Reliability Of Ultrasound Imaging Research Articles

Reliability of Ultrasound Imaging in Examining Integrity and Inflammation in the Dorsalis Pedis Artery

Assessment of small vessel inflammatory diseases such as rheumatoid vasculitis is challenging. Small arteries such as the dorsalis pedis artery (DPA) are difficult to assess for changes in the arterial wall with medical imaging. Ultrasound imaging is a viable tool for examining the integrity and inflammatory changes in the arterial wall; however, no empirical data on its reliability have been described. We measured the intra- and inter-rater reliability of ultrasound measurements across five parameters evaluating arterial integrity of the proximal DPA in participants with and without small vessel disease. We recruited 10 participants with rheumatoid arthritis and 10 healthy controls. Two sonographers using ultrasound independently measured DPA lumen diameter, artery diameter, lumen-to-arterial diameter ratio, arterial Doppler velocity and inflammatory changes in the proximal wall of the DPA. The intraclass correlation coefficient (ICC) was used to evaluate 95% confidence intervals within and between raters. Bland-Altman analyses were used to assess limits of agreement and were compared with minimal clinically important differences (MCID). Four of five selected parameters were found to have excellent intra- and inter-rater reliability within and between raters (ICC=0.903-0.996). Acceptable reliability was found for measurement of arterial blood flow velocity within raters (ICC=0.815-0.909), but not between raters (ICC=0.634). Standard mean errors in all parameters were within minimal clinically important differences. Ultrasound imaging has been found to be a reliable method of assessment of arterial integrity and inflammation of the proximal DPA in people with small vessel disease. Evaluation of arterial blood flow velocity requires cautious interpretation.

Validity of ultrasound imaging for intrinsic foot muscle cross-sectional area measurements demonstrated by strong agreement with MRI

PurposeIntrinsic foot muscles maintain foot structural integrity and contribute to functional movement, posture and balance. Thus, assessing intrinsic foot muscle size and strength are important. Magnetic resonance imaging (MRI) has been shown to accurately image the individual muscles but is costly and time consuming. Ultrasound (US) imaging may provide an alternative that is less costly and more readily available. The purpose of this study was to investigate the validity and intratester reliability of US imaging in measuring intrinsic foot muscle size in comparison to MRI.MethodsUS and MRI were employed to measure the intrinsic foot muscle size involving 35 participants (females = 13; males = 22). The scanned intrinsic foot muscles included the flexor hallucis brevis (FHB), abductor hallucis (ABDH), flexor digitorum brevis (FDB), quadratus plantae (QP) and abductor digiti minimi (ADM). Pearson product correlation (r), intraclass correlation coefficients (ICC), standard error of the measurement (SEm) and minimal detectable difference (MDD) were calculated.ResultsHigh correlations were detected between the US and MRI cross-sectional area (CSA) measurements (r = .971 to 0.995). Test reliability was excellent for both MRI and US (ICC = 0.994 to 0.999). Limits of agreement between MRI and US measurements from ranged from 5.7 to 12.2% of muscle size. SEm values for US ranged from 0.026 to 0.044 cm2, while the SEm for MRI ranged from 0.018 to 0.023 cm2. MDD values for US ranged from 0.073 to 0.122 cm2, while MRI ranged from 0.045 to 0.064 cm2.ConclusionsUS appears to be a valid and reliable alternative to MRI when measuring intrinsic foot muscle CSA. While US is less costly and more readily available, the MRI results were shown to be slightly more precise.

Intra- And Inter-rater Reliability Of Panoramic Ultrasound Muscle Image Quantification Of The Quadriceps Femoris

Ultrasound (US) devices have become commonplace in sport and research facilities. These devices allow practitioners to assess skeletal muscle morphology characteristics, such as muscle thickness, muscle cross-sectional area (mCSA), and muscle quality. It is vital to standardize and assess the reliability of US image analysis to compare results across raters and investigations. PURPOSE: The purpose of this project was to assess the intra- and inter-rater reliability of panoramic quadriceps femoris US images using standardized methodologies. METHODS: Quadriceps images were obtained from previous projects conducted in our laboratory. Fifteen vastus lateralis and 10 rectus femoris images were assessed for muscle thickness, mCSA, and muscle quality, quantified by echo intensity, in ImageJ by three investigators. Data were analyzed through standard error of the measurement (SEM), intraclass correlation coefficients (ICC) with 95% confidence intervals (CI), and coefficients of variations (CV). RESULTS: Muscle thickness had an SEM of 0.19, mCSA had an SEM of 2.32, and echo intensity was 3.09. The inter-rater reliability of muscle thickness, mCSA, and echo intensity of were high with ICCs of 0.994 (95% CI: 0.989-0.997; p < 0.001), 0.999 (0.997-0.999; p < 0.001), and 0.999 (0.999-1.000; p < 0.001), respectively. CVs for the muscle thickness was 2.9 + 2.2%, mCSA was 3.5 + 3.2%, and echo intensity was 1.6 + 1.4%. Intra-rater reliability was also high for each rater and each outcome, as each rater had an ICC greater than 0.989 for all outcomes. CONCLUSION: Panoramic US images of the vastus lateralis and rectus femoris can be reliably assessed across and among independent raters using a set of standardized analysis methods. Future projects should be conducted with the goal of assessing the reliability of panoramic ultrasound of various other skeletal muscles of the upper- and lower-body.

Optimization algorithms for ultrasonic array imaging in homogeneous anisotropic steel components with unknown properties

In this paper, we investigate the ability of an adaptive ultrasonic method to image point-like reflectors inside anisotropic and homogeneous nuclear steels with unknown properties, such as V-shape welds or cladded components. The optimization scheme combines the Total Focusing Method (TFM) imaging algorithm with a customized gradient ascent method to improve both the quality and the reliability of ultrasound images. A statistical analysis of its robustness is performed with simulated echoes and using a surrogate model to speed up the computation times of the TFM images. Then, the optimization procedure is evaluated with several experimental cases and provides highly enhanced images with a 5 MHz array. The positioning of the artificial defects of 2.0 mm diameter is estimated with less than 1 mm error with respect to their actual position, and the signal-to-noise ratio is increased by up to 10 dB. The elastic properties are also estimated with less than 10% error when compared to their actual values.

Reliability of the lateral abdominal muscle thickness measurements in idiopathic scoliosis patients

BackgroundTo date, the reliability of ultrasound imaging (US) measures of the abdominal muscle thickness in idiopathic scoliosis (IS) patients during early stages of adolescence has not been confirmed. ObjectiveTo assess the intra-rater reliability of US measures of the thickness of the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) on convex and concave body sides in adolescents with IS. DesignOne-way repeated-measures analysis of variance (ANOVA) and reliability study. MethodsFifteen patients diagnosed IS were included between the ages of 9 and 14 years. Three repeated US measurements were recorded in the supine resting position over 2 sessions, 24 h apart. ResultsBy assessing the mean value from the first two measurements (ICC3,2), the reliability was between .76 and .95 for all examined muscles on the convex and concave sides. The reliability for the mean values from three measurements (ICC3,3) was between .81 and .96. The smallest detectable difference values for single measurements were twice as high on the convex side than on the concave side for all examined abdominal muscles. ConclusionUS measurements of the thickness of the EO, IO, and TrA muscles in supine rest position in adolescent IS patients are reliable. In order to increase measurement reliability, and due to variability in reliability between concave and convex body side, we recommend using the mean of three consecutive measurements of the EO, IO, and TrA muscles for adolescents with IS.

Measuring ultrasound images of abdominal and lumbar multifidus muscles in older adults: A reliability study

Measurement reliability of the L4/5 lumbar multifidus (MF) muscles is high in older adults, but few studies have investigated measurement reliability of the abdominal and upper lumbar MF muscles in this age group. ObjectivesTo determine measurement reliability of abdominal and lumbar MF muscles from a single ultrasound (US) image in older adults. MethodsResting thickness of rectus abdominis and obliquus externus, resting and contracted thickness of obliquus internus, transversus abdominis and lumbar MF, and resting cross-sectional area (CSA) of MF levels (L2-5) were obtained from US images of 92 community-dwelling older adults (aged 65–89 years). Measurements of images were undertaken by an experienced rater and repeated 7–10 days later for intra-rater, and by a second expert rater for inter-rater calculations. Intra-rater reliability was estimated for all muscles. Inter-rater reliability was estimated for all abdominal muscles and for L5 multifidus. Reliability was estimated by intraclass correlation coefficients (ICC). ResultsIntra-rater ICC(3,1) and inter-rater ICC(2,1) of resting thickness measures of all muscles and CSA of MF were ≥0.86. The ICCs for percentage thickness change were ≥0.76 for the abdominal muscles, and ≥0.42 for MF. ConclusionsMeasurement reliability of US imaging for abdominal and MF muscle thickness and MF CSA was high, and consistent with previous findings for younger adults. Reliability of percentage thickness change was lower suggesting caution is needed when using this as an outcome measure or study factor among older adults.

The reliability of ultrasound imaging in measuring tendon size: systematic review and clinical implications

Background: Pathological tendons are known to increase their diameter, which can be viewed using ultrasound (US) and MRI. Although systematic reviews have confirmed the reliability of US for the measurement of muscle thickness, no such reviews exist to examine the reliability of US measures of tendon size. Purpose: To systematically review the literature on the reliability of US to assess tendon dimensions including thickness and cross-sectional area in human limbs. Methods: A comprehensive review of electronic databases was performed by two reviewers using an agreed range of keywords. Clinical trials which investigated inter or intra rater reliability of real time ultrasound was included in this review. The Quality Appraisal of Reliability Studies (QAREL) checklist was used to assess risk of bias. Included studies performed ultrasound analysis in a range of clinical settings. Variations existed between studies in terms of rater training, tendons studied, and participant pain status. Inter and Intra rater reliability of tendon thickness and cross sectional area were analysed using estimates of both reliability and precision using intraclass correlation coefficients (ICC’s) and coefficients of variation (CVs), percentage coefficient of variation (CV%), percentage standard error of the mean (SEM%), limits of agreement (LOA), pearsons correlation coefficient (r2) and 95% confidence intervals (95% CI). Results: A total number of 615 were included in the review. Of this 136 were Symptomatic and 479 were asymptomatic participants, with an age range: 17.5–73 years. Assessment of the risks of bias indicated 15/16 chosen studies was of high quality. ICC values for inter and intra rater reliability indicate good to excellent reliability for all tendon sites with values ranging from (0.55–0.99). Percentage coefficent of variation (CV%) ranged from 0-16% across all tendon sites. The most commonly studied tendons achilles and supraspinatus, the average measurement error from the included studies on Achilles tendons was 9.5% %CV and 5.39% SEM%, these figures equate to errors of 0.67mm and 0.32mm respectively which is well below the observed differences between symptomatic and asymptomatic tendons. The average measurement error from the included studies on supraspinatus tendons was 11.24% %CV and 5.72% SEM%, which equate to errors of 0.77mm and 0.39mm respectivelywhich is similar to, or below, the proposed differences between symptomatic and asymptomatic tendons.LOA ranged from (0.35–3.50mm), r2 ranged from (0.43–0.92), 95% CI ranged from (0.43–0.98) for all tendons. Conclusion(s): Findings of the current review appear to indicate that real time ultrasound is a clinically reliable method inmeasuring tendondimensions.However thesefindings must be considered in light of the limitations identified in the studies with a wide array of statistical methodology and wide range of measurement protocols and assessors. Implications: The findings of this current review may have important clinical implications as regards indicating future direction for possible injury prevention strategies. An understanding of the relationship between sonographic abnormalities and the likelihood of the development of symptoms in asymptomatic individuals, may allow ultrasound to be used as a screening tool to identify athletes at risk and guide prophylactic treatments or training modifications.

The effect of pelvic compression on deep abdominal muscle thickness during the active straight leg raise test

Background/Aims: The estimated prevalence of sacroiliac joint (SIJ) pain is 13–30% in patients with non-specific low back pain. One common presentation is pain at or near the SIJ, and common physical therapy interventions include lumbopelvic stabilisation programmes and pelvic compression belts. The aim of this study was to: i) assess how compression of the SIJ affects the thickness of the deep abdominal muscles during the active straight leg raise (ASLR); ii) determine between-day intra-tester reliability of ultrasound imaging to assess percentage change in thickness of the deep abdominal muscles. Methods: Participants (n=15) with unilateral symptoms near the SIJ and age-matched and sex-matched controls (n=15) were recruited for this study. Ultrasound imaging was used to obtain the thickness of the transverse abdominis (TrA) and internal oblique (IO) muscles. Measurements were taken at rest and during the ASLR, with and without pelvic compression. Results: Two separate two-way (group × pelvic compression) analysis of variance (ANOVA) designs with repeated measures were used to analyse the thickness of the TrA and IO muscles; interactions were not significant for percentage change in the TrA (p=0.57) or IO (p=0.10) muscles. Intra-tester reliability was higher when testing with pelvic compression and in the control group (ICC: 0.85–0.89 vs 0.70–0.76). Conclusions: Pelvic compression did not immediately affect the muscular response of the TrA or IO muscles during the ASLR. Pelvic compression belts may be used to address the passive systems of the pelvis by increasing stability; however, specific localised exercises may be needed to improve the percentage change in thickness of the deep abdominal muscles during the ASLR.

Intra-rater Reliability of B-Mode Ultrasound Imaging of the Abdominal Muscles in Healthy Adolescents During the Active Straight Leg Raise Test

BackgroundTo date, the reliability of ultrasound imaging (USI) measures of the abdominal muscles in children and adolescents during the active straight leg raise (ASLR) test has not been confirmed. ObjectiveTo assess the intra-rater reliability of USI measures of the thickness and percentage thickness change of the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) on both sides of the body during the ASLR test in healthy adolescents. DesignSingle-group repeated-measures intra-rater reliability study. SettingSchool. ParticipantsThirty-nine adolescents between the ages of 13 and 16 years. MethodsThree repeated USI measurements were recorded in the supine resting position and during the ASLR test at 2 sessions, 6 to 8 days apart. In the supine position, measurements were collected at the end of normal expiration. In the case of ASLR, measurements were collected when the person undergoing examination touched the transverse delimiter with the distal part of their lower leg, that is, to a 30° flexion of the hip. Main Outcome MeasurementsUSI of abdominal muscle thickness. ResultsBy using the mean of 3 measures in the supine, resting position, intra-examiner reliability point estimates (intraclass correlation coefficient [ICC]3.3) ranged from 0.95 to 0.97 for EO, IO, and TrA. During the ASLR test, the ICC result of thickness measurements of all muscles was also above 0.90. In terms of percentage change of muscle thickness, the highest ICC3.3 result obtained for the TrA was 0.81-0.85; for EO the result ranged from 0.72-0.89, and the result for the IO was between 0.65 and 0.79. ConclusionUSI measurements of the thickness of the EO, IO, and TrA muscles at rest and during the ASLR test in healthy adolescents between 13 and 16 years of age are reliable. Because of an increase in the precision of measurements, we recommend using the mean of 3 consecutive measurements of the EO, IO, and TrA muscles in adolescents to ensure a good reliability level. Based on 3 consecutive measurements, good reliability for the percentage change in the TrA thickness was achieved.

Reliability of B-Mode Ultrasound Imaging of the Lateral Abdominal Muscles in Healthy Children During the Active Straight Leg Raise Test

Abstract Background: To date, reliability of ultrasound imaging (USI) measures of the abdominal muscles in children during the active straight leg raise (ASLR) test has not been confirmed. The aim of this study is to assess the intra-rater reliability of USI in measuring of the thickness and percent thickness change of the external oblique (EO), internal oblique (IO) and transversus abdominis (TrA) on both sides of the body during the ASLR test. Material/Methods: Thirty-two healthy children between 10-12 years old participated in the study. Three repeated USI measurements were recorded, in supine and resting positions and during the ASLR test. In supine position, measurements were collected at the end of normal expiration. In the case of ASLR, measurements were collected when the person undergoing examination touched the transverse delimiter with the distal part of the lower leg. A repeat session of the measurements was carried out 6 to 8 days later. Results: The use of mean value of the three repeated measurements showed that ICC3.3 fluctuated from 0.81 to 0.97 for OE, OI and TrA in resting position and during the ASLR test. In terms of percentage change of muscle thickness, the ICC3.3 result obtained for TrA, OE and IO were 0.86, 0.83 and 0.78, respectively. Conclusions: The USI evaluation of the lateral abdominal muscles thickness at rest has high reliability in children between 10-12 years old. The USI of the actual thickness and reflex activity of OE, OI and TrA during the ASLR test, based on three repeated measurements, is also reliable. It is recommended to perform three repeated measurements for children between 10-12 years old. There is still a need to seek solutions that will decrease the SDD value while evaluating the reflex activity of the lateral abdominal muscles during the ASLR test.

Ultrasonographic measurements of lower trapezius muscle thickness at rest and during isometric contraction: a reliability study

Objective: The purpose of this study was to determine the intra-rater reliability and inter-rater reliability of ultrasound imaging (USI) thickness measurements of the lower trapezius (LT) at rest and during active contractions when the transverse process and the lamina were used as reference sites for the measurement process. Participants: Twenty healthy individuals between the ages of 22 and 32 years volunteered. Methods: With the subject prone and the shoulder in 145° of abduction, images of the LT were taken bilaterally by one examiner as the subject: (1) rested; (2) actively held the test position; and (3) actively held the test position while holding a weight. Ten subjects returned and testing was repeated by the same examiner and by a second examiner. LT thickness measurements were recorded at the level of the transverse process and at the level of the lamina. Results: Intra-class correlation coefficients (ICC) for within session intra-rater reliability (ICC3,3) ranged from 0.951 to 0.986 for both measurement sites while between session intra-rater reliability (ICC3,2) ranged from 0.935 to 0.962. Within session inter-rater reliability (ICC2,2) ranged from 0.934 to 0.973. Conclusions: USI can be used to reliably measure LT thickness at rest, during active contraction and during active contraction when holding a weight. The described protocol can be utilized during shoulder examinations to provide an additional assessment tool for monitoring changes in LT thickness.

Reliability of ultrasound measurement of automatic activity of the abdominal muscle in participants with and without chronic low back pain

BackgroundUltrasound (US) imaging has been considered as a non-invasive technique to measure thickness and estimate relative abdominal muscle activity. Although some studies have assessed the reliability of US imaging, no study has assessed the reliability of US measurement of automatic activity of abdominal muscles in positions with different levels of stability in participants with chronic low back pain (cLBP). The purpose of this study was to investigate within-day and between-days reliability of US thickness measurements of automatic activity of the abdominal muscles in asymptomatic participants and within-day reliability in those with cLBP.MethodsA total of 20 participants (10 with cLBP, 10 healthy) participated in the study. The reliability of US thickness measurements at supine lying and sitting positions (sitting on a chair, sitting on a gym ball with both feet on the ground or lifting one foot off the floor) were assessed. We evaluated within-day reliability in all participants and between-days reliability in asymptomatic participants.ResultsWe found high ICC scores (0.85-0.95) and also small SEM and MDC scores in both groups. The reliability of the measurements was comparable between participants with and without LBP in each position but the SEMs and MDCs was slightly higher in patient group compared with healthy group. It indicates high intra-tester reliability for the US measurement of the thickness of abdominal muscles in all positions.ConclusionUS imaging can be used as a reliable method for assessment of automatic activity of abdominal muscles in positions with low levels of stability in participants with and without LBP.

Reliability of ultrasound imaging in the assessment of the dorsal Lisfranc ligament

BackgroundThe Lisfranc ligament plays an integral role in providing stability to the midfoot. Variable clinical presentations and radiographic findings make injuries to the Lisfranc ligament notoriously difficult to diagnose. Currently, radiographic evaluation is the mainstay in imaging such injuries; however, ultrasound has been suggested as a viable alternative. The objective of this study was to evaluate the intra-rater and inter-rater reliability in the measurement of the length of the dorsal Lisfranc ligament using ultrasound imaging in healthy, asymptomatic subjects.MethodsThe dorsal Lisfranc ligaments of fifty asymptomatic subjects (n = 100 feet) were imaged using a Siemens SONOLINE Antares Ultrasound Imaging System© under low, medium, and high stress loads at 0° and 15° abducted foot positions. The lengths of the ligaments were measured, and Interclass correlation coefficients were used to calculate within-session intra-rater reliability (n = 100 feet) as well as between-session intra-rater reliability (n = 40 feet) and between-session inter-rater reliability (n = 40 feet).ResultsThe within-session intra-rater reliability results for dorsal Lisfranc ligament length had an average ICC of 0.889 (min 0.873 max 0.913). The average ICC for between-session intra-rater reliability was 0.747 (min 0.607 max 0.811). The average ICC for between-session inter-rater reliability was 0.685 (min 0.638 max 0.776).ConclusionsThe measurement of the dorsal Lisfranc ligament length using ultrasound imaging shows substantial to almost perfect reliability when evaluating asymptomatic subjects. This imaging modality methodology shows promise and lays the foundation for further work in technique development towards the diagnostic identification of pathology within the Lisfranc ligament complex.

Reliability of ultrasound imaging for the measurement of abdominal muscle thickness in typically developing children

Introduction: A bdominal muscles are key to both posture andgait in both children with typical development (TD) and with disabilities.Ultrasound (US) imaging is a potential non-invasive method for investigatingactivity in these muscles. This study therefore aimed to determine the inter-tester and intra-tester reliability of B-mode US for investigating transverseabdominus (TrA ), rectus abdominus (RA ) and external- (EO) and internaloblique (IO) muscle activity in children with TD. Design: A prospective cor-relational descriptive study. Participants: Eighty six, 6-13year old children from one private and one public mainstream school. Outcome measures: Two sets of B-mode US images where captured per subject during rest and during head-up, resisted head-up and resisted sling activities. Intra-class Correlation Coefficients (ICC) and standard error of measurement (SEM) were used to analyse the data. Results: Good correlation was found for both test - retest condi-tions for all four muscles tested during rest: 0.91(TrA ); 0.90(IO); 0.91(EO); 0.94(RA ) for intra-tester reliability and0.74(TrA ); 0.88(IO); 0.74(EO); 0.83(RA ) for inter-tester reliability. Repeatability of thickness measures during activity however showed variation in recruitment patterns. A significant correlation was found between age and BMI andresting abdominal muscle thickness (p&lt;0.001). Conclusion: The study supports the reliability of US measurement of resting abdominal muscles and of the RA under active conditions in children aged six to 13. However the stability o measurement of the other muscles under active conditions still needs to be established.