Ultrasound Real-time Tissue Elastography Research Articles

Comparative Study of Muscle Hardness during Water-Walking and Land-Walking Using Ultrasound Real-Time Tissue Elastography in Healthy Young People

Compared with land-walking, water-walking is considered to be beneficial as a whole-body exercise because of the characteristics of water (buoyancy, viscosity, hydrostatic pressure, and water temperature). However, there are few reports on the effects of exercise in water on muscles, and there is no standard qualitative assessment method for muscle flexibility. Therefore, we used ultrasound real-time tissue elastography (RTE) to compare muscle hardness after water-walking and land-walking. Participants were 15 healthy young adult males (24.8 ± 2.3 years). The method consisted of land-walking and water-walking for 20 min on separate days. The strain ratio of the rectus femoris (RF) and medial head of gastrocnemius (MHGM) muscles were measured before and immediately after walking using RTE to evaluate muscle hardness. In water-walking, the strain ratio significantly decreased immediately after water-walking, with p < 0.01 for RF and p < 0.05 for MHGM, indicating a significant decrease in muscle hardness after water-walking. On the other hand, land-walking did not produce significant differences in RF and MHGM. Muscle hardness after aerobic exercise, as assessed by RTE, was not changed by land walking but was significantly decreased by water walking. The decrease in muscle hardness induced by water-walking was thought to be caused by the edema reduction effect produced by buoyancy and hydrostatic pressure.

Providing safe and effective rehabilitation by assessing supraspinatus muscle elasticity using ultrasound real-time tissue elastography after rotator cuff repair: A case series

ABSTRACT Introduction Although surgical techniques have advanced to avoid a postoperative re-tear after rotator cuff surgery, it remains unclear how to directly evaluate the risk of a re-tear. Objective To describe how muscle elasticity with real-time tissue elastography could be used to avoid re-tear in individual cases after rotator cuff repair. Case Description This case series included four patients, two per tear size (small and large/massive), with contrasting changes in muscle elasticity of the supraspinatus muscle. All patients underwent primary arthroscopic or open rotator cuff repair. The elasticity of the supraspinatus muscle was evaluated at relaxed and elongated positions of 0° and 60° shoulder abduction angles, respectively. The change in muscle elasticity at 1 month after surgery was characteristically different, and we predicted that a greater elasticity in the elongated position indicated a higher risk of re-tear. The cases with high risk underwent careful rehabilitation to avoid re-tear, and no re-tears were recorded in this report. Conclusion Our findings suggested that evaluation of muscle elasticity using real-time tissue elastography, which provides an indication of the risk of re-tear, in the clinical setting might be useful for therapists, who could adjust the intensity of rehabilitation, and for patients.

Changes in shoulder muscle activities and glenohumeral motion after rotator cuff repair: an assessment using ultrasound real-time tissue elastography.

Although rotator cuff repair is performed to restore the function of the rotator cuff muscles and glenohumeral (GH) joint motion, little has been known regarding the recovery process. The purpose of this study was (1) to investigate changes over time in activities of the supraspinatus and deltoid muscles assessed by ultrasound real-time tissue elastography (RTE) after rotator cuff repair and (2) to determine contributions of the activities of these muscles to the GH joint motion. Twenty patients after rotator cuff repair and 13 control participants were enrolled in this study. Elasticity of the supraspinatus and middle deltoid muscles were measured at rest and 30° of humerothoracic elevation in the scapular plane (scaption) by using RTE. The elasticity at 30° of scaption was normalized to that at rest in each muscle to quantify their muscle activities. In addition, the supraspinatus-to-middle deltoid (SSP/MD) ratio for the normalized elasticity was calculated. The GH elevation angle was measured with a digital inclinometer, which was calculated by subtracting the scapular upward rotation angle from 30° of scaption. For patients after rotator cuff repair, all measurements were performed at 6 weeks, 8 weeks, 3 months, and 6 months after surgery. Rotator cuff integrity was examined with magnetic resonance imaging at 6 months after surgery. Fifteen of 20 patients who remained intact at 6 months after surgery completed this study. The supraspinatus activity at 6 weeks was significantly smaller than that at 3 months (P = .006) and 6 months (P = .010). There was no significant difference in the supraspinatus activity between the patients at 3 months and the control participants (P = .586). The middle deltoid activity at 6 weeks was significantly greater than that at 6 months (P = .003). There was positive correlation between GH elevation angle and the activity of the supraspinatus relative to the deltoid at 6 weeks (r = 0.75, P = .001) and 8 weeks (r = 0.53, P = .041). The supraspinatus activity increased from 6 weeks to 3 months after surgery. The supraspinatus activity at 3 months after surgery was the same level as that in healthy individuals. On the other hand, the deltoid activity decreased from 6 weeks to 6 months after surgery. The increase in activity of the supraspinatus relative to the deltoid was likely to be related to the increase in GH elevation during postoperative at 8 weeks.

Intrinsic foot muscle hardness is related to dynamic postural stability after landing in healthy young men

BackgroundThe human foot has competent mechanisms for supporting weight and adapting movement to various surfaces; in particular, the toe flexor muscles aid in supporting the foot arches and may be important contributors to postural stability. However, the role of intrinsic foot muscle morphology and structure in the postural control system remains unclear, and the relationship between them is not well known. Research questionAre intrinsic foot muscle morphology and toe flexor strength related to static and dynamic postural stability in healthy young men?. MethodsA total of 27 healthy men aged 19–27 years participated in this study. intrinsic foot muscle morphology included muscle hardness and thickness. Cross-sectional area was measured by ultrasonography at an ankle dorsiflexion angle of 0°. The hardness of the abductor hallucis (AbH), flexor hallucis brevis, and flexor digitorum brevis (FDB) muscles was measured using ultrasound real-time tissue elastography. Static postural stability during single-leg standing on a single force platform with closed eyes was assessed for the right leg. In the assessment of dynamic postural stability, the subjects jumped and landed on single-leg onto a force platform and the dynamic postural stability index (DPSI) was measured. ResultsFDB muscle thickness showed a positive correlation with anteroposterior stability index (APSI) (r = 0.398, p = 0.040). AbH muscle hardness was negatively correlated with APSI (r = −0.407, p = 0.035); whereas FDB muscle hardness was positively correlated with DPSI (r = 0.534, p = 0.004), vertical stability index (r = 0.545, p = 0.003), and maximum vertical ground reaction force (r = 0.447, p = 0.020). Multiple regression with forced entry revealed that only DPSI was significantly correlated with FDB muscle hardness (p = 0.003). SignificanceThe results indicated that intrinsic foot muscle hardness plays an important role in dynamic postural control among healthy young men, which may enable a more rapid muscular response to changes in condition during jump landing and better performance in balance tasks.

Differences in scapular motion and parascapular muscle activities among patients with symptomatic and asymptomatic rotator cuff tears, and healthy individuals.

BackgroundAltered scapular motion is thought to be one of the factors associated with the development of symptomatic rotator cuff tears. However, the differences in kinematics and muscle activities of scapular upward/downward rotation between patients with symptomatic and asymptomatic tears are unclear. The purpose of this study was to compare the differences in kinematics and muscle activities of scapular rotation among patients with symptomatic and asymptomatic tears, and healthy individuals.MethodsTwenty-three patients with rotator cuff tears and 9 healthy individuals (healthy group) participated in this study. Based on a visual analog scale (VAS, 0-100 mm), the patients were divided into symptomatic (13 patients; VAS ≥20 mm) and asymptomatic (10 patients; VAS <20 mm) groups. Scapular upward rotation was measured with a digital inclinometer. Elasticities of the upper trapezius, levator scapulae, and rhomboid major were assessed by using ultrasound real-time tissue elastography to quantify their muscle activities. All measurements were performed at 0°, 60°, 90°, and 120° of active arm elevation in the scapular plane.ResultsScapular upward rotation was significantly less in the symptomatic group (9.4° ± 5.6°) compared with the asymptomatic group (15.7° ± 6.0°; P = .022) at 90° of arm elevation. The activity of the levator scapulae was significantly higher in the symptomatic group compared with the asymptomatic and healthy groups (P = .013 and P = .005, respectively) at 90° of arm elevation. The activity of the upper trapezius was significantly higher in the symptomatic group compared with the healthy group (P = .015) at 120° of arm elevation.ConclusionPatients with symptomatic rotator cuff tears showed less scapular upward rotation and higher activity of the levator scapulae at 90° of arm elevation compared to patients with asymptomatic rotator cuff tears.

Ultrasound Real-Time Tissue Elastography Improves the Diagnostic Performance of the ACR Thyroid Imaging Reporting and Data System in Differentiating Malignant from Benign Thyroid Nodules: A Summary of 1525 Thyroid Nodules.

Background To explore the correlation between the ultrasound elasticity score (ES) of real-time tissue elastography (RTE) and the malignant risk stratification of the Thyroid Imaging Reporting and Data System (TI-RADS) and to evaluate the added value of RTE to TI-RADS in differentiating malignant nodules from benign ones. Methods A total of 1,498 patients (885 women and 613 men; mean age of 43.5 ± 12.4 years) with 1,525 confirmed thyroid nodules (D = maximum diameter, D ≤ 2.5 cm) confirmed by fine-needle aspiration (FNA) and/or surgery were included. The nodules were divided into four groups based on their sizes (D ≤ 0.5 cm, 0.5 < D ≤ 1.0 cm, 1.0 < D ≤ 2.0 cm, and 2.0 < D ≤ 2.5 cm). We assigned an ES of RTE and malignant risk stratification of the TI-RADS category to each nodule. The correlation between the ES of RTE and the malignant risk stratification of TI-RADS category was analyzed by the Spearman's rank correlation. The diagnostic performances of RTE, TI-RADS, and their combination were compared by the receiver operator characteristic (ROC) analysis. Results The ES of RTE and the malignant risk stratification of TI-RADS showed a strong correlation in the size intervals of 0.5 < D ≤ 1.0 cm, 1.0 < D ≤ 2.0 cm, and 2.0 < D ≤ 2.5 cm (r = 0.768, 0.711, and 0.743, respectively). The diagnostic performance of their combination for each size interval was always better than RTE or TI-RADS alone (for all, P < 0.001). Conclusions Overall, The ES of RTE was strongly correlated with the malignant risk stratification of TI-RADS. The diagnostic performance of the combination of RTE and TI-RADS outperformed RTE or TI-RADS alone. Therefore, RTE may be an adjunctive tool to the current TI-RADS system for differentiating malignant from benign thyroid nodules.

Clinical analysis on the differential diagnosis of gastrointestinal neoplasms by real-time endoscopic ultrasonography

Abstract: objective: to study and analyze the effect of real-time endoscopic ultrasonography in the differential diagnosis of gastrointestinal tumors.Selection methods: between January 2014 and January 2015 xinyang 53 cases of digestive system cancer patients admitted in hospital, a total of 79 substantial tumor of the digestive system lesions, all patients were diagnosed by endoscopic ultrasonography real-time tissue elastography, use elastic imaging score, for patients with lesions and their surrounding structures control the elastic strain rate ratio of measure and comparison analysis.Results: compared with the malignant lesion group, the difference between the benign lesion group and the benign lesion group was statistically significant (P&lt;0.05).The ratio of elastic strain rate in benign lesion group was lower than that in malignant lesion group (P&lt;0.05).The diagnostic accuracy, sensitivity and specificity were 91.14%, 94.74% and 81.82% respectively.Conclusion: endoscopic ultrasound real-time tissue elastography is effective in the differential diagnosis of digestive system tumors, and can effectively determine the benign and malignant tumors and improve the diagnostic accuracy.

Transabdominal Ultrasound Real-time Tissue Elastography as a Screening Method for Early Chronic Pancreatitis

Transabdominal Ultrasound Real-time Tissue Elastography as a Screening Method for Early Chronic Pancreatitis

The Passive Mechanical Properties of Muscles and Tendons in Children Affected by Osgood-Schlatter Disease

Osgood-Schlatter disease (OSD) is a sports-related disorder involving apophysitis, which affects the tibial tuberosity. The identification of factors related to OSD is important for its prevention and early recovery from the disease. This study aimed to compare the passive mechanical properties of the muscle-tendon unit in children affected by an OSD and healthy children, by using ultrasound real-time tissue elastography. Eighteen legs affected by OSD (OSD group) and 42 healthy legs (control: CON group) were assessed. The elasticity was obtained from the quadriceps muscles and patella tendon (PT) using real-time tissue elastography. The strain ratio (SR; muscle or tendon/reference ratio: strain rate of the muscle or tendon divided by that of the reference material) was calculated as an indicator of the elasticity of the tissue of interest. The SR of the PT in the OSD group was significantly lower than that in the CON group (P<0.05). We found no significant difference between the groups in terms of the SR value of all muscles (P>0.05). The results suggest that a PT with a lower SR may be associated with an OSD and that the passive mechanical properties of the quadriceps muscles have limited association with an OSD. Level IV.

Comparison of median nerve stiffness with and without rheumatoid arthritis by ultrasound real-time tissue elastography: A propensity score matching study

Objectives: This study aimed to compare median nerve stiffness measured by ultrasound real-time tissue elastography in patients with and without rheumatoid arthritis (RA and non-RA groups, respectively).Methods: Altogether, 402 hands of 201 RA group and 222 hands of 111 non-RA group were included in the study. Ultrasonography was performed to evaluate the circumference, cross‐sectional area (CSA) and strain ratio as an elasticity of the median nerve at the inlet level of the carpal tunnel and the proximal portion of the carpal tunnel inlet. Using propensity score matching, the difference between RA and non-RA group were analyzed.Results: After propensity score matching, 135 hands in 104 RA group and 70 non-RA group were finally analyzed. There were no significant differences in the circumference and CSA of the median nerve between the two groups. The strain ratio of the median nerve was significantly higher in RA group than in non-RA group only at the inlet of the carpal tunnel level.Conclusions: The nerve stiffness in patients with RA measured by ultrasound real-time tissue elastography was higher than without RA. Inflammatory condition of the flexor tendon and wrist joint in patients with RA may generate fibrotic changes in the median nerve.Trial registration: University Hospital Medical Information Network Clinical Trials Registry: UMIN000015314.

Comparison of Tongue Hardness at Rest and When Holding Water in the Mouth Using Ultrasound Real-time Tissue Elastography

Comparison of Tongue Hardness at Rest and When Holding Water in the Mouth Using Ultrasound Real-time Tissue Elastography

Diagnostic value of endoscopic ultrasound elastography for benign and malignant digestive system tumors.

Objective:To investigate the effect of endoscopic ultrasound real-time tissue elastography in differential diagnosis of benign and malignant digestive system tumors.Methods:Forty-two patients with solid tumors of digestive system who were admitted to our hospital between October 2017 and October 2018 were selected. All patients were diagnosed by endoscopic ultrasound real-time tissue elastography. Elastography score was used. The strain ratios (SR) of the lesion and the surrounding control tissues were measured and compared.Results:Lesions with elastography score no more than two points were evaluated as benign, while lesions with elastography score no less than three points were evaluated as malignant. The difference of the elastography score between the benign lesion group and malignant lesion group was statistically significant (P<0.05). The sensitivity, specificity and accuracy of endoscopic ultrasound elastography in the diagnosis of malignant tumors of digestive system were 91.4%, 88.9% and 87.5%, respectively. The SR of the benign lesions ranged from 0.01 to 7.34, with a median SR of 7.33; the SR of the malignant lesions ranged from 1.01 to 47.66, with a median SR of 20.07. The SR of the benign lesions was significantly lower than that of the malignant lesions (P<0.05).Conclusion:Elastography of benign and malignant tissues of digestive tract tumors has different image characteristics. Endoscopic ultrasound real-time tissue elastography is effective in differential diagnosis of digestive tract tumors as it can effectively determine whether a tumor is benign or malignant and improve diagnostic accuracy.

Artificial CO2-water Leg-bath Facilitates Recovery From Muscle Hardness Caused By Resistance Exercise

Facilitation of the blood stream and oxygen consumption of the muscle by a local immersion of the extremities into high concentration carbon dioxide water (CO2-water, CO2≥1000ppm), suggests an improvement of muscle performance and joints flexibility. PURPOSE: In the present study, we investigated whether the immersion of extremities including agonist muscles into artificially made CO2-water influenced recovery of the increased muscle hardness induced by a resistance exercise. METHODS: The healthy male college students (n=11, age; 18-19 yrs, height; 168.6±4.5 cm, weight; 66.2±9.3 kg) participated in this study. The subjects performed 100 times calf raise resistance exercise and immersed lower legs into tap-water or artificial CO2-water at 35 °C for 10 minutes immediately after the exercise. Blood flow in the immersed skin (BFskin) and electrocardiogram (ECG) were recorded continuously throughout the experiment. Hardness of the gastrocnemius medialis (MG) was evaluated using ultrasound real-time tissue elastography. Visual analog scale test on muscle pain (VAS) and muscle hardness measurements were performed at 3 time points (prior to exercise, immediately after exercise, at 10 min after exercise). The strain ratio (SR) between the MG and a reference material was calculated. RESULTS: BFskin in the CO2-water leg-bath was significantly higher than that in the tap-water leg-bath (CO2 -water vs. tap-water, 5.5±1.8 vs. 2.1±1.2 ml·min-1·100g-1, p<0.05). At 10 min after exercise, CO2 -water treatment compared with the tap-water treatment, SR decreased significantly quicker (1.37±0.28 vs. 0.67±0.08, p<0.05). In addition, VAS at recovery 10 min became smaller in the CO2-water than the tap-water (18.1±10.2 vs. 33.9±16.2 mm, p<0.05). CONCLUSIONS: We reported previously that the muscle blood flow in the immersed part was larger in CO2-water than tap-water of a same temperature. In addition to a local effect of CO2, suppression of muscular sympathetic activity may also contribute to the increase in local blood flow. Facilitation of muscle hardness recovery shown in this study might be caused by the increased muscle blood flow. The present study suggested that high concentration artificial CO2-water immersion may contribute to rapid recovery from the high intensity exercise-induced muscle fatigue.

Evaluation of the activities of the medial and lateral heads of quadratus plantae in flexion movements of the lateral four toes using ultrasound real-time tissue elastography

Quadratus plantae (QP), one of the plantar intrinsic foot muscles, assist plantarflexion of the lesser toes. QP has medial and lateral muscle heads with different anatomical structures. The two heads of this muscle may have different roles in foot function. Ultrasound real-time tissue elastography (RTE) measurements have allowed quantitative assessment of deep-layer muscle elasticity. The purpose of this study was to determine the activity of the QP in flexion movements of the lateral four toes using RTE.Thirteen healthy subjects performed maximal voluntary contractions using a hand-held dynamometer with external belt fixation for each toe flexion movement. The elasticity of the muscles were measured using RTE during rest and flexion of each toe. The strain ratio of the muscle to that in an acoustic coupler was calculated as an index of muscle elasticity. Higher strain ratio values imply lower elasticity.The strain ratio of the medial head of QP for second toe flexion (0.10±0.11) was significantly stiffer than at rest (0.34±0.33). The strain ratios of the lateral head of QP for flexion of the second (0.32±0.19), third (0.41±0.37), fourth (0.33±0.26), and fifth (0.45±0.39) toes were significantly stiffer than at rest (1.02±0.68). These results suggest that the medial head of QP has a role in assisting second-toe flexion, and the lateral head has a role in assisting flexion of all four lateral toes.

Value of multi-modal image-guided transrectal ultrasonography in the diagnosis of prostatic nodules in elderly patients

Objective To assess the value of multi-modal image-guided transrectal ultrasonography in the diagnosis of prostatic nodules in elderly patients. Methods Sixty-four elderly patients suspected of prostate cancer (PCA) were enrolled from December 2015 to December 2016.Sixty-four patients with 72 nodules underwent transrectal ultrasound (TRUS), contrast-enhanced transrectal ultrasound (CETRUS) and transrectal real-time tissue elastography (TRTE). A combination of systematic biopsy and suspicious site-targeted biopsy was conducted.The accuracies of different detection methods for prostate cancer were assessed against the gold standard of histological examination of prostate biopsy samples. Results Among the 72 nodules, 31 were prostatic hyperplasia, 5 were chronic prostatitis, 35 were prostatic cancer, and one was prostatic lymphoma.There were significant differences in enhancement strength, enhancement time fast-in and degree of elasticity on TRTE and CETRUS between the malignant and benign groups (χ2=28.794, 10.889, 52.898; P=0.000, 0.001, 0.000, respectively). When the 35 PCA nodules were divided into two subgroups based on the Gleason score, there were statistically significant differences in enhancement strength, homogeneity of enhancement, and enhancement time fast-in and fast-out between them (χ2=6.073, 12.315, 4.717, 18.093; P=0.048, 0.001, 0.030, 0.000, respectively). The combination of CETRUS and TRTE in diagnosing prostate nodules produced a sensitivity of 83.3%, a specificity of 86.1%, an accuracy of 84.7%, a positive predictive value of 85.7%, and a negative predictive rate of 83.8%, better than either method alone. Conclusions Multi-modal image-guided transrectal ultrasonography has an advantage in providing information on the perfusion and elasticity of prostate nodules in the elderly patients and thus has important clinical value for the diagnosis of prostate nodules. Key words: Prostatic neoplasms; Ultrasonography; Contrast media; Elasticity imaging techniques

The activity of quadratus plantae in toe flexion movements using ultrasound real-time tissue elastography

The activity of quadratus plantae in toe flexion movements using ultrasound real-time tissue elastography

甲状腺腫瘍診断における超音波エラストグラフィ

甲状腺腫瘍診断における超音波エラストグラフィ

Assessment for diagnosis of lymph node metastasis in esophageal cancer using endoscopic ultrasound elastography.

BackgroundWe performed endoscopic ultrasound real-time tissue elastography to more accurately diagnose lymph node metastasis of esophageal cancer. The aim of this study was to evaluate the ability of EUS elastography to distinguish benign from malignant lymph nodes in esophageal cancer patients.MethodsThe present study had two steps. As the first step (study 1), we developed diagnostic criteria for metastatic lymph nodes using elastography and verified the validity of the criteria. Three hundred and twenty-two lymph nodes from 35 patients treated by surgical resection were included in the study. As the second step (study 2), we preoperatively examined the lymph nodes of esophageal cancer patients with EUS elastography and compared its diagnostic performance with that of the conventional B-mode EUS images. A total of 115 lymph nodes from 31 patients were included.ResultsIn study 1, lymph nodes were considered malignant if 50 % or more of the node appeared blue, or if the peripheral part of the lesion was blue and the central part was red/yellow/green. The sensitivity and specificity of the elastography were 79.7 and 97.6 % with an accuracy of 93.8 %, which was significantly higher than the values for conventional B-mode imaging. In study 2, the sensitivity and specificity of the EUS elastography were 91.2 and 94.5 % with an accuracy of 93.9 %, which was also significantly higher than the values for conventional B-mode EUS imaging.ConclusionsThe present study demonstrated that EUS elastography is useful for diagnosing lymph node metastasis of esophageal cancer.

Changes in the hardness of the gastrocnemius muscle during a Kendo training camp as determined using ultrasound real-time tissue elastography

Changes in the hardness of the gastrocnemius muscle during a Kendo training camp as determined using ultrasound real-time tissue elastography

Noninvasive assessment of the activity of the shoulder girdle muscles using ultrasound real-time tissue elastography

The purpose of this study was to clarify whether the activity of the shoulder girdle muscles could be estimated by measuring the elasticity of these muscles under several levels of muscle contraction through ultrasound real-time tissue elastography (RTE). Ten healthy men performed submaximal voluntary contractions (MVC) in each manual muscle testing position for the middle deltoid, upper trapezius, supraspinatus, levator scapulae, and rhomboid major. The elasticity of these muscles was measured using ultrasound RTE during the task. The strain ratio of the muscle to an acoustic coupler was calculated as an assessment index of the muscle elasticity. Higher strain ratio values imply lower elasticity. In addition, the electromyographic activity was recorded from surface electrodes attached only to the middle deltoid and upper trapezius. The strain ratios were negatively correlated with the normalized root mean square values for the middle deltoid (r=−0.659, p<0.001) and upper trapezius (r=−0.554, p<0.001). The strain ratios of all the muscles decreased with an increase from 10% MVC force to 30% MVC force. Ultrasound RTE may be useful for noninvasively assessing the activity of the shoulder girdle muscles at certain shoulder positions with low levels of muscle contraction.