continuous shear wave elastography as a diagnostic marker for tendinopathy

连续剪切波弹性成像作为肌腱病的诊断标志物

• 批准号: 8808800
• 负责人: Daniel Humberto Cortes Correales
• 金额: $ 16.61万
• 依托单位: UNIVERSITY OF DELAWARE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-13 至 2017-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8808800
• 关键词: Accounting; Adult; Affect; Architecture; Articular Range of Motion; Clinical; Collagen; Cumulative Trauma Disorders; Diagnosis; Diagnostic; Etiology; Evaluation; Exercise; Glycosaminoglycans; Goals; Healed; Healthcare Systems; Immobilization; Incidence; Individual; Injury; Lead; Leg; Localized Lesion; Maps; Measurement; Measures; Mechanics; Methods; Names; Nerve; Occupational; Outcome; Pain; Patient Outcomes Assessments; Patients; Play; Population; Positioning Attribute; Prevalence; Property; Reference Values; Reporting; Role; Rupture; Structure; Symptoms; Techniques; Tendinopathy; Tendon Injuries; Tendon structure; Therapeutic exercise; Time; Tissues; Ultrasonography; Variant; achilles tendon; cost; cost effective; dosage; elastography; experience; foot; functional outcomes; healing; injured; insight; neovascularization; novel; prevent; programs; public health relevance; treatment effect

DESCRIPTION (provided by applicant): Tendinopathy is a localized tendon injury characterized by loss of normal collagen architecture, increased glycosaminoglycans, hypercellularity, neovascularization, and nerve ingrowth. Overuse (excessive loading) is considered the major causation factor. The Achilles tendon is the strongest tendon in the body but still often injured. In the adult population the incidence rate for Achilles tendinopathy is 2.5 per 1000. Mid-portion tendinopathy is the most common pathological condition in the Achilles tendon and represents between 55% and 65% of the Achilles tendon overuse injuries. The preferred treatment for tendinopathy is therapeutic exercise, which is believed to promote remodeling of the collagenous structure of the tendon. Tendon healing is highly affected by exercise dosage. The two extremes in exercise dosage (immobilization and overuse) have shown to be detrimental for tendon healing. This suggests there is an optimum exercise dosage to maximize function and tendon properties. However, quantifying the effect of treatment (i.e., exercise) is difficult due to the lack non-invasive cost-effective methods to quantify tendon composition, structure and remodeling. Currently, treatments are evaluated using clinical, functional and patient-reported outcomes which evaluate the range of motion of the foot, strength of the lower leg, and symptoms. However, a limitation of these outcomes is the lack of evaluation of tendon structure and mechanical properties. To overcome this limitation, we propose non- invasive measurements of viscoelastic properties, via ultrasound elastography, as an equivalent measurement of changes in composition, structure, and ultimately function of the tendon. We recently developed an ultrasound technique, named Continuous Shear Wave Elastography (cSWE), to measure local viscoelastic properties of tendons. This novel technique is safe, non-invasive, inexpensive, and offer two main advantages over commercially available methods: 1) the parameters can be tune to measure tissue with high stiffness such as the Achilles tendon, 2) the technique can be used to measure spatial variations (i.e. a map) of tendon viscoelastic properties. Therefore, this technique is suitable to evaluate localized lesions caused by tendinopathy, tears or ruptures. The objectives of the study are to quantify the effect of mid-portion tendinopathy on the viscoelastic properties of the Achilles tendon at the moment of diagnosis and during treatment and to explore possible correlations between viscoelastic properties and clinical/functional outcomes. This study will help establishing cSWE as a clinical technique that can potentially play an important role in optimizing a therapeutic exercise program and/or other treatments for tendinopathy to achieve faster return of function, preventing long-term deficits and re-injury, and minimizing the burden and cost to the health care system.

描述（由申请人提供）：肌腱病是一种局部肌腱损伤，其特征为正常胶原结构丧失、糖胺聚糖增加、细胞过多、新生血管形成和神经长入。过度使用（过度负荷）被认为是主要的致病因素。跟腱是人体最强壮的肌腱，但也经常受伤。在成人人群中，跟腱病的发病率为2.5/1000。跟腱中段病变是跟腱中最常见的病理状态，占跟腱过度使用损伤的55%至65%。肌腱病的首选治疗方法是治疗性运动，据信其可促进肌腱胶原结构的重塑。肌腱愈合受运动剂量的影响很大。运动量的两个极端（固定和过度使用）已被证明对肌腱愈合有害。这表明存在最佳运动剂量，以最大限度地发挥功能和肌腱特性。然而，量化治疗效果（即，运动）是困难的，因为缺乏非侵入性的成本有效的方法来量化肌腱组成、结构和重塑。目前，使用临床、功能和患者报告的结果来评估治疗，这些结果评估足部的运动范围、小腿的力量和症状。然而，这些结果的局限性是缺乏对肌腱结构和力学性能的评价。为了克服这一局限性，我们提出了非侵入性测量的粘弹性，通过超声弹性成像，作为一个等效的测量的组成，结构和最终功能的肌腱的变化。我们最近开发了一种超声技术，称为连续剪切波弹性成像（cSWE），以测量肌腱的局部粘弹性。这种新技术是安全的、非侵入性的、廉价的，并且提供了优于市售方法的两个主要优点：1）可以调整参数以测量具有高刚度的组织，例如跟腱，2）该技术可以用于测量肌腱粘弹性性质的空间变化（即，映射）。因此，该技术适用于评估局限性病变 由肌腱病撕裂或破裂引起。 本研究的目的是量化诊断时和治疗过程中跟腱中段病变对跟腱粘弹性的影响，并探讨粘弹性与临床/功能结局之间可能的相关性。这项研究将有助于建立cSWE作为一种临床技术，可以在优化治疗性运动计划和/或肌腱病的其他治疗中发挥重要作用，以实现更快的功能恢复，防止长期缺陷和再损伤，并最大限度地减少医疗保健系统的负担和成本。