Shear Wave Elastography of Myofascial Trigger Points Using a Compact Scanner

项目摘要 肌筋膜疼痛是肌肉骨骼疼痛的主要原因，在某些情况下影响85%的人口。 每年花费美国人超过500亿美元。肌筋膜疼痛的特点是 由于肌筋膜触发点（MTrP）的存在，这些触发点是位于肌筋膜内的坚硬、可触及、离散的结节， 骨骼肌的绷紧带，在压迫时会疼痛。目前肌筋膜疼痛的诊断依赖于 临床触诊的可靠性较低。缺乏客观和定量的临床诊断和 结果测量导致了很多关于肌筋膜疼痛和肌筋膜后凸的争议， 无法产生客观诊断，分离有效疗法的作用机制，或准确 评估治疗的益处。在这项研究中，我们提出了一种新的技术，连续振荡 剪切波弹性成像（COSE），其使用由连续振动产生的剪切波， 超声换能器，用于MTrP的实时、高帧率、定量、2D弹性成像。COSE 不需要传输高电压、长持续时间的“推”射束，因此可以在 便携、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 Compact扫描仪上实施和优化COSE。我们将在以下方面实施COSE： Logiq e膝上型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被用来实现剪切波检测的高帧率， Logiq e.将仔细设计脉冲回波的定时，以自动消除组织应变（由于 传感器压缩）与检测到的运动中的剪切波分离。体模实验和体内测试 将用于验证和优化COSE原型。 目的2：初步临床研究。我们将使用目标1中开发的COSE原型来研究40例干细胞性乳腺癌患者， 针刺，这是一种常见的治疗MTRP，并已被证明可以减少触发点刚度。COSE 将在第一次干针治疗前后以及最后一次治疗后第3周进行测量。 干针疗法COSE结果将与MTRP的临床评价（包括触诊）进行比较 由经验丰富的临床医生诊断，疼痛数字评定量表，疼痛压力阈值，颈部残疾指数， 和颈椎的活动范围 该项目的成功完成将产生一种低成本、安全、便携、高帧率的2D超声 剪切波弹性成像系统用于MTrPs客观定量评价。该工具将是理想的 肌筋膜疼痛的即时诊断和治疗评价，这对于研究 作用机制，以开发有效的治疗方法。

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.