the receiver operating characteristic curve (AUC) for the dispersion slope for muscle inflammation and fibrosis assessment was 0.87 (95% confidence interval: 0.705-0.963), which exceeded that of the shear wave speed (0.68, 95% confidence interval: 0.494-0.834). The larger decline in dispersion slope in the fibrotic stage than in the inflammation stage (1-d group vs. 14-d group or 21-d group, p < 0.05) indicated better predictive performance than the shear wave speed.
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Affiliation(s)
- Yuwei Xin
- Department of Ultrasound, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing 100044, China
| | - Feifei Liu
- Department of Ultrasound, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing 100044, China
| | - Diancheng Li
- Department of Ultrasound, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing 100044, China
| | - Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing 100044, China.
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Guerri G, Palozzo A, Straticò P, Varasano V, Celani G, Di Francesco P, Vignoli M, Petrizzi L. 2D-SWE of the Metacarpophalangeal Joint Capsule in Horses. Vet Sci 2022; 9:vetsci9090478. [PMID: 36136694 PMCID: PMC9501397 DOI: 10.3390/vetsci9090478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Two-dimensional shear wave elastography (2D-SWE) employs an ultrasound impulse to produce transversely oriented shear waves, which travel through the surrounding tissue according to the stiffness of the tissue itself. The study aimed to assess the reliability of 2D-SWE for evaluating the elastosonographic appearance of the distal attachment of the fetlock joint capsule (DJC) in sound horses and in horses with osteoarthritis (OA) (2). According to a thorough evaluation of metacarpophalangeal joint (MCPJ), adult horses were divided in a sound Group (H) and in OA Group (P). Thereafter, a 2D-SWE of MCPJs was performed. Shear wave velocity (m/sec) and Young’s modulus (kPa) were calculated independently by two operators at each selected ROI. Statistical analysis was performed with R software. (3) Results: 2D-SWE had good–excellent inter-CC and intra-CC in both groups. Differences in m/s and kPa between Groups H and P were found in transverse scans with lower values in Group P. No correlation with age or DJC thickness was found. (4) Conclusions: 2D-SWE was repeatable and reproducible. In Group H, DJC was statistically stiffer than in Group P only in transverse scan. The technique showed poor sensitivity and specificity in differentiating fetlocks affected by OA.
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Affiliation(s)
- Giulia Guerri
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Adriana Palozzo
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Paola Straticò
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
- Correspondence:
| | - Vincenzo Varasano
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Gianluca Celani
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | | | - Massimo Vignoli
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Lucio Petrizzi
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
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Shear-Wave Elastography and Viscosity PLUS for the Assessment of Peripheric Muscles in Healthy Subjects: A Pre- and Post-Contraction Study. Diagnostics (Basel) 2022; 12:diagnostics12092138. [PMID: 36140536 PMCID: PMC9497738 DOI: 10.3390/diagnostics12092138] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 12/31/2022] Open
Abstract
Viscosity is a novel parameter, recently introduced in the use of elastographic techniques, correlating to shear-wave dispersion. The purpose of this study was to provide normal reference viscosity values for the peripheral muscles in healthy volunteers. This prospective study included 38 subjects who underwent US examinations between November 2021 and January 2022. Measurements were taken on the calf and the deltoid muscles in both pre- and post-contraction states. The age range was 21–29 years, with a median of 26 years. The SWE and ViPLUS values in the deltoid muscles were significantly higher than in the soleus muscles in both pre- and post-contraction sets (p = 0.002). There were statistically significant differences between the pre- and post-contraction values for both the SWE and ViPLUS values in the subgroup analysis. The ICC estimates and the 95% confidence intervals were based on a mean rating (k = 2), an absolute agreement, and a two-way random-effects model, demonstrating excellent agreement between the measurements taken by the two examiners.
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Schulze-Tanzil GG, Delgado-Calcares M, Stange R, Wildemann B, Docheva D. Tendon healing: a concise review on cellular and molecular mechanisms with a particular focus on the Achilles tendon. Bone Joint Res 2022; 11:561-574. [PMID: 35920195 PMCID: PMC9396922 DOI: 10.1302/2046-3758.118.bjr-2021-0576.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Tendon is a bradytrophic and hypovascular tissue, hence, healing remains a major challenge. The molecular key events involved in successful repair have to be unravelled to develop novel strategies that reduce the risk of unfavourable outcomes such as non-healing, adhesion formation, and scarring. This review will consider the diverse pathophysiological features of tendon-derived cells that lead to failed healing, including misrouted differentiation (e.g. de- or transdifferentiation) and premature cell senescence, as well as the loss of functional progenitors. Many of these features can be attributed to disturbed cell-extracellular matrix (ECM) or unbalanced soluble mediators involving not only resident tendon cells, but also the cross-talk with immigrating immune cell populations. Unrestrained post-traumatic inflammation could hinder successful healing. Pro-angiogenic mediators trigger hypervascularization and lead to persistence of an immature repair tissue, which does not provide sufficient mechano-competence. Tendon repair tissue needs to achieve an ECM composition, structure, strength, and stiffness that resembles the undamaged highly hierarchically ordered tendon ECM. Adequate mechano-sensation and -transduction by tendon cells orchestrate ECM synthesis, stabilization by cross-linking, and remodelling as a prerequisite for the adaptation to the increased mechanical challenges during healing. Lastly, this review will discuss, from the cell biological point of view, possible optimization strategies for augmenting Achilles tendon (AT) healing outcomes, including adapted mechanostimulation and novel approaches by restraining neoangiogenesis, modifying stem cell niche parameters, tissue engineering, the modulation of the inflammatory cells, and the application of stimulatory factors.Cite this article: Bone Joint Res 2022;11(8):561-574.
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Affiliation(s)
| | - Manuel Delgado-Calcares
- Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg, Germany
| | - Richard Stange
- Department of Regenerative Musculoskeletal Medicine, Institute for Musculoskeletal Medicine (IMM), University Hospital Münster, Münster, Germany
| | - Britt Wildemann
- Department of Experimental Trauma Surgery, University Hospital Jena, Jena, Germany
| | - Denitsa Docheva
- Department of Musculoskeletal Tissue Regeneration, Orthopaedic Hospital König-Ludwig-Haus, University of Würzburg, Würzburg, Germany
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Assessment of Neck Muscle Shear Modulus Normalization in Women with and without Chronic Neck Pain. Diagnostics (Basel) 2022; 12:diagnostics12081791. [PMID: 35892502 PMCID: PMC9331943 DOI: 10.3390/diagnostics12081791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
Identifying the objective stiffness of the neck muscles facilitates the early and specific diagnosis of neck pain and targeted therapy. However, individual variation in the muscle shear modulus obscures differences between healthy and diseased individuals. Normalization may improve the comparability between individuals. The shear modulus at different functional tasks served as a reference for normalizing the neck muscles’ shear modulus of 38 women, 20 with chronic neck pain and 18 asymptomatic. Reference tasks were maximal voluntary contraction, relaxed sitting, prone head lift, balancing 1 kg on the head, and neck extension at 48 N. The effects of normalization on within-group variation and between-group differences were compared. Normalization with maximal voluntary contraction was discarded due to imaging problems. Normalization with relaxed sitting, prone head lift, balancing 1 kg, and neck extension at 48 N reduced within-group variation, by 23.2%, 26.8%, 11.6%, and 33.6%, respectively. All four normalization approaches reduced the p-values when testing for between-group differences. For the pain group, normalization with relaxed sitting and head lift indicated less normalized muscle stiffness, while normalization with balancing 1 kg and extension at 48 N indicated higher stiffness. The contradictory results are explainable by non-significant group differences in the reference tasks. Normalization of the muscle shear modulus is effective to reduce within-group variation, but a trustworthy normalization approach for group comparisons has yet to be identified.
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Li H, Bhatt M, Qu Z, Zhang S, Hartel MC, Khademhosseini A, Cloutier G. Deep learning in ultrasound elastography imaging: A review. Med Phys 2022; 49:5993-6018. [PMID: 35842833 DOI: 10.1002/mp.15856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 02/04/2022] [Accepted: 07/06/2022] [Indexed: 11/11/2022] Open
Abstract
It is known that changes in the mechanical properties of tissues are associated with the onset and progression of certain diseases. Ultrasound elastography is a technique to characterize tissue stiffness using ultrasound imaging either by measuring tissue strain using quasi-static elastography or natural organ pulsation elastography, or by tracing a propagated shear wave induced by a source or a natural vibration using dynamic elastography. In recent years, deep learning has begun to emerge in ultrasound elastography research. In this review, several common deep learning frameworks in the computer vision community, such as multilayer perceptron, convolutional neural network, and recurrent neural network are described. Then, recent advances in ultrasound elastography using such deep learning techniques are revisited in terms of algorithm development and clinical diagnosis. Finally, the current challenges and future developments of deep learning in ultrasound elastography are prospected. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hongliang Li
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada.,Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada
| | - Manish Bhatt
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Zhen Qu
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Shiming Zhang
- California Nanosystems Institute, University of California, Los Angeles, California, USA
| | - Martin C Hartel
- California Nanosystems Institute, University of California, Los Angeles, California, USA
| | - Ali Khademhosseini
- California Nanosystems Institute, University of California, Los Angeles, California, USA
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada.,Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada.,Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montréal, Québec, Canada
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Valera-Calero JA, Sánchez-Jorge S, Buffet-García J, Varol U, Fernández-de-Las-Peñas C, Álvarez-González J. Changes in stiffness at active myofascial trigger points of the upper trapezius after dry needling in patients with chronic neck pain: a randomized controlled trial. Acupunct Med 2022:9645284221104831. [PMID: 35765779 DOI: 10.1177/09645284221104831] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVE Since, to our knowledge, the effects of dry needling (DN) on active myofascial trigger point (MTrP) stiffness have not been analyzed previously with shear wave elastography (SWE), our aim was to compare the effects of a single session of DN and sham DN applied to the most active MTrP located in the upper trapezius muscle on clinical outcomes. METHODS A randomized, double-blinded sham-controlled trial was conducted; 60 patients were randomized into an experimental (DN) or sham (sham DN) group. Baseline data including sociodemographic and clinical characteristics were collected. SWE and pain pressure thresholds (PPTs) at the MTrP and a control point located 3 cm laterally were the main outcomes assessed before and 10 min after the interventions. RESULTS Patients receiving DN interventions experienced greater increases in the control point PPTs immediately after receiving the intervention compared with sham DN (p < 0.05), but no differences were found for the MTrP (p > 0.05). Post-intervention PPT improvements were found at both locations for both groups (p < 0.01). No significant changes for either MTrP or control locations were found for SWE outcomes in either group (all ps > 0.05). No significant within-group SWE differences were found in the DN or sham DN groups (p > 0.05). CONCLUSION A single session of DN or sham DN applied to active MTrPs located in the upper trapezius muscle produced no detectable changes in stiffness at the MTrP or control locations. Real DN induced an immediate analgesic response at both MTrP and control locations, while sham DN induced an immediate MTrP response. TRIAL REGISTRATION NUMBER NCT04832074 (ClinicalTrials.gov).
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Affiliation(s)
- Juan Antonio Valera-Calero
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Madrid, Spain.,VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Madrid, Spain
| | | | | | - Umut Varol
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Madrid, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain
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Intraobserver Assessment of Shear Wave Elastography in Tensor Fasciae Latae and Gluteus Maximus Muscle: The Importance of the Hip Abductor Muscles in Runners Knee Compared to Healthy Controls. J Clin Med 2022; 11:jcm11133605. [PMID: 35806887 PMCID: PMC9267262 DOI: 10.3390/jcm11133605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Iliotibial band syndrome (ITBS) represents one of the most common running related injuries. The pathophysiology is postulated to be caused by excessive ITB tension, impingement and irritation of soft tissues at the lateral femoral epicondyle. However, direct evidence has yet to be found and the multifactorial etiology is under discussion. The purpose was to evaluate stiffness of ITB, gluteus maximus (GM) and tensor fasciae latae (TFL) muscles using shear wave elastography (SWE). Methods: In 14 patients with clinically verified ITBS and 14 healthy controls, three SWE measurements each of ITB, GM and TFL in both legs was performed to determine measurement reliability and between-group and -leg differences. Results: The mean value of ITB was 12.8 m/s with ICC of 0.76, whereas the values measured in the GM were 3.02 m/s with an ICC of 0.87. No statistically significant difference in controls compared to patients were found (p = 0.62). The mean value of TFL was 5.42 m/s in healthy participants, compared to 3.89 m/s patients with an ICC of 0.98 (p = 0.002). Conclusion: Although SWE showed no difference in ITB stiffness, significant differences for TFL muscle stiffness in runner’s knee was found, suggesting that the hip abductor muscles might play a bigger role in the pathophysiology of ITBS. We aimed to implement baseline values for stiffness assessments and prove reliability for further prospective studies of SWE in runner’s knee.
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Effect of Depth on Ultrasound Point Shear Wave Elastography in an Elasticity Phantom. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12136295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Phantom studies are widely used to assess variability in measurements. This study aimed to assess the reliability and accuracy of point Shear Wave elastography (pSWE) measurements of an elasticity phantom. Methods: Measurements were obtained by an experienced certified clinical sonographer at three different depth levels in kPa, using a curvilinear 5-1MHz transducer of the EPIQ7 ultrasound imaging system. Results: A total of 180 pSWE measurements were obtained at three different depth levels (three cm, five cm, and seven cm) of the phantom background. The mean CV of pSWE was low at all depths (3 cm: 8.8%; 5 cm: 7%; 7 cm: 7.2%). There was a significant difference between measurements at depths of 3 cm vs. 7 cm (MD: −0.85, 95% CI −1.5, −0.11, p = 0.024) and measurements at depths 5 cm vs. 7 cm (MD: −1.1, 95% CI −1.7, −0.47, p = 0.001). An overestimation of mean pSWE measurements at a depth of 7 cm was noted compared to the manufacturer’s value (2.7%, p = 0.006). Conclusions: Superficial phantom SWE measurements in this study had low variability compared to deep measurement. pSWE measurements at deep levels can be overestimated.
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Nakamura M, Akagi R. Ultrasonic shear-wave elastography: a novel method for assessing musculoskeletal soft tissue and nerves. Clin Neurophysiol 2022; 140:163-164. [DOI: 10.1016/j.clinph.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
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Cipriano KJ, Wickstrom J, Glicksman M, Hirth L, Farrell M, Livinski AA, Attaripour Esfahani S, Maldonado RJ, Astrow J, Berrigan WA, Piergies AM, Hobson-Webb LD, Alter KE. A scoping review of methods used in musculoskeletal soft tissue and nerve shear wave elastography studies. Clin Neurophysiol 2022; 140:181-195. [PMID: 35659822 PMCID: PMC9394639 DOI: 10.1016/j.clinph.2022.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 12/18/2022]
Abstract
This scoping review of shear wave elastography (SWE) articles in musculoskeletal soft tissue and nerve research demonstrates methodological heterogeneity resulting from a lack of standardized data collection and reporting requirements. Seven literature databases were searched for original articles published in English from 2004-2020 that examine human skeletal muscles, tendons, and nerves in vivo. Although 5,868 records were initially identified, only 375 reports met inclusion criteria. Of the 375 articles, 260 examined 89 unique muscles, 94 examined 14 unique tendons, and 43 examined 8 unique nerves. Cohorts were often small (n = 11-20) and young (mean = 20-29 years), and participants were typically tested in the prone position. Regarding equipment, a variety of ultrasound systems (n = 11), ultrasound models (n = 18), and transducers (n = 19) were identified. Only 11% of articles contained information on the use of electromyography to confirm absence of muscle activity, and only 8% reported measurement depth. Since musculoskeletal soft tissue and nerve stiffness can vary significantly based on data collection methods, it is essential to standardize SWE collection and reporting procedures. This will allow SWE to serve as a valid and reproducible tool for assessing tissue pathology, disease progression, and response to intervention within a variety of musculoskeletal and nerve-related disorders.
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