声辐射力脉冲成像对存在肌间静脉丛扩张的小腿后侧肌群弹性定量评估的价值

The value of acoustic radiation force impulse imaging in the quantitative evaluation of the elasticity of triceps surae with venous plexus dilatation

目的:探讨应用声辐射力脉冲成像(ARFI)技术评估存在肌间静脉扩张的小腿后侧肌群弹性变化。方法:收集2017年10月至2018年6月在温州医科大学附属第二医院行双下肢静脉超声检查的受检者74例,选择存在小腿后侧肌群肌间静脉丛扩张者为病例组,共48例,66条小腿。按病变累及范围分组,其中病例组1为腓肠肌内侧头(MG)和比目鱼肌(SOL)均存在肌间静脉丛扩张,患者24例,33条小腿;病例组2为仅存在SOL肌间静脉丛扩张,患者24例,33条小腿。对照组为腓肠肌和SOL均不存在肌间静脉丛扩张,共26例,52条小腿。所有受检者均使用ARFI技术的声触诊组织量化(VTQ)模式分别在踝关节自然位、最大跖屈位、最大背屈位3种体位下测量小腿MG、腓肠肌外侧头(LG)、SOL的剪切波速度(SWV)。比较各组间的SWV差异,同时分析每块肌肉在不同体位下获得的SWV的重测信度。结果:在踝关节自然位,病例组1 MG的SWV分别高于病例组2和对照组(P<0.05),病例组1 SOL的SWV高于对照组(P<0.05)。在踝关节最大跖屈位,3组间对应肌肉的SWV比较,差异均无统计学意义(P>0.05)。在踝关节最大背屈位,病例组2 MG的SWV高于对照组(P<0.05),其余组间对应肌肉的SWV比较,差异均无统计学意义(P>0.05)。MG、LG在3种体位下获得的SWV重复测量组内相关系数(ICC)均大于0.75,重测信度良好。SOL在3种体位下获得的SWV重复测量ICC处于0.45~0.75之间,重测信度较好。结论:ARFI技术可定量评估存在肌间静脉丛扩张小腿后侧肌群的弹性变化,有可能成为进一步研究小腿后侧肌群肌肉弹性与肌间静脉丛扩张内在联系的重要手段。

Objective:To investigate the elastic changes of triceps surae with venous plexus dilatation by acoustic radiation force impulse imaging(ARFI).Methods:A total of 74 subjects who underwent double-limb venous ultrasonography at the Second Affiliated Hospital of Wenzhou Medical University from October 2017 to June 2018 were collected.Patients with triceps surae venous plexus dilatation were selected as the case group,in which a total of 48 patients(66 legs)were collected.According to the extent of venous plexus dilatation involvement,the case group was divided as Group One,in which patients had venous plexus dilatation in both medial gastrocnemius(MG)and soleus and Group Two,in which patients only had soleus venous plexus dilatation,with each group having 24 patients(33 legs).Twenty-six individuals(fifty two legs)were collected as the control group who didn’t have venous plexus dilatation in either gastrocnemius or soleus.All subjects underwent ARFI imaging in virtual touch tissues quantification(VTQ)model to obtain the value of shear wave velocity(SWV)of triceps surae which contains MG,lateral gastrocnemius(LG)and soleus(SOL)at three different positions including the natural position,the maximum metatarsal flexion position and the maximum dorsiflexion position of the ankle joint.A comparison was made between different groups at the same position in the value of SWV.Meanwhile, the test-retest reliability of SWV was also analyzed. Results: In natural position of the ankle joint,SWV value of MG obtained in Group One was higher than Group Two and the control group (P<0.05);SWV value of SOL obtained in Group One was higher than the control group (P<0.05). In maximum metatarsal flexion position of the ankle joint, there was no significant difference in SWV value of each muscle among the three groups (P>0.05). In maximum dorsiflexion position of the ankle joint, SWV value of MG obtained in Group Two was higher than the control group (P<0.05), while all other differences between the groups were not statistically significant (P>0.05). The SWV of MG and the SWV of LG both had excellent test-retest reliability as intraclass correlation coefficient (ICC) calculation of three different positions were all larger than 0.75. And ICC calculation of the SWV of SOL at three different positions were between 0.45-0.75. Conclusion: ARFI can be used to quantitatively evaluate the elastic changes of triceps surae with venous plexus dilatation, which may become an important technique to further study the intrinsic relationship between the muscle elasticity and the triceps surae venous plexus dilatation disease.