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Morrison RA, Fetzer DT, Patterson-Lachowicz A, McDowell S, Smeltzer JCC, Mau T, Shembel AC. Optical Flow Analysis of Paralaryngeal Muscle Movement. Laryngoscope 2024; 134:1792-1801. [PMID: 37772838 PMCID: PMC10947946 DOI: 10.1002/lary.31063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/11/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES The paralaryngeal muscles are thought to be hyperfunctional with phonation in patients with primary muscle tension dysphonia (pMTD). However, objective, quantitative tools to assess paralaryngeal movement patterns lack. The objectives of this study were to (1) validate the use of optical flow to characterize paralaryngeal movement patterns with phonation, (2) characterize phonatory optical flow velocities and variability of the paralaryngeal muscles before and after a vocal load challenge, and (3) compare phonatory optical flow measures to standard laryngoscopic, acoustic, and self-perceptual assessments. METHODS Phonatory movement velocities and variability of the paralaryngeal muscles at vocal onsets and offsets were quantified from ultrasound videos and optical flow methods across 42 subjects with and without a diagnosis of pMTD, before and after a vocal load challenge. Severity of laryngoscopic mediolateral supraglottic compression, acoustic perturbation, and ratings of vocal effort and discomfort were also obtained at both time points. RESULTS There were no significant differences in optical flow measures of the paralaryngeal muscles with phonation between patients with pMTD and controls. Patients with pMTD had significantly more supraglottic compression, higher acoustic perturbations, and higher vocal effort and vocal tract discomfort ratings. Vocal load had a significant effect on vocal effort and discomfort but not on supraglottic compression, acoustics, or optical flow measures of the paralaryngeal muscles. CONCLUSION Optical flow methods can be used to study paralaryngeal muscle movement velocity and variability patterns during vocal productions, although the role of the paralaryngeal in pMTD diagnostics (e.g., vocal hyperfunction) remains suspect. LEVEL OF EVIDENCE 2 Laryngoscope, 134:1792-1801, 2024.
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Affiliation(s)
- Robert A. Morrison
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - David T. Fetzer
- Department of Radiology, CACTUS Lab, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Amber Patterson-Lachowicz
- Department of Radiology, CACTUS Lab, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sarah McDowell
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Julianna C. Comstock Smeltzer
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Ted Mau
- Department of Otolaryngology-Head and Neck, Center for Voice Care, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Adrianna C. Shembel
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
- Department of Otolaryngology-Head and Neck, Center for Voice Care, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Shembel AC, Morrison RA, Fetzer DT, Patterson-Lachowicz A, McDowell S, Comstock Smeltzer JC, Mau T. Extrinsic Laryngeal Muscle Tension in Primary Muscle Tension Dysphonia with Shear Wave Elastography. Laryngoscope 2023; 133:3482-3491. [PMID: 37334857 PMCID: PMC10728340 DOI: 10.1002/lary.30830] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES It has been assumed that patients with primary muscle tension dysphonia (pMTD) have more extrinsic laryngeal muscle (ELM) tension, but tools to study this phenomenon lack. Shear wave elastography (SWE) is a potential method to address these shortcomings. The objectives of this study were to apply SWE to the ELMs, compare SWE measures to standard clinical metrics, and determine group differences in pMTD and typical voice users before and after vocal load. METHODS SWE measurements of the ELMs from ultrasound examinations of the anterior neck, supraglottic compression severities from laryngoscopic images, cepstral peak prominences (CPP) from voice recordings, and self-perceptual ratings of vocal effort and discomfort were obtained in voice users with (N = 30) and without (N = 35) pMTD, before and after a vocal load challenge. RESULTS ELM tension significantly increased from rest-to-voiced conditions in both groups. However, the groups were similar in their ELM stiffness levels at SWE at baseline, during vocalization, and post-vocal load. Levels of vocal effort and discomfort and supraglottic compression were significantly higher and CPP was significantly lower in the pMTD group. Vocal load had a significant effect on vocal effort and discomfort but not on laryngeal or acoustic patterns. CONCLUSION SWE can be used to quantify ELM tension with voicing. Although the pMTD group reported significantly higher levels of vocal effort and vocal tract discomfort and, on average, exhibited significantly more severe supraglottic compression and lower CPP values, there were no group differences in levels of ELM tension using SWE. LEVEL OF EVIDENCE 2 Laryngoscope, 133:3482-3491, 2023.
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Affiliation(s)
- Adrianna C. Shembel
- Department of Otolaryngology-Head and Neck, Voice Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Robert A. Morrison
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - David T. Fetzer
- Department of Radiology, CACTUS Lab, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Amber Patterson-Lachowicz
- Department of Radiology, CACTUS Lab, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sarah McDowell
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Julianna C. Comstock Smeltzer
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Ted Mau
- Department of Otolaryngology-Head and Neck, Voice Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Vijay K, Kelley L, Pak T, Kuhlmann P, Patterson-Lachowicz A, Fetzer DT, Reynolds L, Carmel M, Zimmern P, Khatri G. Multimodality Imaging of Anterior Compartment Pelvic Floor Repair. Radiographics 2023; 43:e230032. [PMID: 37498784 DOI: 10.1148/rg.230032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are two common disorders that affect the anterior compartment of the pelvic floor in women. These can be treated conservatively or surgically. Among patients treated surgically, a substantial number present with pain, recurrent POP or SUI, or other conditions that warrant additional interventions. In many of these cases, imaging is key to identifying and characterizing the type of procedure performed, locating synthetic materials that may have been placed, and characterizing complications. Imaging may be particularly helpful when prior surgical records are not available or a comprehensive physical examination is not possible. US and MRI are the most commonly used modalities for such patients, although radiopaque surgical materials may be visible at voiding cystourethrography and CT. The authors summarize commonly used surgical treatment options for patients with SUI and POP, review imaging techniques for evaluation of such patients, and describe the normal imaging appearance and complications of pelvic floor surgical repair procedures in the anterior compartment of the pelvis. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Kanupriya Vijay
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Layne Kelley
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Taemee Pak
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Paige Kuhlmann
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Amber Patterson-Lachowicz
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - David T Fetzer
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Laura Reynolds
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Maude Carmel
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Philippe Zimmern
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Gaurav Khatri
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
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Fetzer DT, Vijay K, Caserta MP, Patterson-Lachowicz A, Dahiya N, Rodgers SK. Artifacts and Technical Considerations at Contrast-enhanced US. Radiographics 2023; 43:e220093. [PMID: 36563094 DOI: 10.1148/rg.220093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Contrast-enhanced US (CEUS), similar to other radiologic modalities, requires specific technical considerations and is subject to image artifacts. These artifacts may affect examination quality, negatively impact diagnostic accuracy, and decrease user comfort when using this emerging technique. Some artifacts are related to commonly known gray-scale US artifacts that can also appear on the contrast-only image (tissue-subtracted image obtained with the linear responses from background tissues nulled). These may include acoustic shadowing and enhancement; reverberation, refraction, and reflection; and poor penetration. Other artifacts are exclusive to CEUS owing to the techniques used for contrast mode image generation and the unique properties of the microbubbles that constitute ultrasound-specific contrast agents (UCAs). UCA-related artifacts may appear on the contrast-only image, the gray-scale image, or various Doppler mode images. Artifacts related to CEUS may include nonlinear artifacts and unintentional microbubble destruction resulting in pseudowashout. The microbubbles themselves may result in specific artifacts such as pseudoenhancement, signal saturation, and attenuation and shadowing and can confound the use of color and spectral Doppler US. Identifying and understanding these artifacts and knowing how to mitigate them may improve the quality of the imaging study, increase user confidence, and improve patient care. The authors review the principles of UCAs and the sound-microbubble interaction, as well as the technical aspects of image generation. Technical considerations, including patient positioning, depth, acoustic window, and contrast agent dose, also are discussed. Specific artifacts are described, with tips on how to identify and, if necessary, apply corrective measures, with the goal of improving examination quality. © RSNA, 2022 Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- David T Fetzer
- From the Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-8896 (D.T.F., K.V., A.P.L.); Department of Radiology, Mayo Clinic, Jacksonville, FL (M.P.C.); Department of Radiology, Mayo Clinic, Phoenix, AZ (N.D.); and Department of Radiology, Jefferson Health New Jersey, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.)
| | - Kanupriya Vijay
- From the Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-8896 (D.T.F., K.V., A.P.L.); Department of Radiology, Mayo Clinic, Jacksonville, FL (M.P.C.); Department of Radiology, Mayo Clinic, Phoenix, AZ (N.D.); and Department of Radiology, Jefferson Health New Jersey, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.)
| | - Melanie P Caserta
- From the Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-8896 (D.T.F., K.V., A.P.L.); Department of Radiology, Mayo Clinic, Jacksonville, FL (M.P.C.); Department of Radiology, Mayo Clinic, Phoenix, AZ (N.D.); and Department of Radiology, Jefferson Health New Jersey, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.)
| | - Amber Patterson-Lachowicz
- From the Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-8896 (D.T.F., K.V., A.P.L.); Department of Radiology, Mayo Clinic, Jacksonville, FL (M.P.C.); Department of Radiology, Mayo Clinic, Phoenix, AZ (N.D.); and Department of Radiology, Jefferson Health New Jersey, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.)
| | - Nirvikar Dahiya
- From the Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-8896 (D.T.F., K.V., A.P.L.); Department of Radiology, Mayo Clinic, Jacksonville, FL (M.P.C.); Department of Radiology, Mayo Clinic, Phoenix, AZ (N.D.); and Department of Radiology, Jefferson Health New Jersey, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.)
| | - Shuchi K Rodgers
- From the Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-8896 (D.T.F., K.V., A.P.L.); Department of Radiology, Mayo Clinic, Jacksonville, FL (M.P.C.); Department of Radiology, Mayo Clinic, Phoenix, AZ (N.D.); and Department of Radiology, Jefferson Health New Jersey, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.)
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