Keywords:
Tissue characterisation, Image verification, Treatment effects, Diagnostic procedure, Ultrasound, Elastography, Musculoskeletal system, Musculoskeletal soft tissue
Authors:
T. Atzori, A. Vettori, B. Crusco, L. Forzoni, A. Grippo; Firenze/IT
DOI:
10.1594/essr2016/P-0126
Results
Transverse and longitudinal US acquisitions were performed by the same expert sonographer at T0 and T1,
following the same protocol.
Specifically,
the right foot was always the first to be scanned and the US images were performed with the probe in both longitudinal and transversal positions.
B-mode US acquisitions were performed on both legs.
They were examined in the same area,
in order to have a direct comparison between the injured (DX) and healthy (SX) leg.
Re-positioning of the probe in almost exactly the same scanning plane at T0 and T1 acquisitions was possible due to the use of real-time Archive visual comparison tool.
A general B-Mode US overview was done,
in order to check and set the correct image quality (XView,
MView and Grayscale were optimized).
The location of the examined area on the RFM was measured between the knee and the ankle (Figure 1) using a tape ruler.
A large amount of US gel (Parker Aquasonic 100,
Parker Laboratories,
USA) was applied in order to avoid compression of the probe coupling with the leg skin.
Indeed,
it is known that even a small compression changes the shape and dimension of the relaxed muscle tissue.
The technique adopted consisted in starting to couple the linear probe (SL1543,
3-13 MHz,
Esaote S.p.A.,
IT) with the leg muscle tissue until complete coupling of the probe on the center part of the echographic image sector was achieved.
The probe movement towards the leg muscle stopped as soon as the first tissue compression was noticed.
Regarding the B-Mode US evaluation,
at T0 a difference in RFM structure between the damaged leg and the healthy one was easily visible,
in terms of muscle dimensions (longitudinal view) and tissue structure.
Figure 2 shows the damaged leg on the left side of the image and the healthy leg on the right side of the image.
B-Mode US T0 measurement in longitudinal and transverse view of the distance between the RFM upper and inner aponeurosis showed a difference between the injured (DX) and healthy (SX) (between 4.5 and 5mm; see Figure 3).
B-Mode US T0 measurement in longitudinal and transverse view of the distance between the RFM upper and inner aponeurosis showed a difference between the injured (DX) and healthy (SX) (between 4.5 and 5mm; see Figure 3).
T0 Elastosonography evaluation of the RFM showed a softer structure in the injured leg (DX) compared to the healthy one (SX).
Elastosonography evaluation and RFM thickness measurement were carried out both in longitudinal (Figure 4) and transverse view (Figure 5).
US B-Mode evaluation performed at T1 showed a 2-mm increase in muscle thickness (Figure 6),
larger presence of defined muscle structure in longitudinal (Figure 7) and transverse (Figure 8) acquisitions and a harder pattern at elastosonography assessment in longitudinal (Figure 9) and transverse acquisitions (Figure 10) than at T0, especially between the RFM upper aponeurosis and the muscle mid line.
At T0 it was not possible to evaluate MCV due to severe pain (VAS=10).
At T1 the MCV was 25% lower than in the healthy leg.
Between T0 and T1 the pain was reduced to VAS=2.
Total scores of the SF-36 increased from 58% (at T0) to 83% (at T1) and physical score increased from 25% (T0) to 76% (T1) for physical function.
There was a leg circumference increase of 4 cm between T0 and T1.