Shear Wave Elastography of Myofascial Trigger Points Using a Compact Scanner

使用紧凑型扫描仪进行肌筋膜触发点的剪切波弹性成像

• 批准号: 9236961
• 负责人: Shigao Chen
• 金额: $ 17.49万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9236961
• 关键词: Address; Affect; Algorithms; American; Articular Range of Motion; Cervical; Clinical; Clinical Management; Clinical Research; Clinical Treatment; Data; Detection; Diagnosis; Diagnostic; Evaluation; Functional disorder; Heating; Image; Investigation; Literature; Manuals; Measurement; Measures; Motion; Movement; Musculoskeletal Pain; Myofascial Pain Syndromes; Myofascial Trigger Point; Nature; Neck; Needles; Nodule; Numeric Rating Scale; Outcome Measure; Pain; Pain management; Palpable; Palpation; Patient Self-Report; Patients; Periodicity; Physiologic pulse; Population; Quantitative Evaluations; Sampling; Short Interspersed Nucleotide Elements; Signal Transduction; Skeletal Muscle; System; Technology; Testing; Time; Tissues; Transducers; Ultrasonic Transducer; Ultrasonography; Update; clinical Diagnosis; clinical diagnostics; clinical translation; common treatment; cost; design; digital; disability; effective therapy; elastography; experience; experimental study; in vivo; indexing; insight; laptop; new technology; novel; pain symptom; point of care; portability; pressure; prototype; reconstruction; research clinical testing; tool; transmission process; trigger point; user-friendly; vibration; voltage

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.

项目概要 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 美国人每年为此花费超过 500 亿美元。肌筋膜疼痛的特点是 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 骨骼肌绷紧带，受压时会感到疼痛。目前肌筋膜疼痛的诊断依赖于 临床触诊，可靠性较低。缺乏客观、定量的临床诊断和 结果测量引起了关于肌筋膜疼痛和 MTrP 的很多争议，并导致了 无法产生客观的诊断、分离有效疗法的作用机制或准确地 评估治疗的益处。在这项研究中，我们提出了一种新技术，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 MTrP 实时、高帧率、定量、2D 弹性成像的超声换能器。科斯 不需要传输高电压、长时间的“推”光束，因此可以在 便携式、紧凑、低成本的超声波扫描仪。提出以下具体目标。 目标 1：在 GE Logiq e Compact 扫描仪上实施和优化 COSE。我们将实施 COSE Logiq e 笔记本电脑扫描仪具有用户友好的界面，可在线显示和持续更新 2D 弹性图。一种新颖的脉冲回波序列将用于实现剪切波检测的高帧率 逻辑e。脉冲回波的时间将经过精心设计，以自动消除组织应变（由于 传感器压缩）来自检测到的运动中的剪切波。模型实验和体内测试 对 MTrP 患者的研究将用于验证和优化 COSE 原型。 目标 2：试点临床研究。我们将使用目标 1 中开发的 COSE 原型来研究 40 名患有干性干眼症的患者。 针刺是 MTrP 的常见治疗方法，已被证明可以降低触发点僵硬。科斯 将在第一次干针治疗之前和之后以及最后一次干针治疗后的第 3 周获得测量值 干针治疗。 COSE 结果将与 MTrP 的临床评估（包括触诊）进行比较 由经验丰富的临床医生进行诊断、疼痛数字评定量表、疼痛压力阈值、颈部残疾指数、 以及颈椎的活动范围。 该项目的成功完成将带来低成本、安全、便携、高帧率的二维超声 用于客观定量评估 MTrP 的剪切波弹性成像系统。该工具非常适合 肌筋膜疼痛的即时诊断和治疗评估，这对于调查肌筋膜疼痛也至关重要 开发有效疗法的作用机制。