André Sprengers

A novel diffusion-tensor MRI approach for skeletal muscle fascicle length measurements

Musculoskeletal (dys‐)function relies for a large part on muscle architecture which can be obtained using Diffusion‐Tensor MRI (DT‐MRI) and fiber tractography. However, reconstructed tracts often continue along the tendon or aponeurosis when using conventional methods, thus overestimating fascicle lengths. In this study, we propose a new method for semiautomatic segmentation of tendinous tissue using tract density (TD). We investigated the feasibility and repeatability of this method to quantify the mean fascicle length per muscle. Additionally, we examined whether the method facilitates measuring changes in fascicle length of lower leg muscles with different foot positions. Five healthy subjects underwent two DT‐MRI scans of the right lower leg, with the foot in 15° dorsiflexion, neutral, and 30° plantarflexion positions. Repeatability of fascicle length measurements was assessed using Bland–Altman analysis. Changes in fascicle lengths between the foot positions were tested using a repeated multivariate analysis of variance (MANOVA). Bland–Altman analysis showed good agreement between repeated measurements. The coefficients of variation in neutral position were 8.3, 16.7, 11.2, and 10.4% for soleus (SOL), fibularis longus (FL), extensor digitorum longus (EDL), and tibialis anterior (TA), respectively. The plantarflexors (SOL and FL) showed significant increase in fascicle length from plantarflexion to dorsiflexion, whereas the dorsiflexors (EDL and TA) exhibited a significant decrease. The use of a tract density for semiautomatic segmentation of tendinous structures provides more accurate estimates of the mean fascicle length than traditional fiber tractography methods. The method shows moderate to good repeatability and allows for quantification of changes in fascicle lengths due to passive stretch.

A comparison between dynamic implicit and explicit finite element simulations of the native knee joint

The finite element (FE) method has been widely used to investigate knee biomechanics. Time integration algorithms for dynamic problems in finite element analysis can be classified as either implicit or explicit. Although previously both static/dynamic implicit and dynamic explicit method have been used, a comparative study on the outcomes of both methods is of high interest for the knee modeling community. The aim of this study is to compare static, dynamic implicit and dynamic explicit solutions in analyses of the knee joint to assess the prediction of dynamic effects, potential convergence problems, the accuracy and stability of the calculations, the difference in computational time, and the influence of mass-scaling in the explicit formulation. The heel-strike phase of fast, normal and slow gait was simulated for two different body masses in a model of the native knee. Our results indicate that ignoring the dynamic effect can alter joint motion. Explicit analyses are suitable to simulate dynamic loading of the knee joint in high-speed simulations, as this method offers a substantial reduction of the computational time with a similar prediction of cartilage stresses and meniscus strains. Although mass-scaling can provide even more gain in computational time, it is not recommended for high-speed activities, in which inertial forces play a significant role.

Water and fat separation in real-time MRI of joint movement with phase-sensitive bSSFP

To introduce a method for obtaining fat‐suppressed images in real‐time MRI of moving joints at 3 Tesla (T) using a bSSFP sequence with phase detection to enhance visualization of soft tissue structures during motion.

Ultrasound imaging of muscle contraction of the tibialis anterior in patients with facioscapulohumeral dystrophy

In fascioscapulohumeral muscular dystrophy (FSHD) and many other neuromuscular disorders there is a need for biomarkers to diagnose, quantify and longitudinally follow muscle disease. Furthermore, the pathophysiological mechanisms leading to muscle weakness in most neuromuscular disorders are not completely understood. Speckle tracking allows to quantify muscle deformation. This dynamic information provides insight in the pathophysiological mechanisms and may help to distinguish the different stages of diseased muscle in FSHD.

A Novel Ultrasound-Based Lower Extremity Motion Tracking System

Tracking joint motion of the lower extremity is important for human motion analysis. In this study, we present a novel ultrasound-based motion tracking system for measuring three-dimensional (3D) position and orientation of the femur and tibia in 3D space and quantifying tibiofemoral kinematics under dynamic conditions. As ultrasound is capable of detecting underlying bone surface noninvasively through multiple layers of soft tissues, an integration of multiple A-mode ultrasound transducers with a conventional motion tracking system provides a new approach to track the motion of bone segments during dynamic conditions. To demonstrate the technical and clinical feasibilities of this concept, an in vivo experiment was conducted. For this purpose the kinematics of healthy individuals were determined in treadmill walking conditions and stair descending tasks. The results clearly demonstrated the potential of tracking skeletal motion of the lower extremity and measuring six-degrees-of-freedom (6-DOF) tibiofemoral kinematics and related kinematic alterations caused by a variety of gait parameters. It was concluded that this prototyping system has great potential to measure human kinematics in an ambulant, non-radiative, and noninvasive manner.

Measuring relative positions and orientations of the tibia with respect to the femur using one-channel 3D-tracked A-mode ultrasound tracking system: A cadaveric study

The purpose of this study is to investigate the technical feasibility of measuring relative positions and orientations of the tibia with respect to the femur in an in-vitro experiment by using a 3D-tracked A-mode ultrasound system and to determine its accuracy of angular and translational measurements. As A-mode ultrasound is capable of detecting bone surface through soft tissue in a non-invasive manner, the combination of a single A-mode ultrasound transducer with an optical motion tracking system provides the possibility for digitizing the 3D locations of bony points at different anatomical regions on the thigh and the shank. After measuring bony points over a large area of both the femur and tibia, the bone models of the femur and tibia that were segmented from CT or MRI images were registered to the corresponding bony points. Then the relative position of the tibia with respect to the femur could be obtained and the angular and translational components could also be measured. A cadaveric experiment was conducted to assess its accuracy compared to the reference measurement obtained by optical markers fixed to intra-cortical bone pins placed in the femur and tibia. The results showed that the ultrasound system could achieve 0.49u202f±u202f0.83°, 0.85u202f±u202f1.86° and 1.85u202f±u202f2.78° (meanu202f±u202fstandard deviation) errors for Flexion-Extension, Adduction-Abduction and External-Internal rotations, respectively, and -2.22u202f±u202f3.62u202fmm, -2.80u202f±u202f2.35u202fmm and -1.44u202f±u202f2.90u202fmm errors for Anterior-Posterior, Proximal-Distal and Lateral-Medial translations, respectively. It was concluded that this technique is feasible and facilitates the integration of arrays of A-mode ultrasound transducers with an optical motion tracking system for non-invasive dynamic tibiofemoral kinematics measurement.

Accelerated 4D phase contrast MRI in skeletal muscle contraction

3D time‐resolved (4D) phase contrast MRI can be used to study muscle contraction. However, 3D coverage with sufficient spatiotemporal resolution can only be achieved by interleaved acquisitions during many repetitions of the motion task, resulting in long scan times. The aim of this study was to develop a compressed sensing accelerated 4D phase contrast MRI technique for quantification of velocities and strain rate of the muscles in the lower leg during active plantarflexion/dorsiflexion.

In situ comparison of A-mode ultrasound tracking system and skin-mounted markers for measuring kinematics of the lower extremity

Skin-mounted marker based motion capture systems are widely used in measuring the movement of human joints. Kinematic measurements associated with skin-mounted markers are subject to soft tissue artifacts (STA), since the markers follow skin movement, thus generating errors when used to represent motions of underlying bone segments. We present a novel ultrasound tracking system that is capable of directly measuring tibial and femoral bone surfaces during dynamic motions, and subsequently measuring six-degree-of-freedom (6-DOF) tibiofemoral kinematics. The aim of this study is to quantitatively compare the accuracy of tibiofemoral kinematics estimated by the ultrasound tracking system and by a conventional skin-mounted marker based motion capture system in a cadaveric experimental scenario. Two typical tibiofemoral joint models (spherical and hinge models) were used to derive relevant kinematic outcomes. Intra-cortical bone pins equipped with optical markers were inserted in the tibial and femoral bones to serve as a reference to provide ground truth kinematics. The ultrasound tracking system resulted in lower kinematic errors than the skin-mounted markers (the ultrasound tracking system: maximum root-mean-square (RMS) error 3.44° for rotations and 4.88u202fmm for translations, skin-mounted markers with the spherical joint model: 6.32° and 6.26u202fmm, the hinge model: 6.38° and 6.52u202fmm). Our proposed ultrasound tracking system has the potential of measuring direct bone kinematics, thereby mitigating the influence and propagation of STA. Consequently, this technique could be considered as an alternative method for measuring 6-DOF tibiofemoral kinematics, which may be adopted in gait analysis and clinical practice.

Strain imaging of the lateral collateral ligament using high frequency and conventional ultrasound imaging : An ex-vivo comparison

Recent first attempts of in situ ultrasound strain imaging in collateral ligaments encountered a number of challenges and illustrated a clear need for additional studies and more thorough validation of the available strain imaging methods. Therefore, in this study we experimentally validated ultrasound strain measurements of ex vivo human lateral collateral ligaments in an axial loading condition. Moreover, the use of high frequency ultrasound (>20u202fMHz) for strain measurement was explored and its performance compared to conventional ultrasound. The ligaments were stretched up to 5% strain and ultrasound measurements were compared to surface strain measurements from optical digital image correlation (DIC) techniques. The results show good correlations between ultrasound based and DIC based strain measures with R2 values of 0.71 and 0.93 for high frequency and conventional ultrasound, subsequently. The performance of conventional ultrasound was significantly higher compared to high frequency ultrasound strain imaging, as the high frequency based method seemed more prone to errors. This study demonstrates that ultrasound strain imaging is feasible in ex vivo lateral collateral ligaments, which are relatively small structures. Additional studies should be designed for a more informed assessment of optimal in vivo strain measurements in collateral knee ligaments.

Three-dimensional ultrasound strain imaging of skeletal muscles

Muscle contraction is characterized by large deformation and translation, which requires a multi-dimensional imaging modality to reveal its behavior. Previous work on ultrasound strain imaging of the muscle contraction was limited to 2D and bi-plane techniques. In this study, a three-dimensional (3D) ultrasound strain imaging technique was tested against 2D strain imaging and used for quantifying deformation of skeletal muscles. A phantom compression study was conducted for an experimental validation of both 2D and 3D methods. The phantom was compressed 3% vertically and pre- and post-compression full volume radio frequency (RF) ultrasound data were acquired using a matrix array transducer. A cross-correlation-based algorithm using either 2D or 3D kernels was applied to obtain the displacement estimates. These estimates were converted to Cartesian space and subsequently, strain was derived using a least-squares strain estimator (LSQSE). The 3D results were compared with the 2D results and the theoretically predicted displacement and strain. Comparison between 2D and 3D kernels was performed on data from a plane with a large tilt angle to study the influence of out-of-plane motion on the two techniques. To demonstrate the in vivo feasibility, 3D strain was calculated from live 3D data, acquired during a 2 second isometric contraction and relaxation of the quadriceps muscle in a healthy volunteer. The phantom study showed good correlation between estimated displacements and the theoretically predicted displacements. Root-mean-squared errors (RMSE) were 0.16, 0.17 and 0.13 mm in the x-, y- and z-direction respectively. The absolute RMSE for the 3D strain values were 0.94, 1.2 and 0.41% in the x-, y- and z-direction respectively. The 2D method performed worse, with 3 (x-direction) to 6 (z-direction) times higher RMSE values. The larger errors in lateral and elevational direction with respect to the axial RMSE are potentially caused by the large angle between the ultrasound beams. Initial in vivo results revealed 3D strain curves which clearly visualized the contraction and relaxation of the quadriceps muscles. Muscle deformation estimation using real-time 3D ultrasound RF-data seems feasible and the use of 3D kernels improves displacement estimation in comparison to 2D techniques. Future work will focus on improving lateral and elevational displacement estimation, and investigating local differences of strain in skeletal muscles and its clinical relevance.