Quantifying extensibility of rotator cuff muscle with tendon rupture using shear wave elastography: A cadaveric study

Surgical repair for large rotator cuff tear remains challenging due to tear size, altered muscle mechanical properties, and poor musculotendinous extensibility. Insufficient extensibility might lead to an incomplete reconstruction; moreover, excessive stresses after repair may result in repair failure without healing. Therefore, estimates of extensibility of cuff muscles can help in pre-surgical planning to prevent unexpected scenarios during surgery. The purpose of this study was to determine if quantified mechanical properties of the supraspinatus muscle using shear wave elastography (SWE) could be used to predict the extensibility of the musculotendinous unit on cadaveric specimens. Forty-five fresh-frozen cadaveric shoulders (25 intact and 20 with rotator cuff tear) were used for the study. Passive stiffness of 4 anatomical regions in the supraspinatus muscle was first measured using SWE. After detaching the distal edge of supraspinatus muscle from other cuff muscles, the detached muscle was axially pulled with the scapula fixed. The correlation between the SWE modulus and the extensibility of the muscle under 30 and 60 N loads was assessed. There was a significant negative correlation between SWE measurements and the experimental extensibility. SWE modulus for the anterior-deep region in the supraspinatus muscle showed the strongest correlation with extensibility under 30 N (r = 0.70, P < 0.001) and 60 N (r = 0.68, P < 0.001). Quantitative SWE assessment for the supraspinatus muscle was highly correlated with extensibility of musculotendinous unit on cadaveric shoulders. This technique may be used to predict the extensibility for rotator cuff tears for pre-surgical planning.     

The shear modulus of lower-leg muscles correlates to intramuscular pressure

Shear wave elastography (SWE) is emerging as an innovative tool to evaluate muscle properties and function. It has been shown to correlate with both passive and active muscle forces, and is sensitive to physiological processes and pathological conditions. Similarly, intramuscular pressure (IMP) is an important parameter that changes with passive and active muscle contraction, body position, exercise, blood pressure, and several pathologies. Therefore, the objective of this study was to quantify the dependency of shear modulus within the lower-leg muscles on IMP in healthy individuals. Nineteen healthy individuals (age: Mean age ± SD, 23.84 ± 6.64 years) were recruited. Shear modulus was measured using ultrasound SWE on the tibialis anterior (TA) and peroneus longus (PL) muscles using pressure cuff inflation around the thigh at 40 mmHg, 80 mmHg, and 120 mmHg. Changes in IMP were verified using a catheter connected to a blood pressure monitor. It was found that IMP was correlated to TA and PL shear modulus (spearman's rank correlation = 0.99 and 0.99, respectively). Applying a gradual increase of cuff pressure from 0 to 120 mmHg increased the shear modulus of the TA and PL muscles from 15.83 (2.46) kPa to 21.88 (4.33) kPa and from 9.64 (1.97) kPa to 12.88 (5.99) kPa, respectively. These results demonstrate that changes of muscle mechanical properties are dependent on IMP. This observation is important to improve interpretation of ultrasound elastograms and to potentially use it as a biomarker for more accurate diagnosis of pathologies related to increased IMP.     

Abdominal girth as an index of muscle tension during abdominal hollowing: Selecting the optimal training intensity for the transversus abdominis muscle

The abdominal hollowing technique is used for training the transversus abdominis (TrA). However, the optimal intensity of hollowing is still unclear. The objective of the present study is to verify the validity of estimating the tension of the TrA by measuring the girth of the abdomen with a tape and to determine the optimum intensity of hollowing to effectively train the TrA. Sixteen healthy males performed hollowing with an intensity of 0%, 25%, 50%, 75%, and 100%, estimated from the girth of the abdomen. The shear elastic modulus was measured for the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and TrA at all intensities via ultrasonic shear wave elastography. The shear elastic modulus was considered as the index of the tension of the abdominal muscles at each intensity, and the ratio of the TrA to RA, EO, and IO respectively was calculated as the index of TrA selectivity. As the intensity of hollowing increased, the girth of abdomen decreased and tension of all the four muscles increased. The ratio of TrA to the RA, EO, and IO did not exhibit a significant variation among hollowing intensities of 25% to 100%. It is rational to estimate the tension of the TrA by measuring the girth of the abdomen. Moreover, considering both TrA contraction intensity and selectivity, abdominal hollowing performed at maximum intensity was effective for the maximum contraction training of the TrA.     

Mapping the spatial variation of mitral valve elastic properties using air-pulse optical coherence elastography

The mitral valve is a highly heterogeneous tissue composed of two leaflets, anterior and posterior, whose unique composition and regional differences in material properties are essential to overall valve function. While mitral valve mechanics have been studied for many decades, traditional testing methods limit the spatial resolution of measurements and can be destructive. Optical coherence elastography (OCE) is an emerging method for measuring viscoelastic properties of tissues in a noninvasive, nondestructive manner. In this study, we employed air-pulse OCE to measure the spatial variation in mitral valve elastic properties with micro-scale resolution at 1 mm increments along the radial length of the leaflets. We analyzed differences between the leaflets, as well as between regions of the valve. We found that the anterior leaflet has a higher elastic wave velocity, which is reported as a surrogate for stiffness, than the posterior leaflet, most notably at the annular edge of the sample. In addition, we found a spatial elastic gradient in the anterior leaflet, where the annular edge was found to have a greater elastic wave velocity than the free edge. This gradient was less pronounced in the posterior leaflet. These patterns were confirmed using established uniaxial tensile testing methods. Overall, the anterior leaflet was stiffer and had greater heterogeneity in its mechanical properties than the posterior leaflet. This study measures differences between the two mitral leaflets with greater resolution than previously feasible and demonstrates a method that may be suitable for assessing valve mechanics following repair or during the engineering of synthetic valve replacements.     

Sensitivity of multifrequency magnetic resonance elastography and diffusion-weighted imaging to cellular and stromal integrity of liver tissue

Microscopic structural alterations of liver tissue induced by freeze-thaw cycles give rise to palpable property changes. However, the underlying damage to tissue architecture is difficult to quantify histologically, and published data on macroscopic changes in biophysical properties are sparse.To better understand the influence of hepatic cells and stroma on global biophysical parameters, we studied rat liver specimens freshly taken (within 30 min after death) and treated by freeze-thaw cycles overnight at either −20 °C or –80 °C using diffusion-weighted imaging (DWI) and multifrequency magnetic resonance elastography (MRE) performed at 0.5 T in a tabletop MRE scanner. Tissue structure was analyzed histologically and rheologic data were analyzed using fractional order derivatives conceptualized by a called spring-pot component that interpolates between pure elastic and viscous responses.Overnight freezing and thawing induced membrane disruptions and cell detachment in the space of Disse, resulting in a markedly lower shear modulus μ and apparent diffusion coefficient (ADC) (μ[−20 °C] = 1.23 ± 0.73 kPa, μ[−80 °C] = 0.66 ± 0.75 kPa; ADC[–20 °C] = 0.649 ± 0.028 μm²/s, ADC[−80 °C] = 0.626 ± 0.025 μm²/s) compared to normal tissue (μ = 9.92 ± 3.30 kPa, ADC = 0.770 ± 0.023 μm²/s, all p < 0.001). Furthermore, we analyzed the springpot-powerlaw coefficient and observed a reduction in −20 °C specimens (0.22 ± 0.14) compared to native tissue (0.40 ± 0.10, p = 0.033) and −80 °C specimens (0.54 ± 0.22, p = 0.002), that correlated with histological observations of sinusoidal dilation and collagen distortion within the space of Disse. Overall, the results suggest that shear modulus and water diffusion in liver tissue markedly decrease due to cell membrane degradation and cell detachment while viscosity-related properties appear to be more sensitive to distorted stromal and microvascular architecture.     

Comment on “Retinal pulse wave velocity measurement using spectral‐domain optical coherence tomography”

This paper comments on the article “Retinal pulse wave velocity measurement using spectral‐domain optical coherence tomography” by Qian Li et al. The authors propose a method to determine the pulse wave velocity in retinal arteries and veins. This method should enable a noninvasive determination of biomechanical properties of the vessel network, particularly the elasticity of the vessel walls. Although the observations the authors made might seem reasonable at first glance, they are in fact highly surprising and contradictory to theoretical predictions and previously published results.     

Optimal stimulation frequency for vibrational optical coherence elastography

Vibrational optical coherence elastography (OCE) is a promising tool for extracting the mechanical property of soft tissue. Purpose of this study is focusing on settling the optimal frequency range for vibrational OCE with evenly distributed stress filed. A finite element model of 2% agar phantom was built by ANSYS with a vibration stimulation frequency range from 200 to 3000 Hz. Practical experiments were carried out for cross‐validation with the same frequencies and sample. Lateral and horizontal stress filed distributions under different frequencies were mathematically evaluated by coefficient of variance and degree of linearity. Results from simulation and practical experiment cross‐validated each other and 1000 Hz was set as the maximum ideal frequency for vibrational OCE, while the minimum frequency is set by theoretical calculation with a result of 250 Hz. An ex vivo biological sample was utilised to testify performance of vibrational OCE with excitation frequencies in and out of concluded optimal range, which showed that stiffness was better mapped out in optimal frequency range.     

Spatial-dependent mechanical properties of the heel pad by shear wave elastography

The heel pad plays an important role in gait, and its biomechanical behavior and functionality are determined by its specialized architecture and mechanical properties. The purpose of this study was to apply supersonic shear wave elastography, an ultrasound-based noninvasive modality that can quantitatively estimate the shear stiffness of the tissue, to investigate the spatial-dependent mechanical properties of the heel pad. Measurements were conducted in 40 heel pads of 20 normal participants aged between 20 and 30 years by shear wave elastography. The continuous change in local shear stiffness of the heel pad along the depth direction of the heel pad was measured. The result showed that the mechanical properties of the heel pad were highly heterogeneous but followed a simple and specific pattern that local heel pad shear stiffness was highest beneath the plantar skin and decreased continuously with increasing depth. This finding provides a better understanding of the heel pad biomechanics and basis for further investigation of the heterogeneous properties of the heel pad.     

实时剪切波弹性定量分析不同睾酮水平大鼠阴茎组织硬度

目的:利用实时剪切波弹性成像(shear wave elastography,SWE)定量分析不同睾酮水平阴茎组织硬度之间的差异。方法:睾酮水平不同SD大鼠两组,低睾酮水平组(1月龄,睾酮水平1.00~1.50 ng/m L,n=10)和高睾酮水平组(13月龄,睾酮水平2.00~2.50ng/m L,n=10)。采用放射免疫法测定各组大鼠血清睾酮水平。选用法国Super Sonic Imagine公司生产的Aixplorer超声诊断仪,启动SWE模式对阴茎进行SWE成像并测量其剪切波硬度(shear wave stiffness,SWS)。分析比较两组大鼠血清睾酮水平之间的差异及SWS之间的差异。结果:所有大鼠血清睾酮水平及阴茎组织SWS的测量均成功完成。低睾酮水平组大鼠血清睾酮水平为(1.30±0.16)ng/m L,高睾酮水平组为(2.29±0.14)ng/m L,两组大鼠血清睾酮水平存在显著差异(P0.01);低睾酮水平组大鼠阴茎组织SWS为(9.86±0.72)k Pa,高睾酮水平组为(7.80±1.43)k Pa,两组大鼠阴茎组织SWS存在显著差异(P0.01)。结论:SWE可以检测出睾酮水平不同导致的阴茎组织硬度的差异,提示SWE可作为一项评价阴茎组织硬度的无创新技术。