Qingshan Chen

Validation of shear wave elastography in skeletal muscle

Skeletal muscle is a very dynamic tissue, thus accurate quantification of skeletal muscle stiffness throughout its functional range is crucial to improve the physical functioning and independence following pathology. Shear wave elastography (SWE) is an ultrasound-based technique that characterizes tissue mechanical properties based on the propagation of remotely induced shear waves. The objective of this study is to validate SWE throughout the functional range of motion of skeletal muscle for three ultrasound transducer orientations. We hypothesized that combining traditional materials testing (MTS) techniques with SWE measurements will show increased stiffness measures with increasing tensile load, and will correlate well with each other for trials in which the transducer is parallel to underlying muscle fibers. To evaluate this hypothesis, we monitored the deformation throughout tensile loading of four porcine brachialis whole-muscle tissue specimens, while simultaneously making SWE measurements of the same specimen. We used regression to examine the correlation between Youngs modulus from MTS and shear modulus from SWE for each of the transducer orientations. We applied a generalized linear model to account for repeated testing. Model parameters were estimated via generalized estimating equations. The regression coefficient was 0.1944, with a 95% confidence interval of (0.1463-0.2425) for parallel transducer trials. Shear waves did not propagate well for both the 45° and perpendicular transducer orientations. Both parallel SWE and MTS showed increased stiffness with increasing tensile load. This study provides the necessary first step for additional studies that can evaluate the distribution of stiffness throughout muscle.

Determination of thigh muscle stiffness using magnetic resonance elastography.

To measure the elastic properties of the vastus lateralis (VL), vastus medialis (VM), and sartorius (Sr) muscles using magnetic resonance elastography (MRE).

Applications of magnetic resonance elastography to healthy and pathologic skeletal muscle.

Magnetic resonance elastography (MRE) is capable of noninvasively quantifying the mechanical properties of skeletal muscles in vivo. This information can be clinically useful to understand the effects of pathologies on the mechanical properties of muscle and to quantify the effects of treatment. Advances in inversion algorithms quantify muscle anisotropy in two‐dimensional (2D) and three‐dimensional (3D) imaging. Databases of the shear stiffness of skeletal muscle have been presented in the relaxed and contracted states in the upper extremity (biceps brachii, flexor digitorum profundus, and upper trapezius), distal leg muscles (tibialis anterior, medial gastrocnemius, lateral gastrocnemius, and trapezius), and proximal leg muscles (vastus lateralis, vastus medialis, and sartorius). MRE measurements have successfully validated a mathematical model of skeletal muscle behavior in the biceps brachii, correlated to electromyographic data in the distal leg muscles and quantified the effects of pathologies on the distal and proximal leg muscles. Future research efforts should be directed toward improving one‐dimensional (1D) and 3D MRE data acquisition and image processing, tracking the effects of treatment on pathologic muscle and correlating the shear stiffness with clinical measurements. J. Magn. Reson. Imaging 2007.

Ability of magnetic resonance elastography to assess taut bands

BACKGROUND Myofascial taut bands are central to diagnosis of myofascial pain. Despite their importance, we still lack either a laboratory test or imaging technique capable of objectively confirming either their nature or location. This study explores the ability of magnetic resonance elastography to localize and investigate the mechanical properties of myofascial taut bands on the basis of their effects on shear wave propagation. METHODS This study was conducted in three phases. The first involved the imaging of taut bands in gel phantoms, the second a finite element modeling of the phantom experiment, and the third a preliminary evaluation involving eight human subjects-four of whom had, and four of whom did not have myofascial pain. Experiments were performed with a 1.5 T magnetic resonance imaging scanner. Shear wave propagation was imaged and shear stiffness was reconstructed using matched filtering stiffness inversion algorithms. FINDINGS The gel phantom imaging and finite element calculation experiments supported our hypothesis that taut bands can be imaged based on its outstanding shear stiffness. The preliminary human study showed a statistically significant 50-100% (P=0.01) increase of shear stiffness in the taut band regions of the involved subjects relative to that of the controls or in nearby uninvolved muscle. INTERPRETATION This study suggests that magnetic resonance elastography may have a potential for objectively characterizing myofascial taut bands that have been up to now detectable only by the clinicians fingers.

Thigh muscle stiffness assessed with magnetic resonance elastography in hyperthyroid patients before and after medical treatment.

To measure the stiffness of the vastus medialis (VM) in hyperthyroid patients before and after treatment.

Quantitative shear wave magnetic resonance elastography: Comparison to a dynamic shear material test

Magnetic resonance elastography (MRE), a phase contrast MRI technique, images the propagation of applied mechanical waves in tissue, allowing shear stiffness to be quantified in vivo. This MRE technique has been validated with static mechanical compression tests. Dynamic mechanical analysis (DMA) may be a more appropriate comparison to MRE because it directly measures the shear modulus dynamically, while compression tests convert the measured elastic modulus to shear modulus with an assumed Poisson ratio. This study compared the shear stiffness estimated with various MRE inversion algorithms (i.e., manual calculation, local frequency estimate, phase gradient, direct inversion, and matched filter) to the dynamic mechanical test. The shear stiffness of five agarose gels with concentrations ranging from 1.5 to 3.5% were measured using MRE and DMA. The phase gradient inversion algorithm overestimated the shear modulus at higher concentrations (i.e., 3–3.5% agar), while the results from the other techniques correlated well with the dynamic mechanical test. Magn Reson Med 53:1197–1201, 2005.

Feasibility assessment of shear wave elastography to rotator cuff muscle.

Pre‐surgical measurement of supraspinatus muscle extensibility is important for rotator cuff repair. The purpose of the present study was to explore the potential feasibility of a shear wave ultrasound elastography (SWE)‐based method, combined with B‐mode ultrasound, to measure the in vivo stiffness of the supraspinatus muscle non‐invasively and thus obtain key information about supraspinatus muscle extensibility. Our investigation comprised two steps. First, we determined the orientation of the supraspinatus muscle fibers in cadaveric shoulders without rotator cuff tear in order to optimize the ultrasound probe positions for SWE imaging. Second, we investigated the feasibility of quantifying the stiffness of the normal supraspinatus muscle by SWE in vivo. The supraspinatus muscle was divided into four anatomical regions: anterior superficial (AS), posterior superficial (PS), anterior deep (AD), and posterior deep (PD). Each region was examined by SWE. The SWE stiffnesses of AD, AS, PD, and PS were 40.0 ± 12.4, 34.0 ± 9.9, 32.7 ± 12.7, 39.1 ± 15.7 kPa, respectively. SWE combined with B‐Mode ultrasound imaging could be a feasible method for quantifying the local stiffness of the rotator cuff muscles. Clin. Anat. 28:213–218, 2015.

Rapid magnetic resonance elastography of muscle using one‐dimensional projection

To demonstrate the feasibility of 1D MR elastography (MRE) to rapidly assess skeletal muscle stiffness in vivo.

Mechanical characteristics of native tendon slices for tissue engineering scaffold

The purpose of this study was to characterize the mechanical behavior of tendon slices with different thicknesses. Tendon slices of 100, 200, 300, 400, and 500 μm thickness were mechanically tested. The 300 μm slices were further tested for strength and modulus after 21,000-cycle fatigue testing under different applied strain levels (0, 1, 3, 5, 8, 10, and 12%). The tendon slice structure, morphology, and viability of bone marrow stromal cells (BMSCs) seeded onto the slices were also examined with histology, scanning electron microscopy, and vital cell labeling, respectively. Tendon slices 300 μm or more in thickness had similar ultimate tensile strength and Youngs modulus to the intact tendon bundle. A strain of 5% or less did not cause any structural damage, nor did it change the mechanical properties of a 300 μm-thick tendon slice after 21,000-cycle fatigue testing. BMSCs were viable between and on the tendon slices after 2 weeks in tissue culture. This study demonstrated that, if tendon slices are used as a scaffold for tendon tissue engineering, slices 300 μm or more in thickness would be preferable from a mechanical strength point of view. If mechanical stimulation is performed for seeded-cell preparations, 5% strain or less would be appropriate.

Wave attenuation as a measure of muscle quality as measured by magnetic resonance elastography: initial results.

Advances in imaging technologies such as magnetic resonance elastography (MRE) have allowed researchers to gain insights into muscle function in vivo. MRE has been used to examine healthy and diseased muscle by calculating shear modulus. However, additional information can be measured from visualizing a mechanical wave as it passes through a tissue. One such measurable quantity is wave attenuation. The purpose of this study was to determine if a simple measure of wave attenuation could be used to distinguish between healthy and diseased muscle. Twenty seven subjects (14 healthy controls, 7 hyperthyroid myopathy patients, 6 myositis patients) participated in this study. Wave amplitude was determined along a linear profile through the center of the muscle, and an exponential decay curve was fit to the data. This measure was able to find significant differences in attenuation between healthy and diseased muscle. Furthermore, four hyperthyroid myopathy subjects who were tested following treatment all showed improvement by this measure. A likely reason for patients with hyperthyroid myopathy and myositis behaving similarly is that this measurement may reflect similar changes in the muscle extracellular matrix. In addition to modulus, attenuation seems to be an important parameter to measure in skeletal muscle. Further research is needed to investigate other potential measures of attenuation as well as examining other potential measures that can be found from visualizing wave propagation. Future studies should also include muscle biopsies to confirm that the changes seen are as a result of changes in extracellular matrix structure.