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Vatovec R, Voglar M. Changes of trunk muscle stiffness in individuals with low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord 2024; 25:155. [PMID: 38373986 PMCID: PMC10875766 DOI: 10.1186/s12891-024-07241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/29/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most common musculoskeletal conditions. People with LBP often display changes of neuromuscular control and trunk mechanical properties, including trunk stiffness. Although a few individual studies have examined back muscle stiffness in individuals with LBP, a synthesis of the evidence appears to be lacking. Therefore, the aim of this systematic review with meta-analysis was to synthesize and evaluate the available literature investigating back muscle stiffness in association with LBP. METHODS We conducted a systematic review of the literature according to the PRISMA guidelines. We searched Pubmed, Scopus, Web of Science and ScienceDirect for studies, that compared back muscle stiffness, measured either by ultrasound-based elastography or myotonometry, between individuals with and without LBP. Pooled data of the included studies were presented descriptively. Additionally, we performed two meta-analyses to calculate the standardized mean difference between the two groups for resting stiffness of the multifidus and erector spinae muscle. For both meta-analyses, the random effect model was used and the weight of individual studies was calculated using the inverse-variance method. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional studies. Furthermore, the certainty of evidence was evaluated using the GRADE approach. RESULTS Nine studies were included in our systematic review. Our results suggest that individuals with LBP have higher stiffness of the multifidus (SMD = 0.48, 95% CI: 0.15 - 0.81, p < 0.01; I2 = 48 %, p = 0.11) and erector spinae at rest (SMD = 0.37, 95% CI: 0.11 - 0.62, p < 0.01; I2 = 39 %, p = 0.14) compared to asymptomatic controls. On the other hand, the evidence regarding muscle stiffness during submaximal contractions is somewhat contradictory. CONCLUSIONS Based on the findings of this systematic review we conclude that people with LBP may have higher back muscle stiffness compared to asymptomatic controls. Addressing muscle stiffness might represent an important goal of LBP treatment. Nevertheless, our findings should be interpreted with extreme caution due to a limited quality of evidence, small number of included studies and differences in measurement methodology.
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Affiliation(s)
- Rok Vatovec
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310, Izola, Slovenia
| | - Matej Voglar
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310, Izola, Slovenia.
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Wang JC, Wu WT, Chang KV, Chen LR, Chi SY, Kara M, Özçakar L. Ultrasound Imaging for the Diagnosis and Evaluation of Sarcopenia: An Umbrella Review. Life (Basel) 2021; 12:life12010009. [PMID: 35054402 PMCID: PMC8781401 DOI: 10.3390/life12010009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 04/24/2023] Open
Abstract
There is an increasing number of reviews investigating the value of ultrasound (US) in the assessment of aging-related muscle loss. The present umbrella review aimed to systematically investigate the evidence of US imaging in the diagnosis and evaluation of sarcopenia. PubMed, Medline, Embase and Web of Science were searched from their inceptions to 31 October 2021. Systematic reviews and reviews using a systematic strategy for literature search were enrolled. The extracted data were narrated at the level of systematic reviews and meta-analyses. This umbrella review included four articles pertaining to 125 original studies and yielded several important findings. First, US is a reliable and valid imaging tool for the assessment of skeletal muscle mass. Second, among all the US parameters in B-mode, muscle thickness is the most commonly used one, which has good correlation with other standard measurements. Third, although sonoelastography and contrast-enhanced US are promising imaging modalities, their clinical utility is still limited at the current stage. Finally, a future systematic review is warranted to analyze how different ultrasonographic diagnostic criteria influence the prevalence of sarcopenia as well as its adverse health outcomes.
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Affiliation(s)
- Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, National Yang Ming University, Taipei 112202, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (L.-R.C.); (S.-Y.C.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (L.-R.C.); (S.-Y.C.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
- Correspondence: ; Tel.: +886-223-717-101-5309
| | - Lan-Rong Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (L.-R.C.); (S.-Y.C.)
| | - Shao-Yu Chi
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (L.-R.C.); (S.-Y.C.)
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey; (M.K.); (L.Ö.)
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey; (M.K.); (L.Ö.)
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Janczyk EM, Champigny N, Michel E, Raffaelli C, Annweiler C, Zory R, Guérin O, Sacco G. Sonoelastography to Assess Muscular Stiffness Among Older Adults and its Use for the Diagnosis of Sarcopenia: A Systematic Review. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:634-642. [PMID: 33187010 DOI: 10.1055/a-1293-8057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Changes in muscle stiffness have been reported with sarcopenia. Sonoelastography is an accessible and non-radiating imaging technique allowing quantification of elastic properties of tissue. We performed a systematic review of the literature to investigate whether sonoelastography can be a reliable method to assess sarcopenia in older patients. We searched Medline, Google Scholar, Scopus, SpringerLink and Science direct from January 1, 1990 to April 1, 2020. Three independent review authors assessed trial eligibility, extracted the data, and assessed risk of bias. We intended to learn which types of elastography have been tested, if such measures are repeatable, and if they have been compared to the currently accepted diagnostic method. Ten studies met the inclusion criteria. Most followed a cross-sectional design with young and older adult subgroups. The gastrocnemius, rectus femoris, and vastus intermedius appeared most frequently. Nine of the included studies used shear wave elastography and one-strain elastography. The passive elastic constant was significantly greater in sarcopenic versus healthy subjects after passive stretching (124.98 ± 60.82 vs. 46.35 ± 15.85, P = 0.004). However, even in non-sarcopenic patients, the age of the patient was responsible for about 45.5 % of the variance in SWV. Among ten included articles, four reported higher stiffness in the muscles of older adults, two reported lower stiffness, and four found no significant difference. Due to the substantial heterogenicity of actual data, we could not make any conclusions about the potential usefulness of elastography to assess sarcopenia. Further studies are needed, including a larger sample of older patients and using a standardized and reproducible protocol.
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Affiliation(s)
- Ewa Magdalena Janczyk
- Department of Therapeutic and Geriatric Medicine, University Hospital Centre of Nice, Côte d'Azur University, Nice, France
| | - Noémie Champigny
- Department of Therapeutic and Geriatric Medicine, University Hospital Centre of Nice, Côte d'Azur University, Nice, France
| | - Emeline Michel
- Department of Therapeutic and Geriatric Medicine, University Hospital Centre of Nice, Côte d'Azur University, Nice, France
- LAMHESS UPR 6312, Côte d'Azur University, Nice, France
| | - Charles Raffaelli
- Department of Ultrasounds, University Hospital Centre of Nice, Côte d'Azur University, Nice, France
| | - Cédric Annweiler
- Robarts Research Institute, Department of Medical Biophysics, University of Western Ontario Schulich School of Medicine and Dentistry, London, Canada
- UPRES EA 4638, University of Angers, France
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
| | - Raphael Zory
- LAMHESS UPR 6312, Côte d'Azur University, Nice, France
| | - Olivier Guérin
- Department of Therapeutic and Geriatric Medicine, University Hospital Centre of Nice, Côte d'Azur University, Nice, France
- Institute for Research on Cancer and Aging Nice (IRCAN) CNRS UMR 7284/INSERM U108, Côte d'Azur University, Nice, France
| | - Guillaume Sacco
- UPRES EA 4638, University of Angers, France
- Research Center Edmon and Lily Safra, Memory Clinic, University Hospital Centre Nice, Côte d'Azur University, Nice, France
- CoBTek Lab UPR 7276, Côte d'Azur University, Nice, France
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Yin L, Du L, Li Y, Xiao Y, Zhang S, Ma H, He W. Quantitative Evaluation of Gastrocnemius Medialis Stiffness During Passive Stretching Using Shear Wave Elastography in Patients with Parkinson's Disease: A Prospective Preliminary Study. Korean J Radiol 2021; 22:1841-1849. [PMID: 34431245 PMCID: PMC8546131 DOI: 10.3348/kjr.2020.1338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 01/11/2023] Open
Abstract
Objective To prospectively investigate the feasibility of shear wave elastography (SWE) as a new quantitative and objective method for evaluating the stiffness of the gastrocnemius medialis (GM) muscle during passive stretching in patients with Parkinson's disease (PD). Materials and Methods SWE of the GM muscle was performed in 28 patients with PD [13 female and 15 male; mean age ± standard deviation (SD): 63.0 ± 8.5 years] and 12 healthy controls (5 female and 7 male; mean age ± SD: 59.3 ± 6.4 years) during passive ankle rotation. A Young's modulus-ankle angle curve was constructed. The GM slack angle and baseline Young's modulus (E0) were compared between the markedly symptomatic and mildly symptomatic sides of patients with PD, and healthy controls. Additionally, the correlation between the GM slack angle and the severity of rigidity, and the observer reproducibility of SWE in determining the GM slack angle were evaluated. Results The GM slack angle was smaller on both the markedly and mildly symptomatic sides in patients with PD than in healthy controls (mean ± SD of −29.13° ± 3.79° and −25.65° ± 3.39°, respectively, vs. −21.22° ± 3.52°; p < 0.001 and p = 0.006, respectively). Additionally, in patients with PD, the GM slack angle on the markedly symptomatic side was smaller than that on the mildly symptomatic side (p = 0.003). The E0 value was lower on both the markedly and mildly symptomatic sides in patients with PD than in healthy controls (mean ± SD of 10.11 ± 2.85 kPa and 10.08 ± 1.88 kPa, respectively, vs. 12.23 ± 1.02 kPa; p = 0.012 and p < 0.001, respectively). However, no significant difference was found between the markedly and mildly symptomatic sides in patients with PD (p = 0.634). A negative linear relationship was observed between the GM slack angle and lower limb rigidity score on the markedly symptomatic side in patients with PD (r = −0.719; p < 0.001). The intraclass correlation coefficients for observer reproducibility of SWE ranged from 0.880 to 0.951. Conclusion The slack angle determined by SWE may be a useful quantitative and reproducible method for evaluating muscle stiffness in patients with PD.
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Affiliation(s)
- Lu Yin
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lijuan Du
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanzi Li
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Xiao
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Shiquan Zhang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Huizi Ma
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Cornelson SM, Ruff AN, Wells C, Sclocco R, Kettner NW. Sonographic measures and sensory threshold of the normal sciatic nerve and hamstring muscles. J Ultrasound 2021; 25:47-57. [PMID: 33515412 PMCID: PMC8964850 DOI: 10.1007/s40477-020-00552-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/13/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The sciatic nerve innervates the hamstring muscles. Occasionally, the sciatic nerve is injured along with a hamstring muscle. Detailed biomechanical and sensory thresholds of these structures are not well-characterized. Therefore, we designed a prospective study that explored high-resolution ultrasound (US) at multiple sites to evaluate properties of the sciatic nerve, including cross-sectional area (CSA) and shear-wave elastography (SWE). We also assessed SWE of each hamstring muscle at multiple sites. Mechanical algometry was obtained from the sciatic nerve and hamstring muscles to assess multi-site pressure pain threshold (PPT). METHODS Seventy-nine asymptomatic sciatic nerves and 147 hamstring muscles (25 males, 24 females) aged 18-50 years were evaluated. One chiropractic radiologist with 4.5 years of US experience performed the evaluations. Sciatic nerves were sampled along the posterior thigh at four sites obtaining CSA, SWE, and algometry. All three hamstring muscles were sampled at two sites utilizing SWE and algometry. Descriptive statistics, two-way ANOVA, and rater reliability were assessed for data analysis with p ≤ 0.05. RESULTS A significant decrease in sciatic CSA from proximal to distal was correlated with increasing BMI (p < 0.001). Intra-rater and inter-rater reliability for CSA was moderate and poor, respectively. Elastographic values significantly increased from proximal to distal with significant differences in gender and BMI (p = 0.002). Sciatic PPT significantly decreased between sites 1 and 2, 1 and 3, and 1 and 4. Significant correlation between gender and PPT was noted as well as BMI (p < 0.001). Hamstring muscle elastographic values significantly differed between biceps femoris and semitendinosus (p < 0.001) and biceps femoris and semimembranosus (p < 0.001). All three hamstring muscles demonstrated increased PPT in males compared to females (p < 0.001). In addition, PPT of the biceps femoris correlated with BMI (p = 0.02). CONCLUSION High-resolution US provided useful metrics of sciatic nerve size and biomechanical properties. PPT for the normal sciatic nerve and hamstring muscles was obtained for future clinical application.
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Affiliation(s)
- Stacey M Cornelson
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, 63017, USA.
| | - Ashley N Ruff
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, 63017, USA
| | - Courtney Wells
- Human Performance Center, Logan University, Chesterfield, MO, USA
| | - Roberta Sclocco
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, 63017, USA
- Department of Radiology, Athinoula. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Norman W Kettner
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, 63017, USA
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Liu X, Yu HK, Sheng SY, Liang SM, Lu H, Chen RY, Pan M, Wen ZB. Quantitative evaluation of passive muscle stiffness by shear wave elastography in healthy individuals of different ages. Eur Radiol 2020; 31:3187-3194. [PMID: 33052467 DOI: 10.1007/s00330-020-07367-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/27/2020] [Accepted: 10/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate age-related changes on passive muscle stiffness in healthy individuals and measure the shear modulus in different age groups. METHODS Shear wave elastography (SWE) movies of gastrocnemius medialis (GM) were collected during passive stretching induced by ankle rotation from plantarflexion (PF) to dorsiflexion (DF). A series of SWE images at ankle angles of PF 40°, PF 30°, PF 20°, PF 10°, 0°, DF 10°, DF 20°, and DF 30° were collected and shear moduli measured accordingly for analyses. RESULTS Eighty-six healthy volunteers (27 children, 31 middle-aged adults, and 28 older people) were recruited. No significant difference was observed in the shear modulus between the three groups at ankle angles of PF 40°, PF 30°, PF 20°, PF 10°, and 0° (p > 0.05). The difference in the shear modulus among the three groups became significant as DF increased. At ankle angles of DF 10°, DF 20°, and DF 30°, the shear modulus was the greatest in the older group, followed by the middle-aged group and then the children group (p = 0.007, 0.000, and 0.000, respectively). CONCLUSIONS Passive muscle stiffness increases with age, and the difference between age groups was pronounced only after reaching a certain degree of stretching. KEY POINTS • The influence of age on passive muscle stiffness becomes pronounced only after reaching a certain degree of stretching. • Age should be considered when evaluating passive muscle stiffness in muscular disorders.
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Affiliation(s)
- Xiao Liu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253, Gongye Avenue, Guangzhou, 510282, Guangdong, China
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, 6001, Beihuan Avenue, Shenzhen, 518034, Guangdong, China
| | - Hong-Kui Yu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253, Gongye Avenue, Guangzhou, 510282, Guangdong, China
| | - Shu-Ya Sheng
- Shenzhen Middle School, Shenzhen, Guangdong, China
| | - Si-Min Liang
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, 6001, Beihuan Avenue, Shenzhen, 518034, Guangdong, China
| | - Hao Lu
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, 6001, Beihuan Avenue, Shenzhen, 518034, Guangdong, China
| | - Rui-Yun Chen
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, 6001, Beihuan Avenue, Shenzhen, 518034, Guangdong, China
| | - Min Pan
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, 6001, Beihuan Avenue, Shenzhen, 518034, Guangdong, China.
| | - Zhi-Bo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, 253, Gongye Avenue, Guangzhou, 510282, Guangdong, China.
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Wang L, Xiang X, Zhu BH, Qiu L. Determination of reference ranges for normal upper trapezius elasticity during different shoulder abduction using shear wave elastography: a preliminary study. Sci Rep 2020; 10:17104. [PMID: 33051541 PMCID: PMC7555503 DOI: 10.1038/s41598-020-74307-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 09/15/2020] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study was to determine the reference ranges of normal upper trapezius (UT) elasticity during different shoulder abduction using shear wave elastography (SWE). Mean shear wave velocity (SWV) of UT elasticity in eighty healthy participants were measured at left and right shoulder 0° abduction and 90° passive abduction (L0°, R0°, L90°, R90°) with SWE. The effects of potential factors (gender, UT thickness, age, and body mass index) on UT elasticity were analyzed. The reference ranges of normal UT elasticity were calculated by using the normal distribution method. UT elasticity was significantly different among various shoulder abduction (P < 0.0001). UT elasticity was significantly higher in males at both L90° (P < 0.05) and R90° (P < 0.01) than in females. The reference ranges of normal UT elasticity were 2.90-4.01 m/s at L0° and 3.01-4.29 m/s at R0°, and were 4.90-6.40 m/s in males and 4.40-6.20 m/s in females at L90°, 5.20-7.02 m/s in males and 4.71-6.80 m/s in females at R90°. Our results suggest that gender should be considered when determining the reference ranges of normal UT elasticity at L90° and R90° with SWE. These values may provide quantitative baseline measurements for the assessment of UT muscle strain in the future.
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Affiliation(s)
- Lei Wang
- Department of Ultrasound, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.,Department of Ultrasound, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, Sichuan Province, China
| | - Xi Xiang
- Department of Ultrasound, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Bi-Hui Zhu
- Department of Ultrasound, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Li Qiu
- Department of Ultrasound, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
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