Shear Wave Elastography of Myofascial Trigger Points Using a Compact Scanner

项目总结 肌肉筋膜痛是肌肉骨骼疼痛的主要原因，在某些情况下影响到85%的人口 这是他们一生中的一个关键时刻，每年花费美国人超过500亿美元。肌筋膜痛的特征是 通过肌筋膜触发点(MTrP)的存在，MTrP是位于 骨骼肌束紧绷，受压时疼痛。目前对肌筋膜痛的诊断依赖于 临床触诊，可信度低。缺乏客观和定量的临床诊断和诊断 结果测量导致了关于肌筋膜疼痛和MTrP的许多争议，并导致了 不能产生客观的诊断，分离出有效治疗的作用机制，或准确地 评估治疗的益处。在本研究中，我们提出了一种新的技术--连续振荡 剪切波弹性成像(COSE)，它使用由连续振动产生的剪切波 用于实时、高帧速率、定量、二维弹性成像的超声换能器。科斯 不需要传输高电压、持续时间长的波束，因此可以在 便携式、紧凑、低成本的超声波扫描仪。提出了以下具体目标。 目标1：在GE Logiq e紧凑型扫描仪上实现和优化COSE。我们将在以下方面实施COSE Logiq e笔记本电脑扫描仪具有用户友好的界面，用于在线显示和连续更新2D 弹性图。一种新的脉冲-回波序列将用于实现高帧速率的横波检测 将仔细设计脉冲回波定时以自动去除组织应变(由于 换能器压缩)从检测到的运动中的横波。体模实验和活体实验 将用于验证和优化COSE原型。 目的2：先导性临床研究。我们将使用在目标1中开发的COSE原型来研究40名干燥症患者 针刺，这是一种常见的治疗MTrp的方法，已被证明可以降低触发点僵硬。科斯 测量将在第一次干针治疗前后和最后一次针刺后的第三周进行。 干针疗法。COSE的结果将与MTrp的临床评估相比较，包括触诊。 有经验的临床医生的诊断，疼痛数字分级量表，疼痛压力阈值，颈部残疾指数， 以及颈部的活动范围。 该项目的成功完成将带来一种低成本、安全、便携、高帧频、二维超声 剪切波弹性成像系统对MTRPS的客观定量评价此工具将非常适用于 肌筋膜痛的护理点诊断和治疗评估，这也是调查 开发有效治疗方法的作用机制。

PROJECT SUMMARY Myofascial pain is the leading cause of musculoskeletal pain, which affects 85% of the population at some point during their lives and costs Americans more than $50 billion each year. Myofascial pain is characterized by the presence of myofascial trigger points (MTrP), which are hard, palpable, discrete nodules located within taut bands of skeletal muscles that are painful upon compression. Current diagnosis for myofascial pain relies on clinical palpation, which has low reliability. The lack of objective and quantitative clinical diagnostic and outcome measures has led to much controversy regarding myofascial pain and MTrPs, and has resulted in an inability to generate an objective diagnosis, isolate a mechanism of action of effective therapies, or accurately assess the benefits of treatment. In this study, we propose a new technology, Continuous Oscillation Shearwave Elastography (COSE), which uses shear waves generated by continuous vibration of the ultrasound transducer for real-time, high frame rate, quantitative, 2D elastography imaging of MTrPs. COSE does not require the transmission of high voltage, long duration “push” beams, thus can be implemented on portable, compact, low-cost ultrasound scanners. The following specific aims are proposed. Aim 1: Implement and Optimize COSE on the GE Logiq e Compact Scanner. We will implement COSE on the Logiq e laptop scanner with a user friendly interface for on-line display and continuous update of 2D elastograms. A novel pulse-echo sequence will be used to achieve high frame rate of shear wave detection on the Logiq e. Timing of pulse-echo will be carefully designed to automatically remove tissue strains (due to transducer compression) from the shear waves in the detected motion. Phantom experiments and in vivo tests on patients with MTrPs will be used to validate and optimize the COSE prototype. Aim 2: Pilot Clinical Study. We will use the COSE prototype developed in Aim 1 to study 40 patients with dry needling, which is a common treatment for MTrPs and has been shown to reduce trigger point stiffness. COSE measurements will be obtained before and after the first dry needling treatment, and at week 3 after the final dry needling treatment. COSE results will be compared to clinical evaluations of the MTrPs, including palpation diagnosis by experienced clinicians, pain numeric rating scale, pain pressure threshold, Neck Disability Index, and the cervical range of motion. Successful completion of this project will result in a low-cost, safe, portable, high frame rate, 2D ultrasound shear wave elastography system for objective and quantitative evaluation of MTrPs. This tool will be ideal for point-of-care diagnosis of myofascial pain and treatment evaluation, which is also crucial for investigating the mechanism of action to develop effective therapies.