Changes In Ultrasound Measurements Research Articles

Congruency of Ultrasound Measure Changes Against Patient-Reported Outcome Measures in Patellar Tendinopathy: A Systematic Review and Meta-Analysis.

Patellar tendinopathy is a highly prevalent clinical diagnosis supported by ultrasound changes. Numerous interventions are targeted at improving both symptoms and structure of dysfunctional tendons, however little is known of the diagnostic value in a changing ultrasound profile whilst patient-reported outcome measures (PROMs) determine recovery.The aim is to assess if changes in ultrasound measures are congruent with changes in Victorian Institute of Sports Assessment - Patella (VISA-P) scores, thereby supporting the use of ultrasound to assess patellar tendinopathy during symptom improvement. Four databases (PubMed, Web of Science, Embase, CINAHL) were searched in January 2019. Studies selected contained ultrasound and VISA-P scores from ≥ 2 type points. All included studies were quality assessed depending on the type and available data and underwent meta-analysis. A total of 10 papers of varying study types,limited to high quality, were synthesized. The meta-analysis indicated that changes in ultrasound measures were not congruent with changes in the VISA-P score. The variation in study quality, along with significant heterogeneity of ultrasound measure outcomes and reporting may influence the congruency of the data, but the association between gradual structure change and varying vascularity with pain or function is questionable throughout tendinopathy literature. The small study yield coupled with omission of data, along with alterations to form coherent analysis may impact outcomes, with an absence of homogeneity throughout studies. Ultrasound assessment is not useful in the follow-up of patellar tendinopathy after treatment and is of limited use as an indicator of normal function.

Test-Retest Reliability and Sensitivity to Change of Ultrasound-Based Methods of Measuring Synovial Inflammation in Knee Osteoarthritis.

To assess test-retest reliability of musculoskeletal ultrasound (US) measures of inflammation in patients with knee osteoarthritis (OA) and to assess the sensitivity to change of US measures of inflammation in patients with knee OA. To mimic a common clinical scenario, 36 patients (n=70 knees) with symptomatic knee OA who were in stable condition underwent 2 assessments within 14 days by different operators and different US machines, graded by a single rater. Test-retest reliability was measured using Cohen's kappa coefficient, intraclass correlation coefficient (ICC), and absolute agreement parameters. A total of 51 patients (n=72 knees) were tested immediately before and 21-28 days after intraarticular glucocorticoid injection to investigate sensitivity to change and longitudinal construct validity. Paired t-tests and standardized response mean (SRM) were used to assess sensitivity to change. Multivariate linear regression was used to investigate longitudinal construct validity of US with Knee Injury and Osteoarthritis Outcome Score (KOOS) pain scores, while adjusting for covariates. US measures of inflammation demonstrated moderate (κ=0.41, 0.60) to substantial (κ=0.61, 0.80) agreement. Quantitative measures of synovitis and effusion demonstrated good test-retest reliability (ICC2,1 0.71, 0.92). US measures of synovitis and effusion demonstrated low-to-moderate sensitivity to change (SRM -0.29, -0.50). The associations between changes in US measures and KOOS pain scores over time were low, and 95% confidence intervals included zero. In a clinical setting, US measures of inflammatory features of knee OA have substantial reliability and low-to-moderate sensitivity to change, whereas measures of structural OA features are less reliable. Longitudinal construct validity of US measures of synovitis and effusion to KOOS pain scores is not strongly supported.

Changes in Ultrasound Measurements of the Ulnar Nerve at Different Elbow Joint Positions in Patients with Cubital Tunnel Syndrome.

Ultrasound imaging (US) is increasingly being used in the diagnosis of entrapment neuropathies. The aim of the current study was to evaluate changes in stiffness (shear modulus), cross-sectional area (CSA), and trace length (TRACE) of the ulnar nerve in patients with cubital tunnel syndrome (CuTS), with shear wave elastography (SWE). A total of 31 patients with CuTS were included. CSA, shear modulus, and TRACE examinations were performed in the SWE mode in four positions of the elbow: full extension, 45° flexion, 90° flexion, and maximum flexion. There were significant side-to-side differences in the ulnar nerve elasticity value at 45°, 90°, and maximal elbow flexion (all, p < 0.001) but not at elbow extension (p = 0.36). There were significant side-to-side differences in the ulnar nerve CSA value at each elbow position (all, p < 0.001). There were significant side-to-side differences in the ulnar nerve trace value at each elbow position (all, p < 0.001). The symptomatic ulnar nerve in patients with CuTS exhibited greater stiffness (shear modulus), CSA, and TRACE values, compared with the asymptomatic side. US examinations (shear modulus, CSA, and TRACE evaluation) of the ulnar nerve can be helpful in supporting and supplementing the diagnosis in patients with CuTS.

Effects of gait training with auditory biofeedback on biomechanics and talar cartilage characteristics in individuals with chronic ankle instability: A randomized controlled trial

BackgroundAltered walking gait is a typical impairment following ankle sprains which may increase susceptibility to recurring injuries and development of posttraumatic osteoarthritis at the ankle. There is a lack of targeted gait training interventions focusing on specific modifications in individuals with chronic ankle instability (CAI). Additionally, there is a need to focus on cartilage health changes following gait training to mitigate osteoarthritis progression. Research questionTo determine the immediate and retention effects of gait training using auditory biofeedback (AudFB) in patients with chronic ankle instability (CAI) on biomechanics and talar cartilage characteristics. MethodsEighteen participants with CAI were randomly assigned into Control (n = 7) or AudFB (n = 11) groups. Each group completed 8-sessions of 30-minute treadmill walking. The AudFB group received biofeedback through a pressure sensor fashioned to the lateral foot and instructions to walk while avoiding noise from the sensor. The Control group did not receive instructions during sessions. An in-shoe insole system measured peak pressure, maximum force, and center of the pressure gait line (COP) during walking. Ultrasonography captured talar cartilage thickness and echo intensity before and after walking. Biomechanics and ultrasound were measured at baseline, immediately, and 1-week after the intervention. Repeated measures mixed-methods analysis of variance assessed changes within groups across time. ResultsThe AudFB group significantly reduced pressure and force in the lateral foot and medially shifted their COP at Immediate and 1-week Post. There were no observed changes in the Control group. In addition, neither group demonstrated changes in ultrasound measures at follow-up. SignificanceImplementation of auditory biofeedback during gait training can be a valuable tool for clinicians treating patients with CAI.

Diaphragmatic atrophy and dysfunction in critically ill mechanically ventilated children.

The extent of diaphragmatic atrophy and dysfunction in critically ill children from developing countries is not established. To estimate changes in ultrasound measurements of diaphragmatic thickness over the first week of mechanical ventilation. To assess magnitude and risk factors of diaphragmatic atrophy. In an observational cohort study, children aged 1-18 years, requiring mechanical ventilation were included. Ultrasound measurements of diaphragmatic thickness at end-expiration (DTe) and end-inspiration (DTi), and diaphragmatic thickening fraction (DTF) were performed daily during the first week of admission, and pre- and post-extubation. Diaphragmatic atrophy (%) and atrophy rate (rate of decline in DTe, % per day) were calculated. Of 55 children (74.6% boys) enrolled, 20 (36.4%) died. Of 35 children with planned extubation, 5 (14.3%) required reintubation. Baseline median (interquartile range [IQR]) DTe, DTi, and DTF were 1.27 mm (1, 1.6), 1.76 mm (1.35, 2.10),and 33.75% (26.90, 44.60), respectively. There was a significant reduction in DTe over the first week of mechanical ventilation (p < .001), median (IQR) diaphragmatic atrophy and atrophy rate of 9.91% (5.26, 17.35) and 2.01% (1.08, 3.04)per day, respectively. Diaphragmatic atrophy rate was lower in pressure targeted ventilation (n = 44; 1.79%[1.03, 2.87])than volume targeted ventilation (n = 11; 3.10% [1.31, 5.49]), p = .038. There was no difference in diaphragmatic parameters (atrophy rate, and peri-extubation DTe and DTF) in extubation success versus failure. The diaphragm undergoes progressive atrophy during the first week of mechanical ventilation in critically ill children. Future studies should evaluate ventilation strategies to reduce the diaphragmatic atrophy.

Role of Ultrasound to Monitor Patients With Carpal Tunnel Syndrome Treated With a Local Corticosteroid.

Carpal tunnel syndrome (CTS) is an entrapment neuropathy resulting from compression of the median nerve at the carpal tunnel (CT). We assessed the role of high-resolution ultrasound (US) in monitoring patients with CTS treated with corticosteroid injection. We performed high-resolution US evaluations of the wrists of patients with CTS before and after treatment with local corticosteroid. Thirty-nine and 17 wrists were included for analysis at the end of 1 and 3 months, respectively. The cross-sectional area (CSA) and anteroposterior diameter (APD) of the median nerve at the CT and clinical and electrophysiologic data were recorded. We assessed whether changes in US measurements before and after the treatment correlated with clinical and electrophysiologic parameters. The Boston symptom severity scale (p < .01), Boston functional status scale (p < .01), median nerve motor latency (p = .017), median nerve sensory velocity (p = .003), and difference in motor latencies (p = 0.03) and difference in sensory latencies (p = .03) between median and ulnar nerves showed significant changes over 1 or/and 3 months compared to baseline values. Changes in the CSA and APD correlated with changes in some clinical and electrophysiologic parameters. However, measurements of the CSA and APD at 1 or 3 months were not significantly different from baseline values. High-resolution US parameters such as the APD and CSA of the median nerve at the CT inlet were not useful to monitor patients with CTS treated with corticosteroid injections.

Comparison of sonographic inferior vena cava and aorta indexes during fluid administered in children

ObjectivesThis prospective, observational study evaluated changes in ultrasound measurements of the inferior vena caval index (IVCI), the aorta diameter/IVC diameter index (Ao/IVCD), and the aorta area/IVC area index (Ao/IVCA) during fluid administration in children requiring intravenous fluid administration. MethodsChildren who presented to the pediatric emergency department with symptoms of dehydration were enrolled between May 2015 and February 2016. The maximum diameter of the aorta, from inner wall to inner wall, and the long and short axis diameters of IVC were measured using a convex array transducer in the transverse view. Subsequently, we measured the diameter of the IVC at the subxiphoid area during inspiration and expiration in longitudinal view. We calculated IVCI, Ao/IVCD, and Ao/IVCA during administration of 10ml/kg and 20ml/kg normal saline boluses. ResultsIVCI and Ao/IVCA significantly changed immediately after administration of initial 10ml/kg of NS. Ao/IVCA showed significant change during the additional administration of 10ml/kg (total 20ml/kg) normal saline boluses (1.43, IQR 1.12–1.86 vs. 1.08, IQR 0.87–1.45, p value<0.001). No significant changes were observed for IVCI and Ao/IVCD. Ao/IVCA was significantly correlated with the volume of fluid administered. The coefficient between initial and administration of the 10ml/kg normal saline bolus was −0.396 (p value=0.010), and that between the 10ml/kg and 20ml/kg normal saline boluses was −0.316 (p value=0.038). ConclusionsAo/IVCA showed better correlations with the volume of fluid administered than IVCI and Ao/IVCA. Ao/IVCA might be a promising index for assessing the effects of fluid administration.

Effect of feeding system and breed on growth performance, and carcass and meat quality traits in two continental beef breeds

A total of 100 young bulls were allotted a 2×2 factorial arrangement of treatments to determine the effect of the feeding system (concentrate and wheat straw: T; total mixed ration comprised of the same concentrate, maize silage and wheat straw: TMR) and breed (Limousine: LI; Retinta: RE) on growth performance, carcass characteristics and meat quality. The diets were administrated ad libitum for 193days. The average daily weight gain was similar (P>0.05) for both diets, while the LI bulls grew significantly (P<0.05) more than RE. T bulls showed higher L*, a* and rib bone percentage. TMR bulls showed higher carcass yield, conformation and fatness, and greater changes in ultrasound measurements, except Δ UGMD and rib fat percentage. Instrumental meat quality, except shear force at 1 and 21days of ageing, was not affected (P>0.05) by the diets. Breed significantly affected most of the analyzed characteristics.

Correlation between changes in ultrasound measurements and clinical curative effect of tension-free vaginal tape-SECUR* procedure

The hypotheses of this study were that the TVT-SECUR procedure restricts urethral mobility, which leads to a greater likelihood of curative effect, and that the restriction might change over time. Analyses of the position of the urethra and the tape of 85 patients who underwent the TVT-S procedure were performed using perineal ultrasonography. The efficacy of the TVT-S procedure was evaluated by cough test and by the questionnaire ICIQ-UI SF. Objectively, 53/85 (62%) of patients had a negative cough test, and in 32/85 (38%) of patients leakage of urine persisted. The TVT-S procedure restricts urethral mobility, and a higher degree of obstruction is associated with a higher likelihood of cure. The restriction weakens within the first 3 months after surgery. The objective cure rate of TVT-S procedure is low irrespective of placement technique. This may be due to insufficient restriction of urethral mobility.

The effect of anabolic implants on intramuscular lipid deposition in finished beef cattle

Two experiments were conducted to determine the effects of anabolic implants on performance, changes in ultrasound measurements, carcass quality, cellularity of i.m. and s.c. adipose depots, and mRNA expression of acetyl CoA carboxylase (ACC), stearoyl CoA desaturase (SCD), and lipoprotein lipase (LPL) in i.m. adipose tissue of finished beef cattle. Angus heifers (experiment 1: n = 10; 411 kg of BW) and steers (experiment 2: n = 18; 279 kg of BW) were randomly allotted as control (C) or implanted with Synovex-Plus (SP) at d 0 and midway through the finishing period. The cattle were fed a high-concentrate diet and were weighed at approximately 28-d intervals. Heifers and steers were finished for 108 and 133 d, respectively. At slaughter, a section of the LM (sixth to ninth rib) was removed, and i.m. adipose tissue was dissected for mRNA analysis. Subcutaneous and i.m. adipose tissues also were collected for determination of cellularity. At 48 h postmortem, carcass data were collected, and a steak (12th rib) was removed for analysis of lipid and fatty acid composition. Body weight did not differ (P > 0.10) between treatments until after reimplanting of the heifers (d 55) or steers (d 73). Average daily gain was 36 and 16% faster (P < or = 0.01) for implanted heifers and steers, respectively, compared with their control counterparts. Implanting resulted in larger (P < or = 0.10) HCW and LM area for heifers and steers. However, implanting did not affect (P > 0.10) dressing percent, fat thickness, percentage of KPH, yield grade, or marbling score. Intramuscular lipid content and concentrations of major fatty acids did not differ (P > 0.10) between treatments. Percentage of SC adipocytes was greater at larger diameters ( > 150 microm), whereas the majority of i.m. adipocytes were at small to middle diameters (50 to 150 microm). The number of i.m. adipocytes per gram of tissue was greater (P < 0.05) for SP than C and also were greater (P < 0.05) than the number of s.c. adipocytes in SP heifers. In experiment 2, adipocytes per gram of tissue tended to be greater (P = 0.07) for SP than C and were greater (P < 0.01) for i.m. than s.c. In experiment 1, average cell diameter and volume did not differ (P > 0.10) between treatments and tissues, but in experiment 2 both cellularity traits were greater (P < 0.01) for s.c. than for i.m.. Implanting did not alter mRNA expression of ACC, SCD, or LPL in i.m. adipose tissue. This study shows that anabolic implants do not appear to have direct effects on i.m. lipid deposition.

Longitudinal changes in ultrasound measurements: A parallel study in subjects with genetic disorders and healthy controls

Disturbances in skeletal status in subjects with genetic disorder may increase their fracture risk. The aim of the study was longitudinal observation of phalangeal speed of sound changes across the bone over a period of 2 y in 24 patients (14 boys and 10 girls, mean age 9.63 ± 1.8 y.) and 24 age-matched healthy controls (14 boys and 10 girls, mean age 9.65 ± 1.71 y.). Weight and height did not differ between patients and controls at baseline and follow-up. Patients with the following disorders were evaluated: 7 with Down syndrome, 6 nonspecific mental retardations of unknown etiology, 5 Martin-Bell syndrome and 6 with other diseases. In patients and controls, no factors potentially influencing bone metabolism (except for genetic disorder) were present. Bone status was assessed by quantitative ultrasound at hand phalanges using DBM Sonic 1200 (IGEA, Carpi, Italy), which measures amplitude-dependent speed of sound (Ad-SoS [m/s]). At baseline, Ad-SoS and Z-score were significantly lower in patients than in controls (1892 ± 51 m/s versus 1936 ± 43 m/s, p < 0.01 and −1.47 ± 1.43 versus −0.14 ± 1.04, p < 0.001, respectively. In follow-up, Ad-SoS and Z-score increased significantly in patients (1892 ± 51m/s to 1934 ± 48 m/s, p < 0.0001 and −1.47 ± 1.43 to −0.76 ± 1.00, p < 0.01, respectively) and in controls (1936 ± 43 m/s to 1976 ± 60 m/s and −0.14 ± 1.04 to 0.31 ± 1.08, p < 0.05, respectively). Follow-up Ad-SoS and Z-sScore were significantly lower in patients ( p < 0.01). Longitudinal changes in Ad-SoS, Z-score weight did not differ between patients and control, and height increased more in controls (13.2 ± 2.8 cm versus 11.4 ± 5.9 cm, p < 0.05)+). In patients, Ad-SoS increased by 42 m/s (2.22%), and in controls increased by 40 m/s (2.07%). Difference in Ad-SoS between patients and controls was 44 m/s at baseline and 42 m/s at follow-up. Using the value of the least significant change (LSC = 20.5 m/s), in 16 patients (67%) and in 18 controls (75%) Ad-SoS showed an increase greater than the LSC, in one control (4%) a decrease greater than the LSC and in rest of subjects studied remained unchanged (33% patients and 19% controls) over a period of observation. In conclusion, despite comparable improvement in measured ultrasound parameter in patients and controls observed over a study duration, the difference between them remained stable.

Changes in ultrasound measures of muscle and its genetic variation during lactation in dairy cows

AbstractChanges in ultrasound measures of muscle area (UtM) during lactation in different breeds and parities and with different feeding levels were examined. Random regressions were fitted to repeated measures of UtM in order to study changes in variance components of UtM during lactation. Correlations between measures taken in different stages of lactation and in different parities were also calculated. The shape of UtM curves during lactation appeared to be fairly consistent for all breeds and parities. The lowest point of all curves coincided with the expected nadir of body reserves during lactation. With lower-than-normal feeding level, the drop of UtM after calving was deeper and the overall level was lower. A major proportion of the variance in UtM was found to be determined by additive genetic variation. In all three breeds studied, repeatability and heritability estimates were high and fairly consistent during lactation and between parities. The very high genetic correlations between measures taken in different periods of lactation suggested that muscle growth and recovery are controlled by the same gene complex throughout lactation.Our results suggest that UtM, if used jointly with other body measures such as body condition score, could be a useful indicator of tissue mobilization and deposition in the lactating cow, especially during the early stage of lactation.