剪切波超声弹性成像对脑卒中患者肱二头肌硬度变化的定量评估

Quantitative evaluation of biceps brachii muscle stiffness in post-stroke patients using shear wave ultrasound elastography

目的应用剪切波弹性超声成像技术定量评估脑卒中患者痉挛的肱二头肌(biceps brachii muscle,BBM)在不同屈肘角度以及肌肉不同深度的硬度变化。方法选取2019年5月1日-2020年1月20日就诊于解放军总医院第一医学中心的脑卒中偏瘫患者共20例,其中男性16例,女性4例,平均年龄53.8(30~75)岁。应用实时剪切波弹性超声定量比较BBM痉挛侧与非痉挛侧、屈肘90°与屈肘0°以及浅层与深层杨氏模量的差异。结果屈肘0°时,痉挛侧BBM杨氏模量值中位数均明显大于健侧杨氏模量值(中位数:浅层57.2 vs 31.0,P<0.01;深层74.2 vs 32.5,P<0.01);痉挛侧BBM在屈肘90°时的杨氏模量值中位数明显小于屈肘0°时的杨氏模量值(中位数:浅层39.1 vs 57.2,P<0.01;深层42.6 vs 74.2,P<0.01);当痉挛侧屈曲0°时,BBM浅层的杨氏模量值中位数明显小于深层(57.2 vs 74.2,P<0.01)。屈肘0°时,BBM浅层和深层杨氏模量均与改良Ashworth分级(Modified Ashworth Scale,MAS)呈正相关(浅层:r=0.612,P=0.004;深层:r=0.732,P=0.000)。结论剪切波弹性超声成像技术可用于评估脑卒中后BBM硬度的变化。

Objective To quantitatively evaluate the stiffness of spastic biceps brachii muscle(BBM)at different angles of elbow flexion and in different muscle layers by real-time shear wave ultrasonic elastography.Methods From May 1,2019 to January 20,2020,20 patients with post-stroke hemiplegia admitted to the First Medical Center of Chinese PLA General Hospital were included in our study.Of the 20 cases,there were 16 males and 4 females with average age of 53.8(range,30-75)years.The difference of Young’s modulus between the affected BBM and unaffected BBM,BBM at 90°elbow flexion and BBM at 0°elbow flexion,and superficial and deep BBM were compared quantitatively by real-time shear wave elastography.Results The Young’s modulus of the affected BBM was significantly higher than that of the unaffected BBM(Md:superficial muscle 57.2 vs 31.0,P<0.01;deep muscle 74.2 vs 32.5,P<0.01)at 0°elbow flexion;the Young’s modulus of spastic BBM at 90°elbow flexion was significantly lower than that of spastic BBM at 0°elbow flexion(Md:superficial muscle,39.1 vs 57.2,P<0.01;deep muscle,42.6 vs 74.2,P<0.01);and the Young’s modulus of superficial BBM was significantly lower than that of deep BBM(Md:57.2 vs 74.2,P<0.01)at 0°elbow flexion.At 0°elbow flexion,the Young’s modulus in the superficial and deep layers of BBM was positively correlated with MAS score(superficial,r=0.612,P=0.004;deep,r=0.732,P=0.000).Conclusion The real-time shear wave ultrasound elastography can evaluate the stiffness of spastic BBM after stroke.