剪切波弹性成像技术检测正常人髌腱弹性特征的初步研究
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摘要
目的使用剪切波弹性成像技术(SWE),获得正常人髌腱弹性值,研究不同膝关节屈曲角度、髌腱不同部位以及是否优势腿对于其影响。方法选取满足入组标准的80例健康成年人作为研究对象。分别使用灰阶成像和剪切波弹性成像技术对160条髌腱进行测量,灰阶成像技术测量内容包括髌腱的连续性及其回声情况,以判断其是否存在损伤;剪切波弹性成像技术测量内容包括髌腱近、中、远三个部位的长轴及短轴的弹性值,而且每例受试者的测量都包括三种屈曲角度(30°、60°、120°)。结果相同部位在不同屈曲角度下的弹性值差异显著,120°时髌腱弹性值最大,60°时次之,30°时弹性值最小。膝关节屈曲角度为120°时,优势腿髌腱弹性值明显高于非优势腿;60°和120°时,近、中、远三个部位的弹性值没有统计学差异,30°时,近、中、远三个部位的弹性值有差异,差异有统计学意义。结论剪切波弹性成像技术是描述正常髌腱弹性特征的可靠方法,不同测量条件下髌腱的弹性值不同,需要规范化该技术的操作方法,注意膝关节屈曲角度及是否优势腿对于髌腱弹性值测量的影响。
Objective To access the elasticity of normal patellar tendons with Shear-wave elastography(SWE),and evaluate the influence of different knee flexion angles,different points of the patellar tendon and whether the dominant leg influences the elastic properties.Methods 80 volunteers(ages range from 18-35)were included in the examination.Each subject(160 patellar tendons)was evaluated both by grey-scale US and SWE.Continuity and echo of each tendon was evaluated by grey-scale US to determine whether there has been injury.The measurements of elastics of tendons were acquired by one physician on the axial and sagittal sections at 3 positions(proximal,middle and distal segment)and 3 knee flexion angles(30,60 and 120 degree)for 3 times respectively.Results Obvious difference of elastic modulus and shear-wave velocity at the same segment was observed among different knee flexion angles,biggest at120°and smallest at 30°.Dominant legs are harder than the others with the knee flexing at 120°.NO significant difference in EM and SWV were observed among the three parts of patellar tendon when knees were flexied at 60°and 120°,While there is a significant difference among three segments with knee joint flexing at 30°.Conclusions SWE is a reliable modality to describe the elastic characteristics of normal patellar tendons.But we should standardize the operation of this technique,including the knee flexion angles and the dominant leg.
Objective To access the elasticity of normal patellar tendons with Shear-wave elastography(SWE),and evaluate the influence of different knee flexion angles,different points of the patellar tendon and whether the dominant leg influences the elastic properties.Methods 80 volunteers(ages range from 18-35)were included in the examination.Each subject(160 patellar tendons)was evaluated both by grey-scale US and SWE.Continuity and echo of each tendon was evaluated by grey-scale US to determine whether there has been injury.The measurements of elastics of tendons were acquired by one physician on the axial and sagittal sections at 3 positions(proximal,middle and distal segment)and 3 knee flexion angles(30,60 and 120 degree)for 3 times respectively.Results Obvious difference of elastic modulus and shear-wave velocity at the same segment was observed among different knee flexion angles,biggest at120°and smallest at 30°.Dominant legs are harder than the others with the knee flexing at 120°.NO significant difference in EM and SWV were observed among the three parts of patellar tendon when knees were flexied at 60°and 120°,While there is a significant difference among three segments with knee joint flexing at 30°.Conclusions SWE is a reliable modality to describe the elastic characteristics of normal patellar tendons.But we should standardize the operation of this technique,including the knee flexion angles and the dominant leg.
引文
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[6] PORTA F,DAMJANOV N,GALLUCCIO F,et al.Ultrasound elastography is a reproducible and feasible tool for the evaluation of the patellar tendon in healthy subjects[J].Int J Rheum Dis,2014,17(7):762-766.
[7] KUBO K,TESHIMA T,HIROSE N,et al.Growth changes in morphological and mechanical properties of human patellar tendon in vivo[J].J Appl Biomech,2014,30(3):415-422.
[8] DEWALL R J,SLANE L C,LEE K S,et al.Spatial variations in Achilles tendon shear wave speed[J].J Biomech,2014,47(11):2685-2692.
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[10] AUBRY S,RISSON J R,KASTLER A,et al.Biomechanical properties of the calcaneal tendon in vivo assessed by transient shear wave elastography[J].Skeletal Radiol,2013,42(8):1143-1150.
[11] BERKO N S,MEHTA A K,LEVIN T L,et al.Effect of knee position on the ultrasound elastography appearance of the patellar tendon[J].Clin Radiol,2015,70(10):1083-1086.
[12]卫雍绩,郏潜新,屈辉,等.MRI诊断女子排球运动员髌腱腱病[J].中国医学影像技术,2011,27(11):2307-2310.
[13]王玥,刘俐,刘欣婷,等.声辐射力脉冲成像技术检测健康成人髌韧带的可行性研究[J].临床超声医学杂志,2017,10:666-669.
[14] HSIAO M Y,CHEN Y C,LIN C Y,et al.Reduced patellar tendon elasticity with aging:In vivo assessment by shear wave elastography[J]. Ultrasound Med Biol,2015,41(11):2899-2905.
[2] SPOREA I,BOTA S,PECK-RADOSAVLJEVIC M,et al.Acoustic Radiation Force Impulse elastography for fibrosis evaluation in patients with chronic hepatitis C:an international multicenter study[J].Eur J Radiol,2012,81(12):4112-4118.
[3]俞清,王文平,季正标,等.实时超声弹性成像评估物体硬度的实验研究[J].中华超声影像学杂志,2007,16(11):997-999.
[4] DIRRICHS T,QUACK V,GATZ M,et al.Shear Wave Elastography(SWE)for the Evaluation of Patients with Tendinopathies[J].Acad Radiol,2016,23(10):1204-1213.
[5] TAS S,ONUR M R,YILMAZ S,et al.Shear Wave Elastography Is a Reliable and Repeatable Method for Measuring the Elastic Modulus of the Rectus Femoris Muscle and Patellar Tendon[J].J Ultrasound Med,2017,36(3):565-570.
[6] PORTA F,DAMJANOV N,GALLUCCIO F,et al.Ultrasound elastography is a reproducible and feasible tool for the evaluation of the patellar tendon in healthy subjects[J].Int J Rheum Dis,2014,17(7):762-766.
[7] KUBO K,TESHIMA T,HIROSE N,et al.Growth changes in morphological and mechanical properties of human patellar tendon in vivo[J].J Appl Biomech,2014,30(3):415-422.
[8] DEWALL R J,SLANE L C,LEE K S,et al.Spatial variations in Achilles tendon shear wave speed[J].J Biomech,2014,47(11):2685-2692.
[9] CHERNAK L A,DEWALL R J,LEE K S,et al.Length and activation dependent variations in muscle shear wave speed[J].Physiol Meas,2013,34(6):713-721.
[10] AUBRY S,RISSON J R,KASTLER A,et al.Biomechanical properties of the calcaneal tendon in vivo assessed by transient shear wave elastography[J].Skeletal Radiol,2013,42(8):1143-1150.
[11] BERKO N S,MEHTA A K,LEVIN T L,et al.Effect of knee position on the ultrasound elastography appearance of the patellar tendon[J].Clin Radiol,2015,70(10):1083-1086.
[12]卫雍绩,郏潜新,屈辉,等.MRI诊断女子排球运动员髌腱腱病[J].中国医学影像技术,2011,27(11):2307-2310.
[13]王玥,刘俐,刘欣婷,等.声辐射力脉冲成像技术检测健康成人髌韧带的可行性研究[J].临床超声医学杂志,2017,10:666-669.
[14] HSIAO M Y,CHEN Y C,LIN C Y,et al.Reduced patellar tendon elasticity with aging:In vivo assessment by shear wave elastography[J]. Ultrasound Med Biol,2015,41(11):2899-2905.