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，其特征是正常胶原结构丧失、糖胺聚糖增加、细胞增多、新血管形成和神经向内生长。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，但仍然经常受伤。在成年人群中，跟腱病的发病率为每 1000 人 2.5 例。中部肌腱病是跟腱最常见的病理状况，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，据信这可以促进肌腱胶原结构的重塑。肌腱愈合很大程度上受运动量的影响。运动剂量的两个极端（固定和过度使用）已被证明不利于肌腱愈合。这表明存在最佳的运动剂量来最大化功能和肌腱特性。然而，由于缺乏非侵入性的、经济有效的方法来量化肌腱的组成、结构和重塑，量化治疗（即运动）的效果很困难。目前，治疗是通过临床、功能和患者报告的结果来评估的，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机械性能的评估。为了克服这一限制，我们提出通过超声弹性成像对粘弹性特性进行非侵入性测量，作为肌腱成分、结构和最终功能变化的等效测量。我们最近开发了一种名为连续剪切波弹性成像 (cSWE) 的超声技术，用于测量肌腱的局部粘弹性。这种新技术安全、非侵入性、廉价，与市售方法相比具有两个主要优点：1）可以调整参数来测量高硬度组织，如跟腱，2）该技术可用于测量肌腱粘弹性特性的空间变化（即地图）。因此，该技术适合评估局部病变 由肌腱病、撕裂或破裂引起。 该研究的目的是量化中部肌腱病在诊断时和治疗期间对跟腱粘弹性特性的影响，并探索粘弹性特性与临床/功能结果之间可能的相关性。这项研究将有助于将 cSWE 建立为一种临床技术，该技术可以在优化治疗性锻炼计划和/或其他肌腱病治疗方法方面发挥重要作用，以实现功能更快恢复、防止长期缺陷和再次受伤，并最大限度地减少肌腱病的发生。医疗保健系统的负担和成本。