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，其为特征，其特征是正常的胶原蛋白结构，糖胺聚糖增加，高细胞性，新血管形成和神经向内生长。过度使用（过度加载）被认为是主要因果因素。跟腱是体内最强的肌腱，但仍然经常受伤。在成人人群中，阿喀琉斯肌腱病的发病率为每1000个2.5。中期肌腱病是阿喀琉斯肌腱中最常见的病理状况，占致命肌肌腱过度损伤的55％至65％。肌腱病的首选治疗方法是治疗运动，据信这可以促进肌腱胶原结构的重塑。肌腱愈合受运动剂量的高度影响。运动剂量的两个极端（固定和过度使用）已证明对肌腱愈合有害。这表明有最佳的运动剂量可以最大化功能和肌腱特性。但是，由于缺乏无创的成本效益方法来量化肌腱组成，结构和重塑，因此很难量化治疗的影响（即运动）。目前，使用临床，功能性和患者报告的结果评估治疗方法，这些结局评估了脚运动范围，下腿强度以及症状。但是，这些结果的局限性是缺乏对肌腱结构和机械性能的评估。为了克服这一局限性，我们提出了通过超声弹性图的非侵入性测量，作为对肌腱组成，结构以及最终功能的等效测量。我们最近开发了一种超声技术，称为连续剪切波弹性图（CSWE），以测量肌腱的局部粘弹性。这项新型技术是安全，无创，廉价的，并且在市售方法中提供了两个主要优势：1）参数可以调节以测量具有高刚度的组织，例如致敬肌腱，2）该技术可用于测量空间变体（即，即粘性粘膜图）的技术。因此，该技术适合评估局部病变 由肌腱病，眼泪或破裂引起。 该研究的目的是量化中期肌腱病对诊断和治疗期间跟腱特性的影响，并探索粘弹性特性与临床/功能结果之间的可能相关性。这项研究将有助于确立CSWE作为一种临床技术，可以在优化治疗性运动计划和/或其他治疗肌腱病治疗方面发挥重要作用，以实现更快的功能回报，防止长期赤字和重新受伤，并最大程度地减少对医疗保健系统的负担和成本。