获得高质量的骨骼肌扩展视野超声图像，以测量肌肉束长度
1Department of Biomedical Engineering,Northwestern University, 2Department of Physical Medicine & Rehabilitation,Northwestern University Feinberg School of Medicine, 3Department of Physical Therapy and Human Movement Sciences,Northwestern University Feinberg School of Medicine, 4Shirley Ryan AbilityLab, 5Edward Hines, Jr. VA Hospital
Summary
本研究描述了如何使用扩展视场超声（EFOV-US）方法获得高质量的肌肉骨骼图像，以进行肌肉束长度测量。我们将这种方法应用于具有束状物的肌肉，这些肌肉延伸到普通传统超声（T-US）探针的视野之外。
Abstract
肌肉束长度通常在体内使用传统超声测量，是定义肌肉力产生能力的重要参数。然而，超过 90% 的上肢肌肉和 85% 的下肢肌有比普通传统超声（ T – US ）探头的视野更长的最佳分束长度。一种较新、不太常用的称为扩展视场超声（EFOV-US）的方法，可以直接测量比单个T-US图像的视场更长的薄片。这种方法可以自动将来自动态扫描的T-US图像序列拟合在一起，已被证明对于在体内获得肌肉束长度是有效和可靠的。尽管有许多具有长筋膜的骨骼肌，并且EFOV-US方法对这种筋膜进行测量的有效性，但很少有已发表的研究使用这种方法。在这项研究中，我们展示了如何实施EFOV-US方法来获得高质量的肌肉骨骼图像，以及如何量化这些图像的分筋膜长度。我们预计，该演示将鼓励使用EFOV-US方法来增加健康和受损人群中的肌肉池，我们有体内肌肉束长度数据。
Introduction
筋膜长度是骨骼肌结构的一个重要参数，总体上表明肌肉产生力的能力1，2。具体而言，肌肉的筋膜长度可以深入了解肌肉可以产生活动力的绝对长度范围3，4。例如，给定除筋膜长度外，所有等轴测力生成参数（即平均肌节长度、下角、生理横截面积、收缩状态等）具有相同值的两块肌有较长筋膜的肌肉将在较长的长度上产生其峰值力，并且将产生比具有较短束的肌肉更宽的长度范围的力 3.肌肉筋膜长度的量化对于了解健康的肌肉功能和肌肉的力产生能力的变化非常重要，这些变化可能是由于肌肉使用改变（例如，固定5，6，运动干预7，8，9，高跟鞋佩戴10）或肌肉环境的变化（例如，肌腱转移手术11，肢体分心12）而发生的).肌肉束长度的测量最初是通过离体尸体实验获得的，该实验允许直接测量解剖的筋膜13，14，15，16。这些离体实验提供的宝贵信息导致人们有兴趣实施体内方法17，18，19以解决尸体无法回答的问题;体内方法允许在天然状态以及不同的关节姿势，不同的肌肉收缩状态，不同的加载或卸载状态以及具有不同条件（即健康/受伤，年轻/年老等）的人群中量化肌肉参数。最常见的是，超声波是用于获得体内肌肉束长度的方法18，19，20;它比其他成像技术（如扩散张量成像（DTI））更快，更便宜，更容易实现18，21。
扩展视野超声（EFOV-US）已被证明是测量体内肌肉束长度的有效且可靠的方法。虽然通常采用传统超声（T-US），但其视场受超声换能器阵列长度的限制（通常在4至6厘米之间，尽管有些探头延伸至10 cm10）18，20。为了克服这一限制，Weng等人开发了一种EFOV-US技术，该技术可以从动态的长距离扫描中自动获取复合的二维”全景”图像（长达60厘米）22。图像是通过实时拟合一系列传统的B型超声图像而创建的，因为换能器动态扫描感兴趣的物体。由于连续的 T-US 图像具有较大的重叠区域，因此一个图像与下一个图像之间的微小差异可用于计算探头运动，而无需使用外部运动传感器。一旦计算出两个连续图像之间的探头运动，”当前”图像将连续与前面的图像合并。EFOV-US方法允许直接测量长而弯曲的肌肉束，并且已被证明在肌肉，试验和超声医师中是可靠的23，24，25 并且对平坦和弯曲的表面都有效23，26。
实施超声波来测量体内肌肉束长度并非易事。与其他涉及更多自动化方案（即MRI，CT）的成像技术不同，超声依赖于超声医师的技能和解剖学知识27，28。有人担心探头与分册平面的不对中可能导致分册措施出现重大误差。一项研究表明，使用超声和 DTI MRI 测量的分束长度测量几乎没有差异（平均< 3 mm），但也表明测量精度较低（差的标准偏差约为 12 mm）29。尽管如此，已经表明，新手超声医师在经验丰富的超声医师的实践和指导下，可以使用EFOV-US23获得有效的测量值。因此，应努力证明适当的协议，以减少人为错误并提高使用EFOV-US获得的测量的准确性。最终，开发和共享适当的方案可能会扩大实验者和实验室的数量，这些实验者和实验室可以从文献中重现分册长度数据，或者在尚未在体内研究的肌肉中获得新的数据。
在该协议中，我们展示了如何实施EFOV-US方法以获得可用于量化肌肉束长度的高质量肌肉骨骼图像。具体而言，我们解决了（a）收集单个上肢和单个下肢肌肉的EFOV-US图像（b）实时确定EFOV-US图像的”质量”，以及（c）离线量化肌肉结构参数。我们提供此详细指南，以鼓励采用EFOV-US方法在由于长筋膜而未在体内研究的肌肉中获取肌肉束长度数据。
Protocol
西北大学的机构审查委员会（IRB）批准了这项研究的程序。所有参加这项工作的参与者在开始下面详述的方案之前都给予了知情同意。注意：本研究中使用的特定超声系统具有EFOV-US功能，并且被采用，因为我们能够审查科学文献中有关该算法的详细信息和有效性评估22，26;还存在多个具有EFOV-US的其他系统18，20…
Representative Results
实施扩展视野超声（EFOV-US）以从4名健康志愿者的肱二头肌长头和胫骨前部获得图像（表1）。 图1 显示了在这个代表性成像会议中两块肌肉的EFOV-US图像，并突出显示了每个图像的重要方面，例如肌肉腱鞘炎，中心肌腱，筋膜路径等。成像过程结束后，对每个个体中每块肌肉的3张定性”良好”图像（图2）进行了分析。实施ImageJ以测量每张图像…
Discussion
协议中的关键步骤。
获得高质量的EFOV-US图像有几个关键组成部分，可以产生有效和可靠的分册长度测量。首先，如方法1.1.2所示，超声医师必须花时间熟悉被成像肌肉的解剖结构以及周围的肌肉，骨骼和其他软组织结构。这将提高超声医师对正确肌肉进行成像的能力，并确定多个图像是否捕获了相同的肌肉平面。其次，超声医师在收集数据以供发表之前，应练习…
Divulgations
The authors have nothing to disclose.
Acknowledgements
我们要感谢Vikram Darbhe和Patrick Franks的实验指导。这项工作得到了美国国家科学基金会研究生研究奖学金计划的支持。DGE-1324585以及NIH R01D084009和F31AR076920。本材料中表达的任何意见，发现和结论或建议均为作者的观点，并不一定反映美国国家科学基金会或NIH的观点。
Materials
| 14L5 linear transducers | Siemens | 10789396 | |
| Acuson S2000 Ultrasound System | Siemens | 10032746 | |
| Adjustable chair (Biodex System) | Biodex Medical Systems | System Pro 4 | |
| Skin Marker Medium Tip | SportSafe | n/a | Multi-color 4 Pack recommended |
| Ultrasound Gel – Standard 8 Ounce Non-Sterile Fragrance Free Glacial Tint | MediChoice, Owens &Minor | M500812 |
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Citer Cet Article
Adkins, A. N., Murray, W. M. Obtaining Quality Extended Field-of-View Ultrasound Images of Skeletal Muscle to Measure Muscle Fascicle Length. J. Vis. Exp. (166), e61765, doi:10.3791/61765 (2020).