KEYWORDS: Magnetic resonance imaging, Ultrasonography, Surgery, Injuries, 3D image processing, Image analysis, Diagnostics, Tissues, Ultrasound transducers, Education and training
Partial flexor tendon tears are common, but their diagnosis presents a few challenges. The degree of a partial flexor tendon tear necessitating surgical intervention remains under debate. This is primarily due to the lack of a sensitive and accessible imaging modality to assess the depth of a tendon laceration. We suggest the use of three-dimensional ultrasound (3DUS) to provide a more accurate grading of partial flexor tendon tears by providing surgeons with a decision-making tool to identify when surgical intervention is necessary. As a proof of concept, we dissected 6 digits from 2 fresh-frozen cadaveric specimens. Each digit was imaged using 3DUS and MRI to determine if the tendons and tendon lacerations are identifiable in the 3DUS images. This will be performed in preparation for a larger trial where each digit will be randomly assigned to an intact, low-grade laceration, or high-grade laceration group. 3DUS images were collected from each digit. MR images were also collected from each digit to compare the sensitivity of each imaging modality. Further analysis of the images will require a trained radiologist to grade the lacerations in each image, while being blinded to the actual grade of each laceration and comparing the radiologist’s grading of each image to each laceration’s actual grading to assess the sensitivity of 3DUS and MR in detecting partial tendon lacerations. We anticipate that 3DUS imaging to be comparable to MR imaging in detecting partial tendon tears. Future work includes applying load to the affected fingers to investigate whether that will improve partial tendon laceration detection. This work expands on the applications of 3DUS in musculoskeletal imaging and provides clinicians with an accessible tool to accurately detect and grade partial tendon lacerations.
Osteoarthritis (OA) is a prevalent, degenerative disease that affects the bone and soft tissue structures of the joint. The basal thumb joint is a common site of OA and is the most important joint in the thumb. Thumb OA causes pain, stiffness, and swelling. Inflammation is recognized as an important aspect of OA, contributing to disease pathogenesis and symptoms. Blood vessel growth in the joint lining, known as the synovium, has also been associated with inflammation. Ultrasound (US) imaging provides joint visualization and Doppler US technologies can detect and visualize blood flow which indicates active joint inflammation. Despite the ability to visualize the vasculature within the synovium with Doppler technologies, its function and the role it plays in disease progression are not well understood in thumb OA. Physical therapy programs for thumb OA have shown improved patient pain and function, and changes in Doppler ultrasound signal in rheumatoid arthritis. This paper investigates synovial blood flow changes with exercise in thumb OA patients using three-dimensional (3D) US with Doppler technologies. Ten thumb OA patients were imaged with 3D US before and after resistance thumb exercises. Synovial volumes and synovial Doppler signals were determined and quantified. Changes in synovial blood flow measures with exercise were investigated to evaluate the role of synovial blood flow and the effect of exercise on the vasculature. This work aims to improve the understanding of synovial microvasculature in thumb OA.
The first carpometacarpal (CMC-1) joint is a common site of osteoarthritis (OA). The joint disease commonly presents with inflammation of the synovial membrane, synovitis. Inflammation and the formation of new blood vessels, angiogenesis, are integrated processes. Increased blood flow, angiogenesis and inflammation of the synovial tissue can contribute to symptoms of OA. The role angiogenesis plays in pathogenesis and disease progression is not fully understood. Imaging modalities, such as power Doppler (PD) ultrasound (US) can detect blood flow. Recently, a new Doppler ultrasound technique, superb microvascular imaging (SMI), was developed and uses an algorithm that can more effectively visualize low-velocity blood flow. To better understand the role of angiogenesis in OA and to visualize the three-dimensional (3D) vasculature, we developed a 3DUS system. This paper is a preliminary study, which demonstrates our 3DUS system acquiring PD and SMI images for CMC-1 OA to provide quantification as well as improved blood flow visualization. As part of a clinical trial, a patient presenting with CMC-1 OA was imaged using 3DUS PD and SMI technologies to quantify the synovial volume and Doppler signals. We found synovial Doppler signals present in 3D PD and SMI images. To optimize the temperature of the device scanning solution, healthy volunteers were imaged at increasing temperatures. The Doppler signals in the blood vessels were quantified and we observed an increase in Doppler signal with higher temperatures. This work demonstrates the ability of the 3DUS PD and SMI system to detect, quantify, and visualize vessel and synovial blood flow.
First carpometacarpal osteoarthritis (CMC-1 OA) is the most common form of OA in the hand, disproportionately affecting more women than men. The risk factors predisposing women to CMC-1 OA remain poorly understood. Fourdimensional CT (4DCT) imaging coupled with four-dimensional ultrasound (4DUS) imaging was utilized in this study to assess sex differences in joint kinematics and laxity. A male to female ratio of 1:2 CMC-1 OA patients were recruited for this preliminary study. 4DCT and 4DUS images were collected while patients performed primary thumb motions without loading on the joint. Kinematic models of the CMC-1 joint were developed to assess differences in joint kinematics between men and women. Ligament recruitment patterns at the thumb joint were assessed using our 4DUS system. The developed biomechanical models presented joint motion accurately throughout all performed motions. Current work is focused on evaluating the biomechanical risk factors that predispose women to CMC-1 OA. Anticipated results include assessing sex differences in CMC-1 joint bone morphology, the degree of joint centroid translation, joint space narrowing, as well as changes in joint congruency throughout each motion. In addition, changes in length of the dorsoradial ligament throughout thumb motion will be measured from the 4D ultrasound images collected. To the best of our knowledge, this is the first study utilizing 4DCT and 4DUS in tandem to assess thumb joint kinematics and ligament recruitment patterns. This work is a step forward in understanding the biomechanical factors and ligament recruitment patterns that result in women’s increased predisposition to the development of CMC-1 OA.
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