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Rational use of MSK POCUS
S42
Ultrasound in Medicine & Biology
cornerstone in the management of recalcitrant tendon pathologies around the heel, knee, elbow and shoulder in my practice.
Rational use of MSK POCUS Iain Bell Musculoskeletal Medicine Physician, Christchurch, New Zealand Musculoskeletal point of care ultrasound (MSKPOCUS) holds potential to greatly improve patient outcomes. In order to develop a rational approach to its use, the clinician needs to be aware of multiple factors that influence its ability to do so. These factors include educational aspects relating to competence, normative data and disease prevalence, definitions of pathology, the influence of technology, validity and reliability, how MSKPOCUS influences patient management, and more importantly, patient outcomes. This presentation looks at the MSK POCUS process and these factors, and using clinical examples, discusses how we can use our findings to develop a rational approach to MSKPOCUS in order to improve patient management and outcomes. Assessing crystal disease such as gout with ultrasound Fred Joshua President, Australian Society for Ultrasound in Medicine (ASUM), Kogarah, NSW, Australia Crystal diseases are a common musculoskeletal complaint. The use of ultrasound is increasingly being used to aid in diagnosis and management of these conditions. The ultrasound features of crystal diseases and the data around the use of ultrasound for assessment and management of gout will be presented.
Volume 45, Number S1, 2019 parameters used in the study included mean pixel-intensity, axial peak strain ratio (SR, SR = muscle strain / subcutaneous tissue strain.), and longitudinal peak SR. Statistical analyses included one-way ANOVA and post-hoc to test the difference in QUI parameters among three groups (1. affected muscle in MS, 2. non-affected muscle in MS, and 3. healthy muscles of the controls) and in all paired groups, unpaired ttest to analyze the difference in muscle SR between MS subjects with MAS 1 and MAS= 0. Results: We observed a significant difference in QUI parameters among the affected, non-affected, and healthy muscles, in all paired groups, and between MS subjects with MAS 1 and MAS=0 (p< 0.05). Pixel intensity was high and SR was low in affected muscles. Inter- and intra-observer variability in performing QUI was good to excellent (ICC=0.77-0.97, p <0.001). Conclusions: Our results suggest that QUI is feasible to assess muscle mechanical behaviors and echo-intensity in adult MS. References: 1. Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011; 69(2):292 302. 2. Ansari N, Naghdi S, Arab T, Jalaie S. The interrater and intrarater reliability of the Modified Ashworth Scale in the assessment of muscle spasticity: limb and muscle group effect. Neurorehabilitation 2008; 23(3):231-37. 3. Illomei G. Muscle elastography in multiple sclerosis spasticity. Neurodegener Dis Manag. 2016; 6:13-6. 4. Gao J, Chen J, O’Dell M, et al. Ultrasound strain imaging to assess the biceps brachii muscle in chronic poststroke spasticity. J Ultrasound Med. 2018; 37:2043-52.
SESSION 9D: BREAST Quantitative ultrasound imaging to assess skeletal muscles in adults with multiple sclerosis: A feasibility study Jing Gao, Benjamin Memmott, Jonathan Poulson Rocky Vista University, Ivins, UT, USA Introduction: Multiple sclerosis (MS) is a chronic neurodegenerative disease. The disease initiates in the central nervous system (CNS) that compromises the communication between the CNS and the rest of the body resulting in movement coordination impairment of the skeletal muscles. In addition, approximately 84% of MS patients have experienced some degree of spasticity. MRI of the brain and spinal is used for the diagnosis of MS. Electromyography is to measure electrical activity of the muscle without imaging guidance. The Modified Ashworth Scale (MAS) is commonly applied for assessing spasticity nonquantitatively. There have been a few reports on using ultrasound to evaluate muscle spasticity in MS. The aim of the study was to assess the feasibility of quantitative ultrasound imaging (QUI) in assessing the biceps brachii muscle (BBM) and gastrocnemius muscle (GM) in adults with multiple sclerosis (MS). Methods: The IRB at the University approved study and all subjects provided written informed consent before the ultrasound examination. From May to October 2018, we prospectively performed B-mode sonography and ultrasound strain elastography (USE) in 10 female healthy volunteers (mean age 43 y) and 24 female patients with MS (mean age 43 y). Image J was used to count muscle pixel-intensity in grayscale image. 2-D speckle tracking software was used to estimate tissue axial peak strain representing maximum muscle deformation produced by manual compression using an ultrasound transducer and longitudinal peak strain representing maximum muscle displacement produced by passive elbow and ankle movements. Muscle QUI
Multicenter study to evaluate the difference between benign and malignant breast tumors by contrastenhanced ultrasonography (JABTS FLOW-CEUS 01 study -part 2-) Toshitaka Okuno,1,2 Takashi Nakamura,2 Toshiko Hirai,2 Yukio Mitsuzuka,2 Aya Noro,2 Yumi Imayoshi,2 Terumi Kaga,2 Megumi Satoh,2 Midori Noma,2 Shinsaku Kanazawa2 1 Breast Surgery, Kobe-City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan, 2 Flow Imaging Research Group, the Japan Association of Breast and Thyroid Sonology, Tokyo, Japan Background: Contrast-enhanced ultrasonography (CEUS) of the breast using perflubutane (SonazoidÒ ) has been utilized for over 6 years in Japan. Owing to advances in equipment and technology, reevaluation of CEUS findings and diagnostic criteria is of importance. Therefore, in the present study, we examined the contrast patterns of benign and malignant lesions on CEUS (JABTS FLOW-CEUS01, UMINID: 000026289). Objective: First, we aimed to select typical CEUS images of malignant and benign breast tumors. Second, we aimed to reevaluate the diagnostic criteria for CEUS of breast tumors. Methods: Two hundred and eighteen breast tumors from nine institutions evaluated using CEUS and subsequently histological examinations were analyzed in the present study. After evaluation of 30 educational cases that were extracted from the registered cases, we proposed CEUS findings and criteria for the differential diagnosis of breast tumors. The remaining 188 cases were used for the analysis, and the diagnosis was made by three blind readers. In accordance with the new findings and criteria, the diagnostic accuracy of CEUS of breast tumors was evaluated. This study was approved by the ethics committee and institutional review board of Kobe City NishiKobe Medical Center.
Ultrasound in Medicine & Biology
cornerstone in the management of recalcitrant tendon pathologies around the heel, knee, elbow and shoulder in my practice.
Rational use of MSK POCUS Iain Bell Musculoskeletal Medicine Physician, Christchurch, New Zealand Musculoskeletal point of care ultrasound (MSKPOCUS) holds potential to greatly improve patient outcomes. In order to develop a rational approach to its use, the clinician needs to be aware of multiple factors that influence its ability to do so. These factors include educational aspects relating to competence, normative data and disease prevalence, definitions of pathology, the influence of technology, validity and reliability, how MSKPOCUS influences patient management, and more importantly, patient outcomes. This presentation looks at the MSK POCUS process and these factors, and using clinical examples, discusses how we can use our findings to develop a rational approach to MSKPOCUS in order to improve patient management and outcomes. Assessing crystal disease such as gout with ultrasound Fred Joshua President, Australian Society for Ultrasound in Medicine (ASUM), Kogarah, NSW, Australia Crystal diseases are a common musculoskeletal complaint. The use of ultrasound is increasingly being used to aid in diagnosis and management of these conditions. The ultrasound features of crystal diseases and the data around the use of ultrasound for assessment and management of gout will be presented.
Volume 45, Number S1, 2019 parameters used in the study included mean pixel-intensity, axial peak strain ratio (SR, SR = muscle strain / subcutaneous tissue strain.), and longitudinal peak SR. Statistical analyses included one-way ANOVA and post-hoc to test the difference in QUI parameters among three groups (1. affected muscle in MS, 2. non-affected muscle in MS, and 3. healthy muscles of the controls) and in all paired groups, unpaired ttest to analyze the difference in muscle SR between MS subjects with MAS 1 and MAS= 0. Results: We observed a significant difference in QUI parameters among the affected, non-affected, and healthy muscles, in all paired groups, and between MS subjects with MAS 1 and MAS=0 (p< 0.05). Pixel intensity was high and SR was low in affected muscles. Inter- and intra-observer variability in performing QUI was good to excellent (ICC=0.77-0.97, p <0.001). Conclusions: Our results suggest that QUI is feasible to assess muscle mechanical behaviors and echo-intensity in adult MS. References: 1. Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011; 69(2):292 302. 2. Ansari N, Naghdi S, Arab T, Jalaie S. The interrater and intrarater reliability of the Modified Ashworth Scale in the assessment of muscle spasticity: limb and muscle group effect. Neurorehabilitation 2008; 23(3):231-37. 3. Illomei G. Muscle elastography in multiple sclerosis spasticity. Neurodegener Dis Manag. 2016; 6:13-6. 4. Gao J, Chen J, O’Dell M, et al. Ultrasound strain imaging to assess the biceps brachii muscle in chronic poststroke spasticity. J Ultrasound Med. 2018; 37:2043-52.
SESSION 9D: BREAST Quantitative ultrasound imaging to assess skeletal muscles in adults with multiple sclerosis: A feasibility study Jing Gao, Benjamin Memmott, Jonathan Poulson Rocky Vista University, Ivins, UT, USA Introduction: Multiple sclerosis (MS) is a chronic neurodegenerative disease. The disease initiates in the central nervous system (CNS) that compromises the communication between the CNS and the rest of the body resulting in movement coordination impairment of the skeletal muscles. In addition, approximately 84% of MS patients have experienced some degree of spasticity. MRI of the brain and spinal is used for the diagnosis of MS. Electromyography is to measure electrical activity of the muscle without imaging guidance. The Modified Ashworth Scale (MAS) is commonly applied for assessing spasticity nonquantitatively. There have been a few reports on using ultrasound to evaluate muscle spasticity in MS. The aim of the study was to assess the feasibility of quantitative ultrasound imaging (QUI) in assessing the biceps brachii muscle (BBM) and gastrocnemius muscle (GM) in adults with multiple sclerosis (MS). Methods: The IRB at the University approved study and all subjects provided written informed consent before the ultrasound examination. From May to October 2018, we prospectively performed B-mode sonography and ultrasound strain elastography (USE) in 10 female healthy volunteers (mean age 43 y) and 24 female patients with MS (mean age 43 y). Image J was used to count muscle pixel-intensity in grayscale image. 2-D speckle tracking software was used to estimate tissue axial peak strain representing maximum muscle deformation produced by manual compression using an ultrasound transducer and longitudinal peak strain representing maximum muscle displacement produced by passive elbow and ankle movements. Muscle QUI
Multicenter study to evaluate the difference between benign and malignant breast tumors by contrastenhanced ultrasonography (JABTS FLOW-CEUS 01 study -part 2-) Toshitaka Okuno,1,2 Takashi Nakamura,2 Toshiko Hirai,2 Yukio Mitsuzuka,2 Aya Noro,2 Yumi Imayoshi,2 Terumi Kaga,2 Megumi Satoh,2 Midori Noma,2 Shinsaku Kanazawa2 1 Breast Surgery, Kobe-City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan, 2 Flow Imaging Research Group, the Japan Association of Breast and Thyroid Sonology, Tokyo, Japan Background: Contrast-enhanced ultrasonography (CEUS) of the breast using perflubutane (SonazoidÒ ) has been utilized for over 6 years in Japan. Owing to advances in equipment and technology, reevaluation of CEUS findings and diagnostic criteria is of importance. Therefore, in the present study, we examined the contrast patterns of benign and malignant lesions on CEUS (JABTS FLOW-CEUS01, UMINID: 000026289). Objective: First, we aimed to select typical CEUS images of malignant and benign breast tumors. Second, we aimed to reevaluate the diagnostic criteria for CEUS of breast tumors. Methods: Two hundred and eighteen breast tumors from nine institutions evaluated using CEUS and subsequently histological examinations were analyzed in the present study. After evaluation of 30 educational cases that were extracted from the registered cases, we proposed CEUS findings and criteria for the differential diagnosis of breast tumors. The remaining 188 cases were used for the analysis, and the diagnosis was made by three blind readers. In accordance with the new findings and criteria, the diagnostic accuracy of CEUS of breast tumors was evaluated. This study was approved by the ethics committee and institutional review board of Kobe City NishiKobe Medical Center.