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Paramalingam S, Needham M, Bulsara M, Mastaglia FL, Keen HI. The longitudinal study of muscle changes with ultrasound: differential changes in idiopathic inflammatory myopathy subgroups. Rheumatology (Oxford) 2024; 63:490-497. [PMID: 37225404 DOI: 10.1093/rheumatology/kead239] [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: 02/23/2023] [Revised: 04/21/2023] [Accepted: 05/13/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVES We investigated shear wave elastography (SWE), B mode US and power Doppler (PDUS) as imaging biomarkers for longitudinal follow-up in idiopathic inflammatory myopathy (IIM), with a particular focus on immune-mediated necrotizing myopathy (IMNM) and DM. METHODS Participants had serial SWE, PDUS on the deltoid (D) and vastus lateralis (VL) muscles on four occasions at intervals of 3-6 months. Clinical assessments included manual muscle testing, and patient- and physician-reported outcome scales. RESULTS Thirty-three participants were included: IMNM = 17, DM = 12, overlap myositis = 3, PM = 1. Twenty were in a prevalent clinic group, and 13 were recently treated cases in an incident group. Differential changes in SWS and US domains occurred with time in both the prevalent and incident groups. In the VL-prevalent subgroup, echogenicity increased over time (P = 0.040), while in the incident cases there was a trend for reduction to normal over time (P = 0.097) with treatment. Muscle bulk reduced in the D-prevalent subgroup over time (P = 0.096), suggesting atrophy. SWS also reduced in the VL-incident subgroup over time (P = 0.096), suggesting a trend towards improvement in muscle stiffness with treatment. CONCLUSION SWE and US appear promising as imaging biomarkers for patient follow-up in IIM and indicate changes over time, especially with echogenicity, muscle bulk and SWS in the VL. Due to the limitations of the participant numbers, additional studies with a larger cohort are needed to help evaluate these US domains further and outline specific characteristics within the IIM subgroups.
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Affiliation(s)
- Shereen Paramalingam
- University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Merrilee Needham
- University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
- Department of Neurology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Frank L Mastaglia
- Perron Institute for Neurological and Translational Science, University of Western Australia, Australia
| | - Helen I Keen
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, University of Western Australia, Australia
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Götschi T, Snedeker JG, Fitze DP, Sarto F, Spörri J, Franchi MV. Three-dimensional mapping of ultrasound-derived skeletal muscle shear wave velocity. Front Bioeng Biotechnol 2023; 11:1330301. [PMID: 38179131 PMCID: PMC10764491 DOI: 10.3389/fbioe.2023.1330301] [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: 10/30/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction: The mechanical properties of skeletal muscle are indicative of its capacity to perform physical work, state of disease, or risk of injury. Ultrasound shear wave elastography conducts a quantitative analysis of a tissue's shear stiffness, but current implementations only provide two-dimensional measurements with limited spatial extent. We propose and assess a framework to overcome this inherent limitation by acquiring numerous and contiguous measurements while tracking the probe position to create a volumetric scan of the muscle. This volume reconstruction is then mapped into a parameterized representation in reference to geometric and anatomical properties of the muscle. Such an approach allows to quantify regional differences in muscle stiffness to be identified across the entire muscle volume assessed, which could be linked to functional implications. Methods: We performed shear wave elastography measurements on the vastus lateralis (VL) and the biceps femoris long head (BFlh) muscle of 16 healthy volunteers. We assessed test-retest reliability, explored the potential of the proposed framework in aggregating measurements of multiple subjects, and studied the acute effects of muscular contraction on the regional shear wave velocity post-measured at rest. Results: The proposed approach yielded moderate to good reliability (ICC between 0.578 and 0.801). Aggregation of multiple subject measurements revealed considerable but consistent regional variations in shear wave velocity. As a result of muscle contraction, the shear wave velocity was elevated in various regions of the muscle; showing pre-to-post regional differences for the radial assessement of VL and longitudinally for BFlh. Post-contraction shear wave velocity was associated with maximum eccentric hamstring strength produced during six Nordic hamstring exercise repetitions. Discussion and Conclusion: The presented approach provides reliable, spatially resolved representations of skeletal muscle shear wave velocity and is capable of detecting changes in three-dimensional shear wave velocity patterns, such as those induced by muscle contraction. The observed systematic inter-subject variations in shear wave velocity throughout skeletal muscle additionally underline the necessity of accurate spatial referencing of measurements. Short high-effort exercise bouts increase muscle shear wave velocity. Further studies should investigate the potential of shear wave elastography in predicting the muscle's capacity to perform work.
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Affiliation(s)
- Tobias Götschi
- Orthopaedic Biomechanics Laboratory, Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Department of Orthopaedics, Sports Medical Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jess G. Snedeker
- Orthopaedic Biomechanics Laboratory, Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Daniel P. Fitze
- Department of Orthopaedics, Sports Medical Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Orthopaedics, University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Fabio Sarto
- Department of Biomedical Sciences, Institute of Physiology, University of Padua, Padua, Italy
| | - Jörg Spörri
- Department of Orthopaedics, Sports Medical Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Orthopaedics, University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Martino V. Franchi
- Department of Orthopaedics, Sports Medical Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Biomedical Sciences, Institute of Physiology, University of Padua, Padua, Italy
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Coskun M, Sendur HN, Cerit MN, Babayeva A, Cerit ET, Yalcin MM, Altinova AE, Akturk M, Karakoc MA, Toruner FB. Assessment of forearm muscles with ultrasound shear wave elastography in patients with acromegaly. Pituitary 2023; 26:716-724. [PMID: 37899388 DOI: 10.1007/s11102-023-01352-1] [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] [Accepted: 08/24/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE The effects of acromegaly on soft tissues, bones and joints are well-documented, but information on its effects on muscle mass and quality remains limited. The primary goal of this study is to assess the sonoelastographic features of forearm muscles in patients with acromegaly. METHOD Forty-five patients with acromegaly and 45 healthy controls similar in terms of gender, age, and body mass index (BMI) were included in a single-center, multidisciplinary, cross-sectional study. The body composition was analyzed using bioelectrical impedance analysis (BIA), and height-adjusted appendicular skeletal muscle index (hSMI) was calculated. The dominant hand's grip strength was also measured. Two radiologists specialized in the musculoskeletal system employed ultrasound shear wave elastography (SWE) to assess the thickness and stiffness of brachioradialis and biceps brachii muscles. RESULTS The acromegaly group had significantly higher thickness of both the biceps brachii (p = 0.034) and brachioradialis muscle (p = 0.046) than the control group. However, the stiffness of the biceps brachii (p = 0.001) and brachioradialis muscle (p = 0.001) was lower in the acromegaly group than in the control group. Disease activity has not caused a significant difference in muscle thickness and stiffness in the acromegaly group (p > 0.05). The acromegaly group had a higher hSMI (p = 0.004) than the control group. The hand grip strength was similar between the acromegaly and control group (p = 0.594). CONCLUSION The patients with acromegaly have an increased muscle thickness but decreased muscle stiffness in the forearm muscles responsible for elbow flexion. Acromegaly can lead to a permanent deterioration of the muscular structure regardless of the disease activity.
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Affiliation(s)
- Meric Coskun
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey.
| | - Halit Nahit Sendur
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, 06100, Turkey
| | - Mahi Nur Cerit
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, 06100, Turkey
| | - Afruz Babayeva
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey
| | - Ethem Turgay Cerit
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey
| | - Mehmet Muhittin Yalcin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey
| | - Alev Eroglu Altinova
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey
| | - Mehmet Ayhan Karakoc
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Emniyet Street, Yenimahalle, Ankara, 06100, Turkey
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Lin CW, Shieh JY, Tsui PH, Chen CL, Lu CH, Hung YH, Lee HY, Weng WC, Gau SSF. Acoustic radiation force impulse shear wave elastography quantifies upper limb muscle in patients with Duchenne muscular dystrophy. ULTRASONICS SONOCHEMISTRY 2023; 101:106661. [PMID: 37924615 PMCID: PMC10641721 DOI: 10.1016/j.ultsonch.2023.106661] [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: 07/30/2023] [Revised: 10/09/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023]
Abstract
We investigated whether the upper limb muscle stiffness quantified by the acoustic radiation force impulse shear wave elastography (ARFI/SWE) is a potential biomarker for age-related muscle alteration and functional decline in patients with Duchenne muscular dystrophy (DMD). 37 patients with DMD and 30 typically developing controls (TDC) were grouped by age (3-8, 9-11, and 12-18 years). ARFI/SWE measured the biceps and deltoid muscle's shear wave velocities (SWVs). Performance of Upper Limb Module (PUL 1.2 module) assessed muscle function in DMD patients. Mann Whitney test compared muscle SWVs between DMD and TDC, stratified by three age groups. We used analysis of variance with Bonferroni correction to compare muscle SWVs between DMD and TDC and correlated muscle SWVs with PUL results in the DMD group. Results showed that the SWVs of biceps differentiated DMD patients from TDC across age groups. Younger DMD patients (3-8 years) exhibited higher SWVs (p = 0.013), but older DMD patients (12-18 years) showed lower SWVS (p = 0.028) than same-aged TDC. DMD patients had decreasing biceps SWVs with age (p < 0.001), with no such age effect in TDC. The SWVs of deltoid and biceps positively correlated with PUL scores (r = 0.527 ∼ 0.897, P < 0.05) and negatively correlated with PUL timed measures (r = -0.425 ∼ -0.542, P < 0.05) in DMD patients. Our findings suggest that ARFI/SWE quantifying the SWVs in upper limb muscle could be a potential biomarker to differentiate DMD from TDC across ages and that DMD patients showed age-related muscle alteration and limb functional decline.
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Affiliation(s)
- Chia-Wei Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei 10002, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, No.1, Chang-Te St., Taipei 10048, Taipei, Taiwan
| | - Jeng-Yi Shieh
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei 10002, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan Dist, Tao-Yuan City 33302, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei 10002, Taiwan
| | - Chun-Hao Lu
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan Dist, Tao-Yuan City 33302, Taiwan
| | - Yi-Hsuan Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7 Chung-Shan South Road, Taipei 10002, Taiwan
| | - Hsiao-Yuan Lee
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Rd., Zhubei City, Hsinchu County 302, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, Taiwan 10002, Taiwan; Department of Pediatric Neurology, National Taiwan University Children's Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan 10002, Taiwan.
| | - Susan Shur-Fen Gau
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, No.1, Chang-Te St., Taipei 10048, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, and College of Medicine, No. 7 Chung-Shan South Road, Taipei 10002, Taiwan; Graduate Institute of Brain and Mind Sciences, National Taiwan University, No.1 Jen Ai road section 1, Taipei 100 Taiwan.
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Zimmer M, Bunz EK, Ehring T, Kaiser B, Kienzlen A, Schlüter H, Zürn M. In Vivo Assessment of Shear Wave Propagation in Pennate Muscles Using an Automatic Ultrasound Probe Alignment System. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 4:259-267. [PMID: 38196975 PMCID: PMC10776096 DOI: 10.1109/ojemb.2023.3338090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/28/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024] Open
Abstract
Goal: Skeletal muscle mechanics can be assessed in vivo using shear wave elastography. However, the impact of pennation angle on shear wave velocity (SWV) remains unclear. This study aims to quantify the effect by automatically aligning the ultrasound probe with muscle fiber orientation. Methods: We propose an automatic ultrasound probe alignment system and compare it to manual and no alignment. SWV of the gastrocnemius medialis muscle of ten volunteers was measured during rest and isometric contractions. Results: The SWV was different between the conditions (p = 0.008). The highest SWV was obtained during the automatic alignment and differences between the conditions were most pronounced during high-level contractions. The automatic system yielded more accurate alignment compared to a manual operator (p = 0.05). Conclusions: The present study indicates that pennation angle affects SWV, hence muscle fiber orientation must be considered to reliably interpret SWV. Using automatic alignment systems allows for more accurate alignment, improving the methodology of ultrasound elastography in skeletal muscles.
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Affiliation(s)
- Manuela Zimmer
- Institute of Structural Mechanics and Dynamics in Aerospace EngineeringUniversity of Stuttgart70569StuttgartGermany
| | - Elsa K. Bunz
- Institute for Modelling and Simulation of Biomechanical SystemsUniversity of Stuttgart70569StuttgartGermany
| | - Tobias Ehring
- Institute of Applied Analysis and Numerical SimulationUniversity of Stuttgart70569StuttgartGermany
| | - Benedikt Kaiser
- Institute of Electrical Energy ConversionUniversity of Stuttgart70569StuttgartGermany
| | - Annika Kienzlen
- Institute for Control Engineering of Machine Tools and Manufacturing UnitsUniversity of Stuttgart70174StuttgartGermany
| | - Henning Schlüter
- Institute for Systems Theory and Automatic ControlUniversity of Stuttgart70569StuttgartGermany
| | - Manuel Zürn
- Institute for Control Engineering of Machine Tools and Manufacturing UnitsUniversity of Stuttgart70174StuttgartGermany
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Tan AL, Di Matteo A, Wakefield RJ, Biglands J. Update on muscle imaging in myositis. Curr Opin Rheumatol 2023; 35:395-403. [PMID: 37656661 PMCID: PMC10552815 DOI: 10.1097/bor.0000000000000975] [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: 09/03/2023]
Abstract
PURPOSE OF REVIEW Imaging techniques such as MRI, ultrasound and PET/computed tomography (CT) have roles in the detection, diagnosis and management of myositis or idiopathic inflammatory myopathy (IIM). Imaging research has also provided valuable knowledge in the understanding of the pathology of IIM. This review explores the latest advancements of these imaging modalities in IIM. RECENT FINDINGS Recent advancements in imaging of IIM have seen a shift away from manual and qualitative analysis of the images. Quantitative MRI provides more objective, and potentially more sensitive characterization of fat infiltration and inflammation in muscles. In addition to B-mode ultrasound changes, shearwave elastography offers a new dimension to investigating IIM. PET/CT has the added advantage of including IIM-associated findings such as malignancies. SUMMARY It is evident that MRI, ultrasound and PET/CT have important roles in myositis. Continued technological advancement and a quest for more sophisticated applications help drive innovation; this has especially been so of machine learning/deep learning using artificial intelligence and the developing promise of texture analysis.
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Affiliation(s)
- Ai Lyn Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital
| | - Andrea Di Matteo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital
| | - Richard J. Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital
| | - John Biglands
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital
- Department of Medical Physics & Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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de Visser M, Carlier P, Vencovský J, Kubínová K, Preusse C. 255th ENMC workshop: Muscle imaging in idiopathic inflammatory myopathies. 15th January, 16th January and 22nd January 2021 - virtual meeting and hybrid meeting on 9th and 19th September 2022 in Hoofddorp, The Netherlands. Neuromuscul Disord 2023; 33:800-816. [PMID: 37770338 DOI: 10.1016/j.nmd.2023.08.014] [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: 08/09/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023]
Abstract
The 255th ENMC workshop on Muscle Imaging in Idiopathic Inflammatory myopathies (IIM) aimed at defining recommendations concerning the applicability of muscle imaging in IIM. The workshop comprised of clinicians, researchers and people living with myositis. We aimed to achieve consensus on the following topics: a standardized protocol for the evaluation of muscle images in various types of IIMs; the exact parameters, anatomical localizations and magnetic resonance imaging (MRI) techniques; ultrasound as assessment tool in IIM; assessment methods; the pattern of muscle involvement in IIM subtypes; the application of MRI as biomarker in follow-up studies and clinical trials, and the place of MRI in the evaluation of swallowing difficulty and cardiac manifestations. The following recommendations were formulated: In patients with suspected IIM, muscle imaging is highly recommended to be part of the initial diagnostic workup and baseline assessment. MRI is the preferred imaging modality due to its sensitivity to both oedema and fat accumulation. Ultrasound may be used for suspected IBM. Repeat imaging should be considered if patients do not respond to treatment, if there is ongoing diagnostic uncertainty or there is clinical or laboratory evidence of disease relapse. Quantitative MRI is established as a sensitive biomarker in IBM and could be included as a primary or secondary outcome measure in early phase clinical trials, or as a secondary outcome measure in late phase clinical trials. Finally, a research agenda was drawn up.
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Affiliation(s)
- Marianne de Visser
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centre, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Jiří Vencovský
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Kateřina Kubínová
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Corinna Preusse
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Department of Neuropathology, Berlin, Germany
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Lee J, Myrie NO, Jeong GJ, Han WM, Jang YC, García AJ, Emelianov S. In vivo shear wave elasticity imaging for assessment of diaphragm function in muscular dystrophy. Acta Biomater 2023; 168:277-285. [PMID: 37453552 PMCID: PMC10540053 DOI: 10.1016/j.actbio.2023.07.009] [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: 02/25/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
Duchenne muscular dystrophy (DMD) causes patients to suffer from ambulatory disability and cardiorespiratory failure, the latter of which leads to premature death. Due to its role in respiration, the diaphragm is an important muscle for study. A common method for evaluating diaphragm function is ex vivo force testing, which only allows for an end point measurement. In contrast, ultrasound shear wave elastography imaging (US-SWEI) can assess diaphragm function over time; however, US-SWEI studies in dystrophic patients to date have focused on the limbs without preclinical studies. In this work, we used US-SWEI to estimate the shear wave speed (SWS) in diaphragm muscles of healthy (WT) mice, mdx mice, and mdx mice haploinsufficient for utrophin (mdx-utr) at 6 and 12 months of age. Diaphragms were then subjected to ex vivo force testing and histological analysis at 12 months of age. Between 6 and 12 months, a 23.8% increase in SWS was observed in WT mice and a 27.8% increase in mdx mice, although no significant difference was found in mdx-utr mice. Specific force generated by mdx-utr diaphragms was lower than that of WT diaphragms following twitch stimulus. A strong correlation between SWS and collagen deposition was observed, as well as between SWS and muscle fiber size. Together, these data demonstrate the ability of US-SWEI to evaluate dystrophic diaphragm functionality over time and predict the biochemical and morphological make-up of the diaphragm. Additionally, our results highlight the advantage of US-SWEI over ex vivo testing by obtaining longitudinal measurements in the same subject. STATEMENT OF SIGNIFICANCE: In DMD patients, muscles experience cycles of regeneration and degeneration that contribute to chronic inflammation and muscle weakness. This pathology only worsens with time and leads to muscle wasting, including in respiratory and cardiac muscles. Because respiratory failure is a major contributor to premature death in DMD patients, the diaphragm muscle is an important muscle to evaluate and treat over time. Currently, diaphragm function is assessed using ex vivo force testing, a technique that only allows measurement at sacrifice. In contrast, ultrasonography, particularly shear wave elasticity imaging (USSWEI), is a promising tool for longitudinal assessment; however, most US-SWEI in DMD patients aimed for limb muscles only with the absence of preclinical studies. This work broadens the applications of US-SWE imaging by demonstrating its ability to track properties and function of dystrophic diaphragm muscles longitudinally in multiple dystrophic mouse models.
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Affiliation(s)
- Jeehyun Lee
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Nia O Myrie
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Gun-Jae Jeong
- Institute of Cell and Tissue Engineering, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Woojin M Han
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Young C Jang
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA; Department of Orthopedics, Emory Musculoskeletal Institute, Emory School of Medicine, Atlanta, GA 30329, USA.
| | - Andrés J García
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA.
| | - Stanislav Emelianov
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA.
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Xu W, Zheng Y, Jiang Y, Zhang Z, Ma S, Cao Y. Shear wave imaging the active constitutive parameters of living muscles. Acta Biomater 2023; 166:400-408. [PMID: 37230437 DOI: 10.1016/j.actbio.2023.05.035] [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: 11/28/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
Shear wave elastography (SWE) of human skeletal muscles allows for measurement of muscle elastic properties in vivo and has important applications in sports medicine and for the diagnosis and treatment of muscle-related diseases. Existing methods of SWE for skeletal muscles rely on the passive constitutive theory and have so far been unable to provide constitutive parameters describing muscle active behavior. In the present paper, we overcome this limitation by proposing a SWE method for quantitative inference of active constitutive parameters of skeletal muscles in vivo. To this end, we investigate the wave motion in a skeletal muscle described by a constitutive model in which muscle active behavior has been defined by an active parameter. An analytical solution relating shear wave velocities to both passive and active material parameters of muscles is derived, based upon which an inverse approach has been developed to evaluate these parameters. To demonstrate the usefulness of the reported method, in vivo experiments were carried out on 10 volunteers to obtain constitutive parameters, particularly those describing active deformation behaviors of living muscles. The results reveal that the active material parameter of skeletal muscles varies with warm-up, fatigue and rest. STATEMENT OF SIGNIFICANCE: Existing shear wave elastography methods are limited to imaging the passive parameters of muscles. This limitation is addressed in the present paper by developing a method to image the active constitutive parameter of living muscles using shear waves. We derived an analytical solution demonstrating the relationship between constitutive parameters of living muscles and shear waves. Relying on the analytical solution, we proposed an inverse method to infer active parameter of skeletal muscles. We performed in vivo experiments to demonstrate the usefulness of the theory and method; the quantitative variation of the active parameter with muscle states such as warm-up, fatigue and rest has been reported for the first time.
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Affiliation(s)
- Weiqiang Xu
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, PR China
| | - Yang Zheng
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, PR China
| | - Yuxuan Jiang
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, PR China
| | - Zhaoyi Zhang
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, PR China
| | - Shiyu Ma
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, PR China
| | - Yanping Cao
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, PR China.
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Chen W, Li C, Wang Y, Shen X, Wu Z, Li J, Ye Z, Xiang R, Xu X. Comparison of the asymmetries in muscle mass, biomechanical property and muscle activation asymmetry of quadriceps femoris between patients with unilateral and bilateral knee osteoarthritis. Front Physiol 2023; 14:1126116. [PMID: 37284540 PMCID: PMC10239935 DOI: 10.3389/fphys.2023.1126116] [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: 12/17/2022] [Accepted: 04/25/2023] [Indexed: 06/08/2023] Open
Abstract
Background: More and more attention has been paid to the research of muscle mass and muscle quality of quadriceps femoris (QF) in knee osteoarthritis (KOA). This study aimed to explore the asymmetric changes of muscle mass, biomechanical property and muscle activation in the inter-limbs QF of KOA patients, and tried to provide a novel insight for the evaluation, prevention and treatment of KOA. Methods: A total of 56 Participants with unilateral or bilateral KOA were included in this study: 30 patients with unilateral pain and 26 patients with bilateral pain were assigned to the bilateral group (BG) and unilateral group (UG), respectively. The symptom severity of bilateral lower limbs was evaluated by visual analogue scale, and the relatively serious leg (RSL) and relatively moderate leg (RML) were classified. The thickness of rectus femoris (RF), vastus intermedius (VI), vastus medialis (VM) and vastus lateralis (VL) were measured by ultrasound. The Shear wave elastography (SWE) techniqie was used to measure the shear modulus of RF, VM and VL. Surface electromyography (sEMG) was used to assess the root mean square (RMS) of the RF, VM, and VL during straight leg raising in a sitting position and squatting task. We calculated the asymmetry indexes of inter-limbs for the corresponding indices of the measured muscles. Result: Thickness of RF, VI and VL of RSL was lower than those on RML (p < 0.05), and thickness of VM was lower more significant (p < 0.01). Thickness of RF, VI and VL of RSL was also lower than those of RML in BG (p < 0.05), however, there was no significant difference in VM thickness (p > 0.05). There were no significant difference in Asymmetry indexes of all measured muscle thickness between the two groups (p > 0.05). The Shear modulus of RF, VM, and VL in the RML of UG and BG was higher than those in the RSL (p < 0.05). In sitting and straight leg raising task, the RMS of RF, VM and VL in RML were higher than those in RSL, UG and BG both showed this trend (p < 0.05). About squatting task, in UG, the RMS of the three muscles in RML of patients were also higher than those in the RSL (p < 0.05). However, the difference was not significant in BG (p > 0.05). In the straight leg raising task, the asymmetry indexes of RMS in RF, VM, and VL of both the two groups were positively correlated with VAS scores (p < 0.05). Conclusion: The muscle thickness, shear modulus and muscle activation electromyography of QF in RML were higher than those of RSL in unilateral KOA patients. The VM of RML in bilateral KOA patients may show muscle thickness degeneration earlier, which is closer to the VM of RSL. The shear modulus of RF, VM, and VL were higher on the RML side during the single-leg task, but there may be passive compensation for muscle activation in both lower limbs during the bipedal task. In conclusion, there is a general asymmetry of QF muscle mass, biomechanics Characteristic and performance in patients with KOA, which may provide new ideas for the assessment, treatment and rehabilitation of the disease.
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Affiliation(s)
- Weijian Chen
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Congcong Li
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Wang
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xingxing Shen
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zugui Wu
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junyi Li
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zixuan Ye
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ruian Xiang
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuemeng Xu
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China
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11
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Yi J, Cha JG, Hahn S. Comparison of shear wave elastography with gray-scale USG and CT for quantitative evaluation of rectus femoris muscle. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:703-710. [PMID: 36710597 DOI: 10.1002/jcu.23435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE The purpose of this study was to compare the measurement of shear wave elastography (SWE) and gray scale ultrasonography (GSU) and CT attenuation of mid-rectus femoris (RF) muscle in healthy adults. METHODS This prospective study included 70 participants with a healthy body mass index (<25 kg/m2 ) between June 2019 and January 2020. Echo intensity (EI) grading of RF on GSU was performed. SWE was performed for the three levels of the RF. Measurements were repeated 10 min after the first measurement. The mid-RF attenuation on CT was also measured. Interobserver agreement of EI grade among three readers was assessed using weighted-kappa statistics. The reliability of SWE was assessed using intraclass correlation coefficient. The correlations between the SWE and CT/GSU measurements were analyzed. RESULTS Interobserver agreement of EI grade on GSU by the three radiologists was moderate to substantial (k = 0.562-0.767). The inter-session agreements for SWE were almost perfect for mid RF (k = 0.822-0.829) and substantial for proximal and distal RF (k = 0.767-0.795). There were significant correlations between SWE-EI and SWE-CT attenuation (p < 0.001, respectively) at the mid-RF. CONCLUSIONS SWE measurements on mid-RF demonstrated the highest reliability. SWE parameters showed a strong correlation with EI on GSU and attenuation on CT.
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Affiliation(s)
- Jisook Yi
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Seok Hahn
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
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12
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Zubair AS, Salam S, Dimachkie MM, Machado PM, Roy B. Imaging biomarkers in the idiopathic inflammatory myopathies. Front Neurol 2023; 14:1146015. [PMID: 37181575 PMCID: PMC10166883 DOI: 10.3389/fneur.2023.1146015] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Idiopathic inflammatory myopathies (IIMs) are a group of acquired muscle diseases with muscle inflammation, weakness, and other extra-muscular manifestations. IIMs can significantly impact the quality of life, and management of IIMs often requires a multi-disciplinary approach. Imaging biomarkers have become an integral part of the management of IIMs. Magnetic resonance imaging (MRI), muscle ultrasound, electrical impedance myography (EIM), and positron emission tomography (PET) are the most widely used imaging technologies in IIMs. They can help make the diagnosis and assess the burden of muscle damage and treatment response. MRI is the most widely used imaging biomarker of IIMs and can assess a large volume of muscle tissue but is limited by availability and cost. Muscle ultrasound and EIM are easy to administer and can even be performed in the clinical setting, but they need further validation. These technologies may complement muscle strength testing and laboratory studies and provide an objective assessment of muscle health in IIMs. Furthermore, this is a rapidly progressing field, and new advances are going to equip care providers with a better objective assessment of IIMS and eventually improve patient management. This review discusses the current state and future direction of imaging biomarkers in IIMs.
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Affiliation(s)
- Adeel S. Zubair
- Division of Neuromuscular Diseases, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Sharfaraz Salam
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Mazen M. Dimachkie
- Department of Neurology, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Pedro M. Machado
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Centre for Rheumatology, Division of Medicine, University College London, London, United Kingdom
| | - Bhaskar Roy
- Division of Neuromuscular Diseases, Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
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13
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Xie Y, Thomas L, Johnston V, Coombes BK. Cervical and axioscapular muscle stiffness measured with shear wave elastography: A comparison between different levels of work-related neck disability. J Electromyogr Kinesiol 2023; 69:102754. [PMID: 36773478 DOI: 10.1016/j.jelekin.2023.102754] [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: 11/01/2022] [Revised: 12/21/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Assessing muscle mechanical properties in terms of stiffness may provide important insights into mechanisms underlying work-related neck pain. This study compared stiffness of cervical and axioscapular muscles between 92 participants (sonographers) with no (n = 31), mild (n = 43) or moderate/severe (n = 18) neck disability. It was hypothesized that participants with more severe neck pain and disability would present with altered distribution of stiffness in cervical and axioscapular muscles than those with no disability. Using shear wave elastography, the shear modulus (kPa) of five cervical and six axioscapular muscles or muscle segments were measured in a relaxed seated upright or side-lying position. Muscle activity was measured simultaneously using surface electromyography during the elastography measurements and scapular depression was measured using a measurement tape and inclinometer before the elastography measurements to evaluate their potential confounding influences on shear modulus. Increased shear modulus was found in deeper than superficial cervical muscles and more cranial than caudal axioscapular muscles. However, no differences in shear modulus of the cervical or axioscapular muscles were found between sonographers with varying levels of disability. This study suggests no alterations in stiffness of cervical and axioscapular muscles were associated with work-related neck pain and disability.
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Affiliation(s)
- Yanfei Xie
- RECOVER Injury Research Centre, The University of Queensland, Australia.
| | - Lucy Thomas
- School of Health and Rehabilitation Science, The University of Queensland, Australia
| | - Venerina Johnston
- School of Health and Rehabilitation Science, The University of Queensland, Australia; School of Health and Medical Sciences, University of Southern Queensland, Australia
| | - Brooke K Coombes
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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14
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Shin KJ, Yi J, Hahn S. Shear-wave elastography evaluation of thenar muscle in carpal tunnel syndrome. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:510-517. [PMID: 36201602 DOI: 10.1002/jcu.23359] [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: 08/25/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE We aim to evaluate the shear wave velocity (SWV) of the thenar muscle as an adjunct diagnostic tool for carpal tunnel syndrome (CTS). METHODS Ninety-two wrists with CTS and 30 control wrists without CTS underwent ultrasonographic evaluation of thenar muscle and median nerve including shear-wave elastography. Cross sectional area (CSA) of medial nerve and SWV of thenar muscle and median nerve were evaluated. CTS patients were assessed for Boston CTS, Padua CTS, modified Hirani grading scores, and nerve conduction study (NCS). SWVs, CSA, and NCS parameters were compared between two groups. RESULTS The SWVs of thenar muscle and median nerve (p < 0.001, respectively), and CSA of median nerve (p < 0.001) were more significantly greater in patients with CTS than in controls. The SWV of median nerve was moderately correlated with CSA of median nerve (r = 0.35, p < 0.001) and modified Hirani CTS score (r = 0.35, p < 0.001). The SWV of thenar muscle was inversely correlated with modified Hirani CTS score (r = -0.21, p = 0.04). CONCLUSION The SWV of thenar muscle and median nerve of CTS were significantly increased compared to that of control, and significantly negatively correlated with NCS parameters (modified Hirani CTS score). SWVs may be used as an adjunct diagnostic tool for CTS.
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Affiliation(s)
- Kyong Jin Shin
- Department of Neurology, Haeundae-Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jisook Yi
- Department of Radiology, Haeundae-Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Seok Hahn
- Department of Radiology, Haeundae-Paik Hospital, Inje University College of Medicine, Busan, South Korea
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15
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Wolfram S, Takayesu JSK, Pierce LJ, Jagsi R, Lipps DB. Changes in pectoralis major stiffness and thickness following radiotherapy for breast cancer: A 12-month follow-up case series. Radiother Oncol 2023; 179:109450. [PMID: 36572281 DOI: 10.1016/j.radonc.2022.109450] [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: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Radiotherapy (RT) is a common and often essential treatment for breast cancer, but has been associated with pectoralis major (PM) muscle fibrosis and atrophy. In an initial prospective evaluation, we assessed muscle stiffness and muscle thickness of the sternocostal and clavicular regions of the PM with ultrasound shear wave elastography and B-mode imaging. Changes in PM muscle stiffness and thickness following RT can be detected within the first twelve months of RT completion. These parameters may potentially be useful for screening of patients who would benefit from post-RT physical therapy. Further studies with larger sample sizes that include patients who receive nodal radiation are necessary to confirm these findings.
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Affiliation(s)
- Susann Wolfram
- School of Kinesiology: University of Michigan, 830 N. University Ave., School of Kinesiology Building 1250, Ann Arbor, MI 48109, USA.
| | - Jamie Seul Ki Takayesu
- Department of Radiation Oncology: University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA.
| | - Lori Jo Pierce
- Department of Radiation Oncology: University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA.
| | - Reshma Jagsi
- Department of Radiation Oncology: University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA.
| | - David Benjamin Lipps
- School of Kinesiology: University of Michigan, 830 N. University Ave., School of Kinesiology Building 1250, Ann Arbor, MI 48109, USA.
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16
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Li M, Guo R, Tang X, Huang S, Qiu L. Quantitative assessment of muscle properties in polymyositis and dermatomyositis using high-frequency ultrasound and shear wave elastography. Quant Imaging Med Surg 2023; 13:428-440. [PMID: 36620135 PMCID: PMC9816716 DOI: 10.21037/qims-22-423] [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: 04/27/2022] [Accepted: 10/24/2022] [Indexed: 11/24/2022]
Abstract
Background Polymyositis (PM) and dermatomyositis (DM) are two common types of idiopathic inflammatory myopathy and can lead to a poor prognosis and quality of life. We designed this cross-sectional study to investigate the abilities of high-frequency ultrasound (HFUS) and shear wave elastography (SWE) to assess muscle properties in patients with PM and DM and to distinguish healthy muscles from diseased muscles with PM and DM. Methods A total of 60 patients (26 PM cases and 34 DM cases) and 65 matched healthy volunteers were continuously included in the case and control groups, respectively. For the bilateral deltoid, biceps brachii, rectus femoris, and vastus lateralis, the muscle thickness, echo intensity, and longitudinal shear wave velocity (SWV) of all participants were measured using HFUS and SWE. The intra- and interobserver reliability of SWV measurements of patients with PM and DM and the receiver operating characteristic curve for HFUS and SWE for PM and DM were analyzed. Results Patients with PM and DM had significantly decreased muscle thickness and increased muscle echo intensity compared to healthy controls (P<0.001). The patients' and healthy participants' deltoid, biceps brachii, rectus femoris, and vastus lateralis thickness was 19.75 and 23.00 mm, 20.45 and 22.80 mm, 18.40 and 20.20 mm, and 20.00 and 22.80 mm, respectively. Except for the biceps brachii, the mean SWV in the longitudinal orientation in patients with PM and DM significantly decreased (P<0.01). The mean SWV of the patients' and healthy participants' deltoid, rectus femoris, and vastus lateralis was 2.47 and 2.57 m/s, 1.73 and 1.87 m/s, and 1.57 and 1.77 m/s, respectively. Excellent intra- and interobserver reliability of SWV measurements on the deltoid and rectus femoris of PM and DM patients were found (intraclass correlation coefficient >0.95; P<0.001). The diagnostic performance of echo intensity in lower-extremity proximal muscles for PM and DM was excellent [area under the curve (AUC) >0.9]. The thickness of most muscles displayed moderate diagnostic performance (the AUC ranged from 0.700 to 0.775). The SWV of the vastus lateralis showed a stable performance (AUC =0.741). The combined diagnostic performance of echo intensity and thickness and the combined diagnostic performance of the 3 indicators were relatively high (the AUC ranged from 0.871 to 0.936 and from 0.898 to 0.938, respectively). Muscle thickness and echo intensity showed statistical differences in different disease stages of PM and DM (P'<0.01). Conclusions HFUS and SWE may serve as imaging biomarkers for the diagnosis of PM and DM by detecting abnormal muscle thinning, enhanced muscle echo intensity, and reduced muscle SWV.
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Affiliation(s)
- Min Li
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Ruiqian Guo
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Xinyi Tang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Songya Huang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Li Qiu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
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17
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Roots J, Trajano GS, Drovandi C, Fontanarosa D. Variability of Biceps Muscle Stiffness Measured Using Shear Wave Elastography at Different Anatomical Locations With Different Ultrasound Machines. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:398-409. [PMID: 36266142 DOI: 10.1016/j.ultrasmedbio.2022.09.009] [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: 04/08/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Shear wave elastography is an emerging diagnostic tool used to assess for changes in the stiffness of muscle. Each region of the muscle may have a different stiffness; therefore, the anatomical region should be carefully selected. Machine vendors each have unique methods for calculating the returned stiffness values and, consequently, a high level of agreement in measurement between machines (quantified using the intraclass correlation coefficient [ICC] and Bland-Altman analysis) will allow research findings to be translated to the clinic. This study assessed three locations within the biceps muscle (50% and 75% of the distance between the acromioclavicular joint and antecubital fossa, and superior to distal myotendinous junction [MTJ]) of 32 healthy volunteers with two different machines, the Canon Aplio i600 and SuperSonic Imagine Aixplorer (SSI), to compare the reported shear wave velocities and the variability by coefficient of variation (CV) and ICC. There was no difference in the CV between machines, but a significant difference in the CV at muscle regions, with the 75% location having a 40.2% reduction in CV. The 75% location had the highest ICC values with good posterior mean ICCs of 0.84 on the Canon and 0.83 on the SSI. The 50% and MTJ locations had poor ICC values. The 75% location provided the lowest CV and highest ICC and should be used for future stiffness assessments.
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Affiliation(s)
- Jacqueline Roots
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Gabriel S Trajano
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christopher Drovandi
- Centre of Data Science, Queensland University of Technology, Brisbane, Queensland, Australia; School of Mathematical Sciences, Faculty of Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
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18
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Piepenburg SM, Maslarska M, Freund G, Kaier K, von Zur Mühlen C, Westermann D, Hehrlein C. Weakness of lower limb muscle in symptomatic peripheral artery disease with media sclerosis detected by ultrasound shear wave elastography. VASA 2023; 52:46-53. [PMID: 36412039 DOI: 10.1024/0301-1526/a001039] [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: 11/23/2022]
Abstract
Background: Symptomatic peripheral arterial disease (PAD) is difficult to non-invasively diagnose in the presence of calcified, media sclerotic arteries that are incompressible by blood pressure cuffs. Standard ankle-brachial index (ABI) measurements in these PAD patients are very often not helpful. Shear wave elastography (SWE) is a modern ultrasound technique to detect peripheral muscle stiffness changes i.e. muscle weakness during exercise. In a pilot study, we examined whether SWE could be a reproducible tool for diagnosing ischemic loss of muscle stiffness in patients with PAD and concomitant arterial media sclerosis. Patients and methods: N=13 consecutive patients with peripheral artery disease and media sclerosis were enrolled in the pilot study. All 13 patients were symptomatic in different stages of their PAD due to hemodynamically relevant arterial stenosis or occlusions of limb arteries as confirmed by oscillography, color-coded duplex sonography or angiography. Results: ABI measurements were invalid in all 13 patients. Mean SWE measurements of medial gastrocnemius muscles showed a significant transient muscle stiffness loss (weakness) at maximum exercise (active dorsal flexion of the foot, 103.4±25.9 kPa on the asymptomatic vs. 62.5±21.9 kPa on the symptomatic limb (p<0.001). Conclusions: SWE can reproducibly detect peripheral muscle weakness during exercise in the symptomatic leg of media sclerotic PAD patients. SWE of lower limb muscles may help to identify symptomatic PAD in patients presenting with invalid ABI measurements and unclear vascular status.
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Affiliation(s)
- Sven M Piepenburg
- Department of Cardiology and Angiology, Interdisciplinary Vascular Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Germany
| | - Mariya Maslarska
- Department of Cardiology and Angiology, Interdisciplinary Vascular Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Germany
| | - Gabriele Freund
- Department of Cardiology and Angiology, Interdisciplinary Vascular Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.,Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Germany
| | - Constantin von Zur Mühlen
- Department of Cardiology and Angiology, Interdisciplinary Vascular Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Germany.,Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Interdisciplinary Vascular Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Germany
| | - Christoph Hehrlein
- Department of Cardiology and Angiology, Interdisciplinary Vascular Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Germany
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Vuorenmaa AS, Siitama EMK, Mäkelä KS. Inter-operator and inter-device reproducibility of shear wave elastography in healthy muscle tissues. J Appl Clin Med Phys 2022; 23:e13717. [PMID: 35793227 PMCID: PMC9512333 DOI: 10.1002/acm2.13717] [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] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/06/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose The study aimed to assess whether the more limiting factor in reproducibility of shear wave elastography (SWE) would be the operator dependency or the incompatibility of different ultrasound (US) devices. The interrater agreement with less experienced operators was studied. Methods A total of 24 healthy volunteers participated in the study (18 females, 6 males; range of age 27–55 years). SWE of biceps brachii (BB) and tibialis anterior (TA) muscles was performed on both sides from all participants in both longitudinal and transverse orientation of the transducer in respect to muscle fibers. Two operators repeated the SWE with two different US devices from different manufacturers (scanners 1 and 2). Results Intraclass correlation coefficient between the two operators was 0.91 (CI 0.88–0.93) for scanner 1 and 0.81 (CI 0.74–0.86) for scanner 2, respectively. Instead, there were significant differences in the SWE measurements between the two scanners, emphasizing in transverse orientation of the transducer. In the transverse transducer orientation, the mean shear wave velocity (SWV) in TA was 1.45 m/s (standard deviation [SD] ± 0.35 m/s) with scanner 1 and 2.35 m/s (SD ± 0.83 m/s) with scanner 2 (p < 0.001). In BB, the mean transverse SWV was 1.49 m/s (SD ± 0.35 m/s) with scanner 1 and 2.29 m/s (SD ± 0.63 m/s) with scanner 2 (p < 0.001). In longitudinal transducer orientation, the mean SWV in TA was 3.00 m/s (SD ± 0.73 m/s) with scanner 1 and 3.26 m/s (SD ± 0.42 m/s) with scanner 2 (p = 0.050). In BB, the mean longitudinal SWV was 3.60 m/s (SD ± 0.77 m/s) with scanner 1 and 3.96 m/s (SD ± 0.62 m/s) with scanner 2 (p = 0.019). The presented mean values were obtained by operator 1, there were no significant differences in the SWE measurements performed by the two operators. Conclusion The results implicate that the reproducibility of the SWE measurements depends rather on the used US device than on the operator. It is recommendable that clinics collect reference values with their own US device and consider threshold values presented in previous studies only directional.
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Affiliation(s)
- Anna S Vuorenmaa
- Department of Medical Physics, Medical Imaging Center, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
| | - Eetu M K Siitama
- Department of Medical Physics, Medical Imaging Center, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
| | - Katri S Mäkelä
- Department of Clinical Neurophysiology, Medical Imaging Center and Hospital Pharmacy, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
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Albayda J, Demonceau G, Carlier PG. Muscle imaging in myositis: MRI, US, and PET. Best Pract Res Clin Rheumatol 2022; 36:101765. [PMID: 35760742 DOI: 10.1016/j.berh.2022.101765] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Imaging is an important tool in the evaluation of idiopathic inflammatory myopathies. It plays a role in diagnosis, assessment of disease activity and follow-up, and as a non-invasive biomarker. Among the different modalities, nuclear magnetic resonance imaging (MRI), ultrasound (US), and positron emission tomography (PET) may have the most clinical utility in myositis. MRI is currently the best modality to evaluate skeletal muscle and provides excellent characterization of muscle edema and fat replacement through the use of T1-weighted and T2-weighted fat suppressed/STIR sequences. Although MRI can be read qualitatively for the presence of abnormalities, a more quantitative approach using Dixon sequences and the generation of water T2 parametric maps would be preferable for follow-up. Newer protocols such as diffusion-weighted imaging, functional imaging measures, and spectroscopy may be of interest to provide further insights into myositis. Despite the advantages of MRI, image acquisition is relatively time-consuming, expensive, and not accessible to all patients. The use of US to evaluate skeletal muscle in myositis is gaining interest, especially in chronic disease, where fat replacement and fibrosis are detected readily by this modality. Although easily deployed at the bedside, it is heavily dependent on operator experience to recognize disease states. Further, systematic characterization of muscle edema by US is still needed. PET provides valuable information on muscle function at a cellular level. Fluorodeoxyglucose (FDG-PET) has been the most common application in myositis to detect pathologic uptake indicative of inflammation. The use of neurodegenerative markers is now also being utilized for inclusion body myositis. These different modalities may prove to be complementary methods for myositis evaluation.
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Affiliation(s)
- Jemima Albayda
- Division of Rheumatology, Johns Hopkins University, Baltimore, USA.
| | | | - Pierre G Carlier
- Université Paris-Saclay, CEA, DRF, Service Hospitalier Frederic Joliot, Orsay, France
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21
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Lockwood H, McLeod GA. A paired comparison of nerve dimensions using B-Mode ultrasound and shear wave elastography during regional anaesthesia. ULTRASOUND 2022; 30:346-354. [PMID: 36969534 PMCID: PMC10034658 DOI: 10.1177/1742271x221091726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/26/2022] [Indexed: 11/15/2022]
Abstract
Introduction: Shear wave elastography (SWE) presents nerves in colour, but the dimensions of its colour maps have not been validated with paired B-Mode nerve images. Our primary objective was to define the bias and limits of agreement of SWE with B-Mode nerve diameter. Our secondary objectives were to compare nerve area and shape, and provide a clinical standard for future application of new colour imaging technologies such as artificial intelligence. Materials and Methods: Eleven combined ultrasound-guided regional nerve blocks were conducted using a dual-mode transducer. Two raters outlined nerve margins on 110 paired B-Mode and SWE images every second for 20 s before and during injection. Bias and limits of agreement were plotted on Bland-Altman plots. We hypothesized that the bias of nerve diameter would be <2.5% and that the percent limits of agreement would lie ±0.67% (2 SD) of the bias. Results: There was no difference in the bias (95% confidence interval (CI) limits of agreement) of nerve diameter measurement, 0.01 (−0.14 to 0.16) cm, P = 0.85, equivalent to a 1.4% (−56.6% to 59.5) % difference. The bias and limits of agreement were 0.03 (−0.08 to 0.15) cm2, P = 0.54 for cross-sectional nerve area; and 0.02 (−0.03 to 0.07), P = 0.45 for shape. Reliability (ICC) between raters was 0.96 (0.94–0.98) for B-Mode nerve area and 0.91 (0.83–0.95) for SWE nerve area. Conclusions: Nerve diameter measurement from B-Mode and SWE images fell within a priori measures of bias and limits of agreement.
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Affiliation(s)
| | - Graeme A McLeod
- Institute of Academic Anesthesia,
School of Medicine, University of Dundee, Dundee, UK
- Graeme A McLeod, Institute of Academic
Anesthesia, School of Medicine, University of Dundee, Dundee DD1 9SY, UK.
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22
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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: 6] [Impact Index Per Article: 3.0] [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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23
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Blank J, Blomquist M, Arant L, Cone S, Roth J. Characterizing Musculoskeletal Tissue Mechanics Based on Shear Wave Propagation: A Systematic Review of Current Methods and Reported Measurements. Ann Biomed Eng 2022; 50:751-768. [PMID: 35359250 DOI: 10.1007/s10439-022-02935-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/11/2022] [Indexed: 12/17/2022]
Abstract
Developing methods for the non-invasive characterization of the mechanics of musculoskeletal tissues is an ongoing research focus in biomechanics. Often, these methods use the speed of shear wave propagation to characterize tissue mechanics (e.g., shear wave elastography and shear wave tensiometry). The primary purpose of this systematic review was to identify, compare, and contrast current methods for exciting and measuring shear wave propagation in musculoskeletal tissues. We conducted searches in the Web of Science, PubMed, and Scopus databases for studies published from January 1, 1900, to May 1, 2020. These searches targeted both shear wave excitation using acoustic pushes and mechanical taps, and shear wave speed measurement using ultrasound, magnetic resonance imaging, accelerometers, and laser Doppler vibrometers. Two reviewers independently screened and reviewed the articles, identifying 524 articles that met our search criteria. Regarding shear wave excitation, we found that acoustic pushes are useful for exciting shear waves through the thickness of the tissue of interest, and mechanical taps are useful for exciting shear waves in wearable applications. Regarding shear wave speed measurement, we found that ultrasound is used most broadly to measure shear waves due to its ability to study regional differences and target specific tissues of interest. The strengths of magnetic resonance imaging, accelerometers, and laser Doppler vibrometers make them advantageous to measure shear wave speeds for high-resolution shear wave imaging, wearable measurements, and non-contact ex vivo measurements, respectively. The advantages that each method offers for exciting and measuring shear waves indicate that a variety of systems can be assembled using currently available technologies to determine musculoskeletal tissue material behavior across a range of innovative applications.
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Affiliation(s)
- Jonathon Blank
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthew Blomquist
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Lesley Arant
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Stephanie Cone
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Joshua Roth
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA. .,Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 1111 Highland Ave WIMR 5037, Madison, WI, 53705, USA.
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24
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Deep learning based sarcopenia prediction from shear-wave ultrasonographic elastography and gray scale ultrasonography of rectus femoris muscle. Sci Rep 2022; 12:3596. [PMID: 35246589 PMCID: PMC8897437 DOI: 10.1038/s41598-022-07683-6] [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: 09/23/2021] [Accepted: 02/15/2022] [Indexed: 12/13/2022] Open
Abstract
We aim to evaluate the performance of a deep convolutional neural network (DCNN) in predicting the presence or absence of sarcopenia using shear-wave elastography (SWE) and gray-scale ultrasonography (GSU) of rectus femoris muscle as an imaging biomarker. This retrospective study included 160 pair sets of GSU and SWE images (n = 160) from December 2018 and July 2019. Two radiologists scored the echogenicity of muscle on GSU (4-point score). Among them, 141 patients underwent CT and their L3 skeletal muscle index (SMI) were measured to categorize the presence or absence of sarcopenia. For DCNN, we used three CNN architectures (VGG19, ResNet-50, DenseNet 121). The accuracies of DCNNs for sarcopenia classification were 70.0–80.0% (based on SWE) and 65.0–75.0% (based on GSU). The DCNN application to SWE images highlights the utility of deep-learning base SWE for sarcopenia prediction. DCNN application to SWE images might be a potentially useful biomarker to predict sarcopenic status.
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25
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Mensch A, Nägel S, Zierz S, Kraya T, Stoevesandt D. Bildgebung der Muskulatur bei Neuromuskulären Erkrankungen
– von der Initialdiagnostik bis zur Verlaufsbeurteilung. KLIN NEUROPHYSIOL 2022. [DOI: 10.1055/a-1738-5356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungDie bildgebende Diagnostik hat sich zu einem integralen Element der Betreuung von
PatientInnen mit neuromuskulären Erkrankungen entwickelt. Als
wesentliches Diagnostikum ist hierbei die Magnetresonanztomografie als breit
verfügbares und vergleichsweise standardisiertes Untersuchungsverfahren
etabliert, wobei die Sonografie der Muskulatur bei hinreichend erfahrenem
Untersucher ebenfalls geeignet ist, wertvolle diagnostische Informationen zu
liefern. Das CT hingegen spielt eine untergeordnete Rolle und sollte nur bei
Kontraindikationen für eine MRT in Erwägung gezogen werden.
Zunächst wurde die Bildgebung bei Muskelerkrankungen primär in
der Initialdiagnostik unter vielfältigen Fragestellungen eingesetzt. Das
Aufkommen innovativer Therapiekonzepte bei verschiedenen neuromuskulären
Erkrankungen machen neben einer möglichst frühzeitigen
Diagnosestellung insbesondere auch eine multimodale Verlaufsbeurteilung zur
Evaluation des Therapieansprechens notwendig. Auch hier wird die Bildgebung der
Muskulatur als objektiver Parameter des Therapieerfolges intensiv diskutiert und
in Forschung wie Praxis zunehmend verwendet.
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Affiliation(s)
- Alexander Mensch
- Universitätsklinik und Poliklinik für Neurologie,
Martin-Luther-Universität Halle-Wittenberg und
Universitätsklinikum Halle, Halle (Saale)
| | - Steffen Nägel
- Universitätsklinik und Poliklinik für Neurologie,
Martin-Luther-Universität Halle-Wittenberg und
Universitätsklinikum Halle, Halle (Saale)
| | - Stephan Zierz
- Universitätsklinik und Poliklinik für Neurologie,
Martin-Luther-Universität Halle-Wittenberg und
Universitätsklinikum Halle, Halle (Saale)
| | - Torsten Kraya
- Universitätsklinik und Poliklinik für Neurologie,
Martin-Luther-Universität Halle-Wittenberg und
Universitätsklinikum Halle, Halle (Saale)
- Klinik für Neurologie, Klinikum St. Georg,
Leipzig
| | - Dietrich Stoevesandt
- Universitätsklinik und Poliklinik für Radiologie,
Martin-Luther-Universität Halle-Wittenberg und
Universitätsklinikum Halle, Halle (Saale)
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26
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Manzano W, Lenchik L, Chaudhari AS, Yao L, Gupta S, Boutin RD. Sarcopenia in rheumatic disorders: what the radiologist and rheumatologist should know. Skeletal Radiol 2022; 51:513-524. [PMID: 34268590 DOI: 10.1007/s00256-021-03863-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/03/2021] [Accepted: 07/04/2021] [Indexed: 02/02/2023]
Abstract
Sarcopenia is defined as the loss of muscle mass, strength, and function. Increasing evidence shows that sarcopenia is common in patients with rheumatic disorders. Although sarcopenia can be diagnosed using bioelectrical impedance analysis or DXA, increasingly it is diagnosed using CT, MRI, and ultrasound. In rheumatic patients, CT and MRI allow "opportunistic" measurement of body composition, including surrogate markers of sarcopenia, from studies obtained during routine patient care. Recognition of sarcopenia is important in rheumatic patients because sarcopenia can be associated with disease progression and poor outcomes. This article reviews how opportunistic evaluation of sarcopenia in rheumatic patients can be accomplished and potentially contribute to improved patient care.
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Affiliation(s)
- Wilfred Manzano
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305-5105, USA.
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Akshay S Chaudhari
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305-5105, USA
| | - Lawrence Yao
- Department of Radiology, National Institute of Health, Bethesda, MD, 20892, USA
| | - Sarthak Gupta
- Department of Medicine, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health, Bethesda, MD, 20892, USA
| | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305-5105, USA
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27
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Deng M, Zhou X, Li Y, Yin Y, Liang C, Zhang Q, Lu J, Wang M, Wang Y, Sun Y, Li R, Yan L, Wang Q, Hou G. Ultrasonic Elastography of the Rectus Femoris, a Potential Tool to Predict Sarcopenia in Patients With Chronic Obstructive Pulmonary Disease. Front Physiol 2022; 12:783421. [PMID: 35069243 PMCID: PMC8766419 DOI: 10.3389/fphys.2021.783421] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/02/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose: Skeletal muscle dysfunction is common in patients with chronic obstructive pulmonary disease (COPD) and is associated with a poor prognosis. Abnormal muscle quantity of the lower limbs is a manifestation of skeletal muscle dysfunction in patients with COPD. Shear wave ultrasound elastography (SWE) is a novel and possible tool to evaluate qualitative muscle parameters. This study explores the feasibility of SWE to measure the stiffness of the rectus femoris and evaluates its value in predicting sarcopenia in patients with COPD. Methods: Ultrasound examination of the rectus femoris was performed to determine the mean elasticity index (SWEmean), cross-sectional area (RFcsa), and thickness (RFthick) using grayscale ultrasonography (US) and SWE in 53 patients with COPD and 23 age-matched non-COPD healthy controls. The serum levels of circulating biomarkers (GDF15, resistin, and TNF-α) were measured using ELISA. The definition of sarcopenia followed the guidelines from the Asian Working Group for Sarcopenia. Receiver operating characteristic (ROC) curve analysis of the SWEmean, RFthick, and RFcsa was used to evaluate their predictive ability for sarcopenia. Results: The intraobserver and interobserver repeatability of SWE performance was excellent (all correlation coefficients > 0.95; p < 0.05). The SWEmean of the rectus femoris in patients with COPD (8.98 ± 3.12 kPa) was decreased compared with that in healthy controls (17.00 ± 5.14 kPa) and decreased with advanced global initiative for chronic obstructive lung disease (GOLD) stage. Furthermore, SWEmean was found to be independent of sex, height, and body mass, and a lower SWEmean in patients with COPD was positively associated with reduced pulmonary function, worse physical function, poor exercise tolerance, decreased muscle strength, and worse dyspnea index score. The correlation between physical function [five-repetition sit-to-stand test (5STST)], muscle function, and SWEmean was higher than those of RFthick and RFcsa. In addition, SWEmean was negatively correlated with serum GDF15 levels (r = −0.472, p < 0.001), serum resistin levels (r = −0.291, p = 0.035), and serum TNF-α levels (r = −0.433, p = 0.001). Finally, the predictive power of SWEmean [area under the curve (AUC): 0.863] in the diagnosis of sarcopenia was higher than that of RFthick (AUC: 0.802) and RFcsa (AUC: 0.816). Conclusion: Compared with grayscale US, SWE was not affected by the patient’s height, weight, or BMI and better represented skeletal muscle function and physical function. Furthermore, SWE is a promising potential tool to predict sarcopenia in patients with COPD.
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Affiliation(s)
- Mingming Deng
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Xiaoming Zhou
- Department of Pulmonary and Critical Care Medicine, Fourth Hospital of China Medical University, Shenyang, China
| | - Yanxia Li
- Respiratory Department, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yan Yin
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Chaonan Liang
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Qin Zhang
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Jingwen Lu
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Mengchan Wang
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Yu Wang
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Yue Sun
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Ruixia Li
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Liming Yan
- Department of Pulmonary and Critical Care Medicine, Fourth Hospital of China Medical University, Shenyang, China
| | - Qiuyue Wang
- Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital Affiliated to Capital Medical University Beijing, Beijing, China.,Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
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28
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Knight AE, Trutna CA, Rouze NC, Hobson-Webb LD, Caenen A, Jin FQ, Palmeri ML, Nightingale KR. Full Characterization of in vivo Muscle as an Elastic, Incompressible, Transversely Isotropic Material Using Ultrasonic Rotational 3D Shear Wave Elasticity Imaging. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:133-144. [PMID: 34415833 PMCID: PMC8754054 DOI: 10.1109/tmi.2021.3106278] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Using a 3D rotational shear wave elasticity imaging (SWEI) setup, 3D shear wave data were acquired in the vastus lateralis of a healthy volunteer. The innate tilt between the transducer face and the muscle fibers results in the excitation of multiple shear wave modes, allowing for more complete characterization of muscle as an elastic, incompressible, transversely isotropic (ITI) material. The ability to measure both the shear vertical (SV) and shear horizontal (SH) wave speed allows for measurement of three independent parameters needed for full ITI material characterization: the longitudinal shear modulus μL , the transverse shear modulus μT , and the tensile anisotropy χE . Herein we develop and validate methodology to estimate these parameters and measure them in vivo, with μL = 5.77±1.00 kPa, μT = 1.93±0.41 kPa (giving shear anisotropy χμ = 2.11±0.92 ), and χE = 4.67±1.40 in a relaxed vastus lateralis muscle. We also demonstrate that 3D SWEI can be used to more accurately characterize muscle mechanical properties as compared to 2D SWEI.
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29
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Pancreatic shear wave elastography in children with type 1 diabetes: relation to diabetes duration, glycemic indices, fasting C-peptide and diabetic complications. Pediatr Radiol 2022; 52:2348-2358. [PMID: 35460036 PMCID: PMC9616782 DOI: 10.1007/s00247-022-05363-1] [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] [Received: 02/15/2022] [Revised: 03/02/2022] [Accepted: 03/19/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Little is known about changes in the pancreas as the course of type 1 diabetes progresses. Recently, shear wave elastography (SWE) emerged as a tool for assessing pancreatic stiffness in chronic pancreatitis and pancreatic cancer with a few studies assessing it in diabetes. OBJECTIVE To compare pancreatic SWE in children with recent-onset and long-standing type 1 diabetes to healthy controls and to correlate it with diabetes duration, glycated hemoglobin (HbA1C), functional B cell reserve (fasting C-peptide) and diabetic complications. MATERIALS AND METHODS Fifty children with type 1 diabetes (25 with recent-onset and 25 with long-standing type 1 diabetes) and 50 controls were enrolled. Diabetes duration, insulin therapy, fundoscopic examination of the eyes and the neuropathy disability score were assessed. Fasting C-peptide, lipids, HbA1C and urinary albumin-creatinine ratio were measured. Pancreatic SWE was measured using the General Electric Logiq P9 ultrasound system. RESULTS The mean SWE of the studied children with recent-onset type 1 diabetes was 4.81±0.62 kilopascals (Kpa), those with long-standing type 1 diabetes was 7.10±1.56Kpa and for controls was 5.57±0.27 Kpa (P<0.001). SWE was positively correlated to diabetes duration (P<0.001) and negatively correlated to fasting C-peptide (P<0.001). Regarding diabetes complications, SWE was positively correlated to frequency of severe hypoglycemia (P=0.005), HbA1C (P=0.03), low-density lipoproteins (P<0.001) and cholesterol (P<0.001) and significantly related to diabetic neuropathy (P=0.04) and nephropathy (P=0.05). Diabetes duration, fasting C-peptide, HbA1C and frequency of severe hypoglycemia were the significant independent variables related to SWE increase by multivariable regression analysis. CONCLUSION Pancreatic SWE changes significantly with duration of type 1 diabetes, being lowest in those with recent-onset type 1 diabetes and highest in those with long-standing type 1 diabetes, particularly those with diabetic nephropathy and neuropathy.
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30
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Romano A, Staber D, Grimm A, Kronlage C, Marquetand J. Limitations of Muscle Ultrasound Shear Wave Elastography for Clinical Routine-Positioning and Muscle Selection. SENSORS 2021; 21:s21248490. [PMID: 34960581 PMCID: PMC8706081 DOI: 10.3390/s21248490] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 12/12/2022]
Abstract
Shear wave elastography (SWE) is a clinical ultrasound imaging modality that enables non-invasive estimation of tissue elasticity. However, various methodological factors—such as vendor-specific implementations of SWE, mechanical anisotropy of tissue, varying anatomical position of muscle and changes in elasticity due to passive muscle stretch—can confound muscle SWE measurements and increase their variability. A measurement protocol with a low variability of reference measurements in healthy subjects is desirable to facilitate diagnostic conclusions on an individual-patient level. Here, we present data from 52 healthy volunteers in the areas of: (1) Characterizing different limb and truncal muscles in terms of inter-subject variability of SWE measurements. Superficial muscles with little pennation, such as biceps brachii, exhibit the lowest variability whereas paravertebral muscles show the highest. (2) Comparing two protocols with different limb positioning in a trade-off between examination convenience and SWE measurement variability. Repositioning to achieve low passive extension of each muscle results in the lowest SWE variability. (3) Providing SWE shear wave velocity (SWV) reference values for a specific ultrasound machine/transducer setup (Canon Aplio i800, 18 MHz probe) for a number of muscles and two positioning protocols. We argue that methodological issues limit the current clinical applicability of muscle SWE.
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Affiliation(s)
- Alyssa Romano
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, 72074 Tübingen, Germany; (A.R.); (D.S.); (A.G.); (C.K.)
| | - Deborah Staber
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, 72074 Tübingen, Germany; (A.R.); (D.S.); (A.G.); (C.K.)
| | - Alexander Grimm
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, 72074 Tübingen, Germany; (A.R.); (D.S.); (A.G.); (C.K.)
| | - Cornelius Kronlage
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, 72074 Tübingen, Germany; (A.R.); (D.S.); (A.G.); (C.K.)
| | - Justus Marquetand
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, 72074 Tübingen, Germany; (A.R.); (D.S.); (A.G.); (C.K.)
- Department of Neural Dynamics and Magnetoencephalography, Hertie-Institute for Clinical Brain Research, University of Tübingen, 72074 Tübingen, Germany
- MEG-Center, University of Tübingen, 72074 Tübingen, Germany
- Correspondence: ; Tel.: +49-7071-298-0442
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31
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Kolb M, Ekert K, Schneider L, Fritz J, Ioanoviciu SD, Henes J, Horger M. The Utility of Shear-Wave Elastography in the Evaluation of Myositis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2176-2185. [PMID: 34030894 DOI: 10.1016/j.ultrasmedbio.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
Changes in muscle elasticity are expected in patients with untreated myositis. The purpose of this study was to define the accuracy of shear-wave elastography (SWE) in diagnosing myositis. This case control study included 21 patients (mean age, 49.4 y; 12 women) with myositis who underwent SWE, magnetic resonance imaging (MRI) and biopsy of the involved muscle group. SWE was performed accordingly in a control group (n = 24; mean age, 51.2 y; 8 women). Blood tests consisted of creatine kinase (CK) and aldolase. Two operators performed SWE in longitudinal and transverse planes of muscular fibers, quantifying the mean shear-wave velocity (SWV) and the pattern of stiffness. On MRI, short-TI inversion recovery (STIR) signal hyperintensity and T1 contrast enhancement of muscle was considered diagnostic for myositis. The patient group suffered from different types of myositis (nine patients with polymyositis, eight with dermatomyositis and four with other types of myositis). Blood tests showed significantly increased CK and aldolase values in patients with myositis (p < 0.001 and p < 0.0001). MRI showed a sensitivity of 0.95. In the patient group, the mean SWVs of longitudinal and transverse measurements were 2.8 ± 1.4 m/s and 3.1 ± 1.2 m/s, respectively. In the control group, SWVs were 2.3 ± 0.5 m/s and 2.4 ± 0.5 m/s, respectively. The difference between transverse measurements was significant (p = 0.02). Increased heterogeneity as a marker for myositis in transverse SWE showed a sensitivity of 0.8, specificity of 0.79, positive predictive value (PPV) of 0.76 and negative predictive value (NPV) of 0.82. Inter-observer difference was very low (κ = 0.92). Increased heterogeneity in both planes compared with histologic results showed a sensitivity of 0.56, specificity of 0.93, PPV of 0.91 and NPV of 0.62. Spearman correlation between CK <1000 U/L and SWE was 0.54. In conclusion, transverse orientation SWE may serve as an imaging biomarker for the diagnosis of myositis through the display of a heterogeneous pattern and increased absolute SWV values of inflamed muscles.
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Affiliation(s)
- Manuel Kolb
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany.
| | - Kaspar Ekert
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Luisa Schneider
- Department of Internal Medicine II, Eberhard-Karls-University, Tübingen, Germany
| | - Jan Fritz
- Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, Maryland, USA
| | | | - Jörg Henes
- Department of Internal Medicine II, Eberhard-Karls-University, Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
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Effect of Resonant Frequency Vibration on Delayed Onset Muscle Soreness and Resulting Stiffness as Measured by Shear-Wave Elastography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157853. [PMID: 34360146 PMCID: PMC8345543 DOI: 10.3390/ijerph18157853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/31/2022]
Abstract
This study utilized resonant frequency vibration to the upper body to determine changes in pain, stiffness and isometric strength of the biceps brachii after eccentric damage. Thirty-one participants without recent resistance training were randomized into three groups: a Control (C) group and two eccentric exercise groups (No vibration (NV) and Vibration (V)). After muscle damage, participants in the V group received upper body vibration (UBV) therapy for 5 min on days 1-4. All participants completed a visual analog scale (VAS), maximum voluntary isometric contraction (MVIC), and shear wave elastography (SWE) of the bicep at baseline (pre-exercise), 24 h, 48 h, and 1-week post exercise. There was a significant difference between V and NV at 24 h for VAS (p = 0.0051), at 24 h and 1-week for MVIC (p = 0.0017 and p = 0.0016, respectively). There was a significant decrease in SWE for the V group from 24-48 h (p = 0.0003), while there was no significant change in the NV group (p = 0.9341). The use of UBV resonant vibration decreased MVIC decrement and reduced VAS pain ratings at 24 h post eccentric damage. SWE was strongly negatively correlated with MVIC and may function as a predictor of intrinsic muscle state in the time course of recovery of the biceps brachii.
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Tokunaga A, Shimizu M. Age-related change in shear elastic modulus of the thoracolumbar multifidus muscle in healthy Beagle dogs using ultrasound shear wave elastography. J Vet Sci 2021; 22:e3. [PMID: 33522155 PMCID: PMC7850783 DOI: 10.4142/jvs.2021.22.e3] [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: 08/04/2020] [Revised: 10/19/2020] [Accepted: 10/30/2020] [Indexed: 11/21/2022] Open
Abstract
Background Multifidus muscle stiffness decreases in patients with lumbar intervertebral disk herniation; however, age-related changes in humans have not been reported. Objectives The reliability of ultrasound shear wave elastography in dogs, and changes in the shear elastic modulus of the thoracolumbar multifidus muscle with aging in dogs, were investigated. Methods Twelve beagle dogs were divided into 2 groups based on the age of onset of intervertebral disk herniation: young (aged not exceeding 2 years; 1.3 ± 0.6 years old, n = 5) and adult (4.9 ± 1.2 years old, n = 7). The shear elastic modulus of the multifidus muscle, from the thirteenth thoracic spine to the fourth lumbar spine, was measured using ultrasound shear wave elastography. The length, cross-sectional area and muscle to fat ratio of the multifidus muscle, and the grade of intervertebral disk degeneration, were assessed using radiographic and magnetic resonance imaging examinations. Results The length and cross-sectional area of the multifidus muscle increased caudally. In the young group, the shear elastic modulus of the multifidus muscle of the thirteenth thoracic spine was less than that of the third lumbar spine. In the adult group, the shear elastic modulus of the multifidus muscle of first and third lumbar spine was lower than that of the same site in the young group. Conclusions Ultrasound can be used to measure shear wave elastography of the thoracolumbar multifidus in dogs. If the multifidus muscle stiffness decreases, we should consider age-related change.
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Affiliation(s)
- Akari Tokunaga
- Department of Veterinary Diagnostic Imaging, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
| | - Miki Shimizu
- Department of Veterinary Diagnostic Imaging, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan.
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Aarab Y, Flatres A, Garnier F, Capdevila M, Raynaud F, Lacampagne A, Chapeau D, Klouche K, Etienne P, Jaber S, Molinari N, Gamon L, Matecki S, Jung B. Shear Wave Elastography, A New Tool for Diaphragmatic Qualitative Assessment. A Translational Study. Am J Respir Crit Care Med 2021; 204:797-806. [PMID: 34255974 DOI: 10.1164/rccm.202011-4086oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Prolonged mechanical ventilation (MV) is often associated either with a decrease (known atrophy) or an increase (supposed injury) in diaphragmatic thickness. Shear wave elastography is a non-invasive technique that measures shear modulus, a surrogate of tissue stiffness and mechanical properties. OBJECTIVES To describe changes in shear modulus (SM) during the ICU stay and the relationship with alterations in muscle thickness. To perform a comprehensive ultrasound-based characterization of histological and force production changes occurring in the diaphragm. METHODS Translational study using critically ill patients and mechanically ventilated piglets. Serial ultrasound examination of the diaphragm collecting thickness and SM was performed in both patients and piglets. Transdiaphragmatic pressure and diaphragmatic biopsies were collected in piglets. MEASUREMENTS AND MAIN RESULTS We enrolled 102 patients, 88 of whom were invasively mechanically ventilated. At baseline, SM was 14.3+/-4.3 kPa and diaphragm end-expiratory thickness was 2.0+/-0.5 mm. Decrease or increase by more than 10% from baseline was reported in 86% of the patients for thickness and in 92% of the patients for shear modulus. An increase in diaphragmatic thickness during the stay was associated with a decrease in SM (β=-9.34±4.41; p=0.03) after multivariable analysis. In the piglet sample, a decrease in SM over 3 days of MV was associated with loss of force production, slow and fast fiber atrophy and increased lipid droplets accumulation. CONCLUSIONS Increases in diaphragm thickness during critical illness is associated with decreased tissue stiffness as demonstrated by shear wave ultrasound elastography, consistent with the development of muscle injury and weakness.
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Affiliation(s)
| | | | - Fanny Garnier
- Centre Hospitalier Regional Universitaire de Montpellier, 26905, Montpellier, France
| | - Mathieu Capdevila
- Montpellier University and Montpellier Teaching Hospital,, Saint Eloi Anesthesiology and Critical Care Medicine, Montpellier University and Montpellier Teaching Hospital, Montpellier, France , Montpellier, France.,Montpellier Universite d'Excellence, 539031, PhyMedExp, Montpellier, France
| | | | - Alain Lacampagne
- PhyMedExp, Montpellier University, INSERM, CNRS, Montpellier, France
| | - David Chapeau
- Lapeyronie University Hospital, Intensive Care Unit, Montpellier, France
| | - Kada Klouche
- Lapeyronie University Hospital, Intensive Care Unit, Montpellier, France
| | - Pascal Etienne
- Laboratoire Charles Coulomb, 131799, Montpellier, France
| | - Samir Jaber
- University hospital. CHU de MONTPELLIER HOPITAL SAINT ELOI, Intensive Care Unit and transplantation-Departement of Anesthesiology DAR B, Montpellier Cedex 5, France
| | - Nicolas Molinari
- CHU Montpellier - Hôpital la Colombière, DIM, Montpellier, France
| | - Lucie Gamon
- Montpellier University and Montpellier Teaching Hospital,, Saint Eloi Anesthesiology and Critical Care Medicine, Montpellier University and Montpellier Teaching Hospital, Montpellier, France
| | - Stefan Matecki
- Universite de Montpellier, 27037, 4. Pediatric Functional Exploration Unit, University Hospital of Montpellier, Montpellier, France
| | - Boris Jung
- Centre Hospitalier Regional Universitaire de Montpellier, 26905, medical ICU, Montpellier, France;
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Nwawka OK, Gutierrez N, Lin B, Ko LM, Miller TT. Quantitative assessment of change in upper extremity muscle stiffness following fluid injection using shear wave elastography. Skeletal Radiol 2021; 50:1455-1460. [PMID: 33108511 DOI: 10.1007/s00256-020-03648-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantitatively assess changes in muscle stiffness following intramuscular saline injection using shear wave elastography (SWE). MATERIALS AND METHODS Thirty muscles (lateral deltoid (LD), biceps brachii (BB), brachialis, pronator teres (PT), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU)) from fresh-frozen cadaveric specimens were injected with saline under ultrasound guidance. Pre- and post-injection muscle thickness (MT) (mm) and SWE (kPa) measurements were recorded. RESULTS All muscles demonstrated a decrease in the mean SWE value post-injection, with the largest differences ± standard error noted in the LD (14.76 ± 3.55 kPa, p = 0.021) and brachialis muscles (12.02 ± 2.51 kPa, p = 0.013). Muscle thickness increased following injection, although the degree of changes poorly correlated with the change in SWE. CONCLUSION In summary, following intramuscular injection of saline injection, a decrease in upper extremity muscle stiffness is detected using SWE. It is important to note that if performing a longitudinal assessment of muscle stiffness after intramuscular injection, saline will likely contribute to a decrease in muscle stiffness in the immediate post-injection time period.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA. .,Department of Radiology, Weill Cornell Medical College of Cornell University, New York, NY, USA.
| | - Nicholas Gutierrez
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA
| | - Bin Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA
| | - Lydia M Ko
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, 3rd Floor, New York, NY, 10021, USA.,Department of Radiology, Weill Cornell Medical College of Cornell University, New York, NY, USA
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Paramalingam S, Needham M, Raymond W, Mastaglia F, Lightowler D, Morin N, Counsel P, Keen HI. Muscle shear wave elastography, conventional B mode and power doppler ultrasonography in healthy adults and patients with autoimmune inflammatory myopathies: a pilot cross-sectional study. BMC Musculoskelet Disord 2021; 22:537. [PMID: 34118902 PMCID: PMC8199828 DOI: 10.1186/s12891-021-04424-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/18/2021] [Indexed: 12/05/2022] Open
Abstract
Background Before the role of shear wave elastography (SWE) and B mode ultrasound (US) in the diagnosis of different forms of idiopathic inflammatory myopathies (IIM) can be investigated, normative data is required. This study aimed to describe and then compare normative SWE and B mode ultrasound metrics of muscles in healthy controls and patients with IIM. Methods Twenty nine healthy adult controls and 10 IIM patients (5 with inclusion body myositis and 5 with necrotising autoimmune myopathy) underwent a full clinical examination, laboratory investigations, SWE and US measurements of selected proximal and distal limb muscles. Shear wave speed (SWS) and multiple US domains [echogenicity, fascial thickness, muscle bulk and power Doppler (PD)] were measured in both groups. Results In healthy controls (n = 29; mean age 46.60 ± 16.10; 44.8 % female), age was inversely correlated with SWS at the deltoid (stretch) (Rs. -0.40, p = 0.030) and PD score at the deltoid (rest) (Rs. -0.40, P = 0.032). Those ≥ 50 years old had a lower SWS at the deltoid (stretch) compared to the < 50 year group (2.92 m/s vs. 2.40 m/s, P = 0.032). Age correlated with increased echogenicity in the flexor digitorum profundus (Rs. 0.38, P = 0.045). Females had a smaller muscle bulk in the deltoid (P = 0.022). Body mass index (BMI) was inversely associated with SWS in the deltoid (stretch) (Rs – 0.45, P = 0.026), and positively correlated with echogenicity in the deltoid (Rs. 0.69, P = 0.026). In patients ≥50 years of age, patients with IIM (mean age 61.00 ± 8.18; females 20.0 %) had a higher proportion of abnormal echogenicity scores at the flexor digitorum profundus (FDP) (40.00 % vs. 14.30 %, P = 0.022) and tibialis anterior (TA) (80.00 % vs. 28.60 %, P = 0.004). Fascial thickness was lower in the FDP (0.63mm vs. 0.50mm, p = 0.012) and TA (0.58mm vs. 0.45mm, P = 0.001). Conclusions Our findings suggest there is scope for US techniques to be useful for diagnostic screening of affected muscles in patients with IIM, especially in those with suspected inclusion body myositis or necrotising autoimmune myopathy. We provide normative data for future studies into SWE and US techniques in skeletal muscle. The differences between IIM patients and controls warrant further study in a broader IIM patient cohort. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04424-0.
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Affiliation(s)
- Shereen Paramalingam
- University of Notre Dame Australia, Fremantle, Western Australia, Australia. .,Department of Rheumatology, Fiona Stanley Hospital, 11 Robin Warren Dr, Western Australia, 6150, Murdoch, Australia.
| | - Merrilee Needham
- University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Institute of Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia.,Department of Neurology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Warren Raymond
- University of Western Australia, Crawley, Western Australia, Australia
| | - Frank Mastaglia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Daniel Lightowler
- University of Western Australia, Crawley, Western Australia, Australia
| | - Narelle Morin
- Sonowest Healthcare, Siemens Healthineers, Bayswater, Australia
| | - Peter Counsel
- Department of Radiology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Helen Isobel Keen
- Department of Rheumatology, Fiona Stanley Hospital, 11 Robin Warren Dr, Western Australia, 6150, Murdoch, Australia.,University of Western Australia, Crawley, Western Australia, Australia
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Durmaz MS, Yorulmaz A, Gokgoz Durmaz F, Arslan S. Utility of 2-Dimensional Shear Wave Elastography for Assessment of the Bladder Wall in Children With Acute Cystitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1105-1111. [PMID: 32888363 DOI: 10.1002/jum.15486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the efficacy of 2-dimensional (2D) shear wave elastography (SWE) in the diagnosis of acute cystitis (AC) in children. METHODS Between June 2019 and March 2020, 126 children with AC and 126 healthy participants were prospectively investigated by 2D SWE and B-mode ultrasound. Elastographic measurements were performed by drawing the contours of the posterior wall of the bladder between the ureter orifices using a free region of interest. The quantitative 2D SWE values of the patients and the healthy group were compared. RESULTS The mean 2D SWE values of the bladder wall were significantly higher in patients with AC compared to the healthy group (P = .001). On B-mode ultrasound imaging, the bladder wall thickness of patients with AC was higher than that in the healthy group (P = .001). On 2D SWE, when the cutoff value used was 9.25 kPa, the sensitivity, specificity, positive predictive value, and negative predictive value were 92.1%, 88.1%, 89.3%, and 92.6%, respectively, whereas when the cutoff value used was 1.72 m/s, the sensitivity, specificity, positive predictive value, and negative predictive value were 90.5%, 88.9%, 89.1%, and 90.7%. There was a statistically significant positive correlation between the 2D SWE values and wall thickness measurements (P < .001). CONCLUSIONS Two-dimensional SWE is a noninvasive, fast, and effective imaging method to evaluate the bladder wall in children with AC.
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Affiliation(s)
| | - Alaaddin Yorulmaz
- Department of Radiology, Selcuk University, Medical Faculty, Konya, Turkey
| | | | - Serdar Arslan
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Malartre S, Bachasson D, Mercy G, Sarkis E, Anquetil C, Benveniste O, Allenbach Y. MRI and muscle imaging for idiopathic inflammatory myopathies. Brain Pathol 2021; 31:e12954. [PMID: 34043260 PMCID: PMC8412099 DOI: 10.1111/bpa.12954] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/11/2021] [Indexed: 12/22/2022] Open
Abstract
Although idiopathic inflammatory myopathies (IIM) are a heterogeneous group of diseases nearly all patients display muscle inflammation. Originally, muscle biopsy was considered as the gold standard for IIM diagnosis. The development of muscle imaging led to revisiting not only the IIM diagnosis strategy but also the patients' follow-up. Different techniques have been tested or are in development for IIM including positron emission tomography, ultrasound imaging, ultrasound shear wave elastography, though magnetic resonance imaging (MRI) remains the most widely used technique in routine. Whereas guidelines on muscle imaging in myositis are lacking here we reviewed the relevance of muscle imaging for both diagnosis and myositis patients' follow-up. We propose recommendations about when and how to perform MRI on myositis patients, and we describe new techniques that are under development.
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Affiliation(s)
- Samuel Malartre
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Damien Bachasson
- Neuromuscular Physiology Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Guillaume Mercy
- Department of Medical Imaging, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles-Foix, Sorbonne Université, Paris, France
| | - Elissone Sarkis
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Céline Anquetil
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
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Kronlage C, Grimm A, Romano A, Stahl JH, Martin P, Winter N, Marquetand J. Muscle Ultrasound Shear Wave Elastography as a Non-Invasive Biomarker in Myotonia. Diagnostics (Basel) 2021; 11:diagnostics11020163. [PMID: 33498617 PMCID: PMC7911703 DOI: 10.3390/diagnostics11020163] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 12/31/2022] Open
Abstract
Myotonia, i.e., delayed muscle relaxation in certain hereditary muscle disorders, can be assessed quantitatively using different techniques ranging from force measurements to electrodiagnostics. Ultrasound shear wave elastography (SWE) has been proposed as a novel tool in biomechanics and neuromuscular medicine for the non-invasive estimation of muscle elasticity and, indirectly, muscle force. The aim of this study is to provide ‘proof-of-principle’ that SWE allows a quantitative measurement of the duration of delayed muscle relaxation in myotonia in a simple clinical setting. In six myotonic muscle disorder patients and six healthy volunteers, shear wave velocities (SWV) parallel to the fiber orientation in the flexor digitorum superficialis muscle in the forearm were recorded with a temporal resolution of one per second during fist-clenching and subsequent relaxation; the relaxation time to 10% of normalized shear wave velocity (RT0.1) was calculated. Forty-six SWE imaging sequences were acquired, yielding a mean RT0.1 of 7.38 s in myotonic muscle disorder patients, significantly higher than in healthy volunteers (1.36 s), which is comparable to data obtained by mechanical dynamometry. SWV measurements during the baseline relaxation and voluntary contraction phases did not differ significantly between groups. We conclude that SWE is a promising, non-invasive, widely available tool for the quantitative assessment of myotonia to aid in diagnosis and therapeutic monitoring.
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Bastijns S, De Cock AM, Vandewoude M, Perkisas S. Usability and Pitfalls of Shear-Wave Elastography for Evaluation of Muscle Quality and Its Potential in Assessing Sarcopenia: A Review. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2891-2907. [PMID: 32843232 DOI: 10.1016/j.ultrasmedbio.2020.06.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 06/18/2020] [Accepted: 06/30/2020] [Indexed: 05/08/2023]
Abstract
Sarcopenia is age-related progressive and generalized loss of skeletal muscle mass and strength. Its prevalence is rising, which poses a burden for society because it increases disability and dependency and therefore raises health care costs. Muscle mass quality, however-an essential part of sarcopenia-is not easily diagnosable yet. Recent interest has risen for ultrasonographic evaluation of muscle. This review introduces muscle elastography as a possible, easy and cheap tool to evaluate qualitative muscle parameters. Basic principles of muscle elastography are described, as well as different elastography techniques and some technical considerations. Furthermore, a proposal for practical guidelines is offered and factors influencing muscle stiffness are highlighted.
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Affiliation(s)
- Sophie Bastijns
- Department of Medicine, University of Antwerp, Antwerp, Belgium; Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium.
| | - Anne-Marie De Cock
- Department of Medicine, University of Antwerp, Antwerp, Belgium; Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium
| | - Maurits Vandewoude
- Department of Medicine, University of Antwerp, Antwerp, Belgium; Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium; Belgian Ageing Muscle Society, Liege, Belgium
| | - Stany Perkisas
- Department of Medicine, University of Antwerp, Antwerp, Belgium; Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium; Belgian Ageing Muscle Society, Liege, Belgium
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Tang X, Wang L, Guo R, Huang S, Tang Y, Qiu L. Application of ultrasound elastography in the evaluation of muscle strength in a healthy population. Quant Imaging Med Surg 2020; 10:1961-1972. [PMID: 33014728 DOI: 10.21037/qims-20-439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background To investigate the validity of shear wave elastography (SWE) for the evaluation of muscle strength compared with isokinetic muscle testing, and to assess the influence of demographic factors such as height, weight, and body mass index (BMI) on the shear wave velocity (SWV). Methods Sixty healthy volunteers were consecutively enrolled. SWE was used to measure the SWV of the right quadriceps femoris in a relaxed position, in a tensive position, and under loads of 1 and 2 kg. Muscle strength parameters including peak torque (PT), PT to body weight ratio (PT/BW), and total work (TW) were evaluated using isokinetic muscle testing. The SWV of the rectus femoris in different positions were compared using the Friedman test and the Kruskal-Wallis test, and the SWV and muscle strength parameters were compared between different genders and age groups using the Mann-Whitney U test. Additionally, Spearman's correlation coefficient was used to evaluate the correlation between SWV and muscle strength, as well as the possible effects of height, weight, and BMI on SWV. Results As the load increased, the SWV of the rectus femoris increased (P<0.001). In the relaxed position, there was no significant correlation between the SWV and the results of isokinetic muscle testing. With increasing load, the SWV and the results of isokinetic muscle testing were not significantly correlated (r=-0.256--0.392, P<0.05). In the 1 kg load position, height and weight were not significantly correlated with SWV (r=-0.261--0.393, P<0.05). In the relaxed position, there were no significant differences in the maximum, minimum, or mean SWV of the rectus femoris between different genders and age groups (P>0.05). However, under a 1 kg load, the maximum, minimum, and mean SWV of the females in this study were significantly higher than those of the males (4.49±0.60 vs. 3.98±0.68 m/s; 2.55±0.61 vs. 2.20±0.63 m/s; and 3.51±0.60 vs. 3.06±0.58 m/s; P=0.003, 0.028, and 0.004, respectively). Furthermore, there were significant differences in the maximum and mean velocities between the groups aged 20-34 and 35-60 years (4.11±0.62 vs. 4.47±0.70 m/s; 3.17±0.53 vs. 3.52±0.69 m/s; P=0.045 and 0.044, respectively). Conclusions Ultrasound elastography (UE) shows potential for the measurement of muscle strength. The SWV of muscles demonstrate an increasing trend with the increase of impedance. Additionally, age and gender have a significant effect on SWV, while the effects of height, weight, and BMI require further investigation.
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Affiliation(s)
- Xinyi Tang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Liyun Wang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Ruiqian Guo
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Songya Huang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Yuanjiao Tang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Li Qiu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
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Abstract
Purpose of Review The purpose of this review is to critically discuss the use of ultrasound in the evaluation of muscle disorders with a particular focus on the emerging use in inflammatory myopathies. Recent Findings In myopathies, pathologic muscle shows an increase in echogenicity. Muscle echogenicity can be assessed visually, semi-quantitatively, or quantitatively using grayscale analysis. The involvement of specific muscle groups and the pattern of increase in echogenicity can further point to specific diseases. In pediatric neuromuscular disorders, the value of muscle ultrasound for screening and diagnosis is well-established. It has also been found to be a responsive measure of disease change in muscular dystrophies. In chronic forms of myositis like inclusion body myositis, ultrasound is very suitable for detecting markedly increased echogenicity and atrophy in affected muscles. Acute cases of muscle edema show only a mild increase in echogenicity, which can also reverse with successful treatment. Summary Muscle ultrasound is an important imaging modality that is highly adaptable to study various muscle conditions. Although its diagnostic value for neuromuscular disorders is high, the evidence in myositis has only begun to accrue in earnest. Further systematic studies are needed, especially in its role for detecting muscle edema.
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Kubínová K, Mann H, Vrána J, Vencovský J. How Imaging Can Assist with Diagnosis and Monitoring of Disease in Myositis. Curr Rheumatol Rep 2020; 22:62. [DOI: 10.1007/s11926-020-00939-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Farrow M, Biglands J, Alfuraih AM, Wakefield RJ, Tan AL. Novel Muscle Imaging in Inflammatory Rheumatic Diseases-A Focus on Ultrasound Shear Wave Elastography and Quantitative MRI. Front Med (Lausanne) 2020; 7:434. [PMID: 32903395 PMCID: PMC7434835 DOI: 10.3389/fmed.2020.00434] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/06/2020] [Indexed: 12/31/2022] Open
Abstract
In recent years, imaging has played an increasing role in the clinical management of patients with rheumatic diseases with respect to aiding diagnosis, guiding therapy and monitoring disease progression. These roles have been underpinned by research which has enhanced our understanding of disease pathogenesis and pathophysiology of rheumatology conditions, in addition to their key role in outcome measurement in clinical trials. However, compared to joints, imaging research of muscles is less established, despite the fact that muscle symptoms are very common and debilitating in many rheumatic diseases. Recently, it has been shown that even though patients with rheumatoid arthritis may achieve clinical remission, defined by asymptomatic joints, many remain affected by lingering constitutional systemic symptoms like fatigue, tiredness, weakness and myalgia, which may be attributed to changes in the muscles. Recent improvements in imaging technology, coupled with an increasing clinical interest, has started to ignite new interest in the area. This perspective discusses the rationale for using imaging, particularly ultrasound and MRI, for investigating muscle pathology involved in common inflammatory rheumatic diseases. The muscles associated with rheumatic diseases can be affected in many ways, including myositis-an inflammatory muscle condition, and myopathy secondary to medications, such as glucocorticoids. In addition to non-invasive visual assessment of muscles in these conditions, novel imaging techniques like shear wave elastography and quantitative MRI can provide further useful information regarding the physiological and biomechanical status of the muscle.
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Affiliation(s)
- Matthew Farrow
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, United Kingdom.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,School of Pharmacy and Medical Sciences, University of Bradford, Bradford, United Kingdom
| | - John Biglands
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Abdulrahman M Alfuraih
- Radiology and Medical Imaging Department, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, United Kingdom.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Ai Lyn Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, United Kingdom.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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Hvedstrup J, Kolding LT, Ashina M, Schytz HW. Increased neck muscle stiffness in migraine patients with ictal neck pain: A shear wave elastography study. Cephalalgia 2020; 40:565-574. [DOI: 10.1177/0333102420919998] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BackgroundIctal neck pain is a frequent symptom reported by half of migraine patients. It is unknown if neck pain is caused by peripheral or central mechanisms. Neck muscle stiffness can be investigated with ultrasound shear wave elastography.ObjectivesTo determine if migraine patients with ictal neck pain have stiffer neck muscles interictally compared with patients without ictal neck pain and controls.MethodsThis was a cross-sectional study investigating neck muscle stiffness, pressure pain thresholds and neck pain symptoms in 100 migraine patients recruited from a tertiary headache center and 46 controls.ResultsPatients with ictal neck pain had increased mean neck muscle stiffness interictally compared to both migraine patients without ictal neck pain ( p = 0.018) and controls ( p = 0.036). Muscle stiffness was negatively correlated with pressure pain thresholds in the neck in migraine patients with ictal neck pain (r = −0.292, p = 0.042). There were no differences in mean pressure pain thresholds between migraine subgroups.ConclusionsMigraine patients with ictal neck pain have stiffer neck muscles interictally compared with migraine patients without ictal neck pain and controls measured with ultrasound shear wave elastography. The increased stiffness could be due to local alterations in the neck muscles. Trial registration: clinical-trials.gov, identifier: NCT03626805
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Affiliation(s)
- Jeppe Hvedstrup
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Lærke Tørring Kolding
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Henrik Winther Schytz
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
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Current status and recent advances on the use of ultrasonography in pediatric rheumatic diseases. World J Pediatr 2020; 16:52-59. [PMID: 31515696 DOI: 10.1007/s12519-019-00312-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 08/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ultrasonography has become a useful tool in the clinical rheumatology settings in the last two decades, but its use has only recently been explored by pediatric rheumatologists. The aim of this article is to review the literature on the current status and recent advances on the use of ultrasound in pediatric rheumatic diseases. DATA SOURCES We have retrieved and reviewed the relevant articles from MEDLINE/PubMed databases published so far, on the applications of ultrasound in juvenile idiopathic arthritis (JIA), systemic lupus erythematosus, dermatomyositis, enthesitis, Sjogren's syndrome, and other rheumatic diseases. In addition, articles on novel ultrasound imaging technology of potential use in pediatric rheumatology are also reviewed. RESULTS In JIA, ultrasound can be used to detect subclinical synovitis, to improve the classification of patients in JIA subtypes, to capture early articular damage, to monitor treatment response, and to guide intraarticular injections. Ultrasound is also considered useful in other rheumatic disorders for the evaluation of musculoskeletal symptoms, assessment of parotid gland pathology, and measurement of skin thickness and pathology. Novel ultrasound techniques developed to augment the functionality of ultrasonography may also be applicable in pediatric rheumatic disorders. CONCLUSIONS Ultrasound shows great promise in the assessment and management of children with rheumatologic disorders. However, standardization and validation of ultrasound in healthy children and in patients with rheumatic diseases are still needed.
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Alfuraih AM, Tan AL, O’Connor P, Emery P, Wakefield RJ. Muscle stiffness in rheumatoid arthritis is not altered or associated with muscle weakness: A shear wave elastography study. Mod Rheumatol 2019; 30:617-625. [DOI: 10.1080/14397595.2019.1645374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Abdulrahman M. Alfuraih
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj, Saudi Arabia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ai Lyn Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip O’Connor
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Richard J. Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Alfuraih AM, Tan AL, O'Connor P, Emery P, Mackie S, Wakefield RJ. Reduction in stiffness of proximal leg muscles during the first 6 months of glucocorticoid therapy for giant cell arteritis: A pilot study using shear wave elastography. Int J Rheum Dis 2019; 22:1891-1899. [PMID: 31364284 DOI: 10.1111/1756-185x.13667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 01/11/2023]
Abstract
AIM To investigate muscle stiffness changes in patients treated for giant cell arteritis (GCA) with high-dose oral glucocorticoids. METHODS Using ultrasound elastography, shear wave velocity (SWV) was measured in the quadriceps, hamstrings and biceps brachii muscles of 14 patients with GCA (4 male, mean age ± SD, 68.2 ± 4.3 years) within the first 2 weeks of initiating glucocorticoid treatment (baseline) and repeated after 3 and 6 months treatment. Muscle strength and performance tests were performed at each visit. Baseline measures were compared with those from 14 healthy controls. Linear mixed models were used to test for change in patient measures over time. RESULTS At baseline, muscle SWV in patients was not significantly different from controls. With glucocorticoid treatment, there was a reduction in SWV in the leg but not the arm muscles. SWV decreased by a mean of 14% (range 8.3%-17.3%; P = .001) after 3 months and 18% (range 10.2%-25.3%; P < .001) after 6-months in the quadriceps and hamstrings during the resting position. The baseline, 3 and 6 months mean SWV (±SD) for the vastus lateralis were 1.62 ± 0.16 m/s, 1.40 ± 0.10 m/s and 1.31 ± 0.06 m/s, respectively (P < .001). In the patient group as a whole, there was no significant change in muscle strength. However, there were moderate correlations (r = .54-.69) between exhibiting weaker muscle strength at follow-up visits and a greater reduction in SWV. CONCLUSION Glucocorticoid therapy in patients with GCA was associated with a significant reduction in proximal leg muscle stiffness during the first 6 months. Future research should study a larger sample of patients for a longer duration to investigate if diminished muscle stiffness precedes signs of glucocorticoid-induced myopathy.
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Affiliation(s)
- Abdulrahman M Alfuraih
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Kharj, Saudi Arabia.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ai Lyn Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip O'Connor
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sarah Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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