胸锁乳突肌剪切波弹性成像影响因素在先天性肌性斜颈早期诊断中的应用
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摘要
目的应用多模态剪切波弹性成像方法对婴儿早期先天性肌性斜颈(CMT)胸锁乳突肌病变进行诊断及定量分析。方法选取2012年9至12月在深圳市儿童医院就诊的50例先天性肌性斜颈婴儿(斜颈组)和100名健康婴儿(正常组)为观察对象,分析不同因素(性别、左侧与右侧、短轴切面与长轴切面和不同体位)对正常婴儿胸锁乳突肌超声杨氏模量、剪切波速度、剪切模量、应变比等弹性成像检测结果的影响;与正常组婴儿检测参数对照,分析斜颈组婴儿患侧胸锁乳突肌弹性成像参数值的变化。结果弹性成像显示:正常组男性与女性婴儿(100名)之间左侧与右侧胸锁乳突肌杨氏模量、剪切波速度、剪切模量和应变比等弹性成像参数值比较,差异均无统计学意义;胸锁乳突肌长轴切面的杨氏模量、剪切波速度和剪切模量测值均大于短轴切面,差异有统计学意义(P<0.05);但应变比及厚度测值比较差异无统计学意义;伸拉仰卧位的纵切面杨氏模量、剪切波速度和剪切模量在长轴切面和短轴切面的测值均大于对称仰卧位,差异有统计学意义(P<0.05),而应变比及厚度的测值比较差异无统计学意义。斜颈组婴儿(50例)患侧胸锁乳突肌厚度和杨氏模量、剪切波速度、剪切模量、应变比的弹性成像测值(含长轴切面和短轴切面)均大于健侧,差异均有统计学意义(P<0.05)。结论多模态声弹性成像技术可对先天性肌性斜颈婴儿结节型胸锁乳突肌病变进行定量评价,有助于诊断婴儿早期先天性肌性斜颈。
Objective To discuss the application of shear wave elastography and strain elasticity imaging diagnosis of infants with congenital muscular torticollis. Methods Children with congenital muscular torticollis in 50 patients and 100 healthy infants were recruited for the research at Shezhen Children′s Hospital in the period of September to December, analyzing factors in normal sternocleidomastoid two mode ultrasonic elastography, including the young′s modulus, shear wave velocity, shear modulus and the ratio of strain results, comparing the change of elasticity between the patients and normal. Results The elastic parameters of the sternocleidomastoid showed no statistically significant difference between the genders, the left side and the right side. The results of young′s modulus, shear wave velocity and shear wave modulus were higher in long axis section than the short axis section, and the difference was statistically significant(P < 0.05). However, the results of the strain ratio and thickness was not statistically significant. The young′s modulus, shear wave velocity and shear wave modulus are higher in the stretch back position than symmetrical supine position, and the difference is statistically significant(P < 0.05). But those of strain ratio and thickness was not statistically significant. The thickness of the sternocleidomastoid muscle and the young′s modulus, shear wave velocity, shear modulus and the ratio of strain results ultrasound elastic results were higher in the lesion side than the healthy side, and the difference is statistically significant(P< 0.05). Conclusion The ultrasound elastic imaging of multimodal technique can quantify the elasticity of the normal infant and the patients sternocleidomastoid, be used for diagnose for the infants with the congenital muscular torticollis.
Objective To discuss the application of shear wave elastography and strain elasticity imaging diagnosis of infants with congenital muscular torticollis. Methods Children with congenital muscular torticollis in 50 patients and 100 healthy infants were recruited for the research at Shezhen Children′s Hospital in the period of September to December, analyzing factors in normal sternocleidomastoid two mode ultrasonic elastography, including the young′s modulus, shear wave velocity, shear modulus and the ratio of strain results, comparing the change of elasticity between the patients and normal. Results The elastic parameters of the sternocleidomastoid showed no statistically significant difference between the genders, the left side and the right side. The results of young′s modulus, shear wave velocity and shear wave modulus were higher in long axis section than the short axis section, and the difference was statistically significant(P < 0.05). However, the results of the strain ratio and thickness was not statistically significant. The young′s modulus, shear wave velocity and shear wave modulus are higher in the stretch back position than symmetrical supine position, and the difference is statistically significant(P < 0.05). But those of strain ratio and thickness was not statistically significant. The thickness of the sternocleidomastoid muscle and the young′s modulus, shear wave velocity, shear modulus and the ratio of strain results ultrasound elastic results were higher in the lesion side than the healthy side, and the difference is statistically significant(P< 0.05). Conclusion The ultrasound elastic imaging of multimodal technique can quantify the elasticity of the normal infant and the patients sternocleidomastoid, be used for diagnose for the infants with the congenital muscular torticollis.
引文
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2唐盛平,周亚玲,刘正全,等.CMT病变组织中细胞凋亡的研究[J].临床小儿外科杂志,2007,6(1):12-15.
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4 Ryu JH,Kim DW,Kim SH,et al.Factors Correlating Outcome in Young Infants With Congenital Muscular Torticollis[J].Can Assoc Radiol J,2016,67(1):82-87.
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6贺雪华,关步云,朱莉玲,等.实时组织弹性成像对中医推拿治疗小儿先天肌性斜颈的疗效评估[J].广州中医药大学学报,2014,31(6):921-923.
7 Hong SK,Song JW,Woo SB,et al.Clinical Usefulness of Sonoelastography in Infants With Congenital Muscular Torticollis[J].Ann Rehabil Med,2016,40(1):28-33.
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9 Kwon DR,Park GY.Diagnostic value of real-time sonoelastography in congenital muscular torticollis[J].J Ultrasound Med,2012,31(5):721-727.
10 Yanagisawa O,Niitsu M,Kurihara T,et al.Evaluation of human muscle hardness after dynamic exercise with ultrasound real-time tissue elastography:a feasibility study[J].Clin Radiol,2011,66(9):815-819.
11温朝阳,范春芝,安立春,等.实时定量超声弹性成像技术检测肱二头肌松弛和紧张状态下弹性模量值差异[J/CD].中华医学超声杂志(电子版),2011,8(1):129-134.
12 Nakamura M,Ikezoe T,Kobayashi T,et al.Acute effects of static stretching on muscle hardness of the medial gastrocnemius muscle belly in humans:an ultrasonic shear-wave elastography study[J].Ultrasound Med Biol,2014,40(9):1991-1997.
13 Bamber J,Cosgrove D,Dietrich CF,et al.EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography.Part1:Basic principles and technology[J].Ultraschall Med,2013,34(2):169-184.
14 Papazoglou S,Rump J,Braun J,et al.Shear wave group velocity inversion in MR elastography of human skeletal muscle[J].Magn Reson Med,2006,56(3):489-497.
15 Chino K,Kawakami Y,Takahashi H.Tissue elasticity of in vivo skeletal muscles measured in the transverse and longitudinal planes using shear wave elastography[J].Clin Physiol Funct Imaging,2017,37(4):394-399.
16姜镔,王学梅,王云忠,等.实时剪切波弹性成像测量胸锁乳突肌杨氏模量时声束平面与肌束不同角度对测量值的影响[J].中国医学影像技术,2014,30(2):269-272.
2唐盛平,周亚玲,刘正全,等.CMT病变组织中细胞凋亡的研究[J].临床小儿外科杂志,2007,6(1):12-15.
3 Chen HX,Tang SP,Gao FT,et al.Fibrosis,adipogenesis,and muscle atrophy in congenital muscular torticollis[J].Medicine(Baltimore),2014,93(23):e138.
4 Ryu JH,Kim DW,Kim SH,et al.Factors Correlating Outcome in Young Infants With Congenital Muscular Torticollis[J].Can Assoc Radiol J,2016,67(1):82-87.
5石秀英,艾红,王娟,等.超声实时组织弹性成像在甲状腺弥漫性疾病中的初步应用[J].中华超声影像学杂志,2011,20(6):515.
6贺雪华,关步云,朱莉玲,等.实时组织弹性成像对中医推拿治疗小儿先天肌性斜颈的疗效评估[J].广州中医药大学学报,2014,31(6):921-923.
7 Hong SK,Song JW,Woo SB,et al.Clinical Usefulness of Sonoelastography in Infants With Congenital Muscular Torticollis[J].Ann Rehabil Med,2016,40(1):28-33.
8 Lee SY,Park HJ,Choi YJ,et al.Value of adding sonoelastography to conventional ultrasound in patients with congenital muscular torticollis[J].Pediatr Radiol,2013,43(12):1566-1572.
9 Kwon DR,Park GY.Diagnostic value of real-time sonoelastography in congenital muscular torticollis[J].J Ultrasound Med,2012,31(5):721-727.
10 Yanagisawa O,Niitsu M,Kurihara T,et al.Evaluation of human muscle hardness after dynamic exercise with ultrasound real-time tissue elastography:a feasibility study[J].Clin Radiol,2011,66(9):815-819.
11温朝阳,范春芝,安立春,等.实时定量超声弹性成像技术检测肱二头肌松弛和紧张状态下弹性模量值差异[J/CD].中华医学超声杂志(电子版),2011,8(1):129-134.
12 Nakamura M,Ikezoe T,Kobayashi T,et al.Acute effects of static stretching on muscle hardness of the medial gastrocnemius muscle belly in humans:an ultrasonic shear-wave elastography study[J].Ultrasound Med Biol,2014,40(9):1991-1997.
13 Bamber J,Cosgrove D,Dietrich CF,et al.EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography.Part1:Basic principles and technology[J].Ultraschall Med,2013,34(2):169-184.
14 Papazoglou S,Rump J,Braun J,et al.Shear wave group velocity inversion in MR elastography of human skeletal muscle[J].Magn Reson Med,2006,56(3):489-497.
15 Chino K,Kawakami Y,Takahashi H.Tissue elasticity of in vivo skeletal muscles measured in the transverse and longitudinal planes using shear wave elastography[J].Clin Physiol Funct Imaging,2017,37(4):394-399.
16姜镔,王学梅,王云忠,等.实时剪切波弹性成像测量胸锁乳突肌杨氏模量时声束平面与肌束不同角度对测量值的影响[J].中国医学影像技术,2014,30(2):269-272.