Assessment of Arm Volume Using a Tape Measure Versus a 3D Optical Scanner in Survivors with Breast Cancer-Related Lymphedema.

Background: Lymphedema (LE) is a significant clinical problem for breast cancer survivors. While the water displacement test and circumferential assessment using a tape measure (TM) are common methods to assess differences in arm volumes, faster and more reliable methods are needed. Study purposes, in breast cancer survivors (n = 294), were to compare the average total arm volumes and interlimb volume ratios for women with and without a history of LE, using a TM and three-dimensional (3D), whole-body surface scanner (3D scan); compare the level of agreement between arm volumes and interlimb volume ratios obtained using the two devices; and evaluate the percent agreement between the two measures in classifying cases of LE using three accepted thresholds. Methods and Results: Measurements were done using a spring-loaded TM and Fit3D ProScanner. Paired t-tests and Bland-Altman analyses were used to achieve the study aims. For circumference and volume comparisons, compared with the 3D scan, values obtained using the TM were consistently smaller. In terms of level of agreement, the Bland-Altman analyses demonstrated large biases and wide limits of agreement for the calculated arm volumes and volume ratios. In terms of the classification of caseness, using the 200-mL interlimb volume difference criterion resulted in 81.6% overall agreement; using the >10% volume difference between the affected and unaffected arms resulted in 78.5% overall agreement; and using the volume ratio ≥1.04 criterion resulted in 62.5% overall agreement. For all three accepted threshold criteria, the percentage of cases was significantly different between the TM and 3D scan techniques. Conclusions: The 3D technology evaluated in this study has the potential to be used for self-initiated surveillance for LE. With improvements in landmark identification and software modifications, it is possible that accurate and reliable total arm volumes can be calculated and used for early detection.

Semiautomatic Assessment of Fetal Fractional Limb Volume for Weight Prediction in Clinical Praxis: How Does It Perform in Routine Use?

OBJECTIVES: Semiautomatic fractional limb volume (FLV) models have recently produced promising results for fetal birth weight (BW) estimation. We tested those models in a more unselected population hypothesizing that the FLV models would improve accuracy and precision of fetal BW estimation compared to the Hadlock model. METHODS: We compared the performance of different BW prediction models: Hadlock (biparietal diameter [BPD], abdominal circumference (AC), femur diaphysis length) and modified Lee thigh volume (TVol) and arm volume (AVol) (BPD, AC, automated fractional TVol, and AVol). Accuracy (systematic errors, mean percent differences) and precision (random errors, ± 1 SD of percent differences) were calculated. RESULTS: A total of 75 fetuses were included for final analysis. The Hadlock model showed the most consistent results with accurate BW estimation not significantly different from zero (-0.37 ± 8.53%). The modified fractional thigh and arm volume models were less accurate but trended toward more precise results (-2.63 ± 7.69% and -3.85 ± 7.47%, respectively). In addition, the modified TVol model showed the trend to predict more BWs within ±10% of the actual BW compared to the Hadlock model (81.3 versus 74.67%, ns). CONCLUSIONS: Based on our results, fetal weight estimation using the modified semiautomatic FLV models generates less accurate results in third-trimester fetuses compared to the Hadlock model. Those models recently published might improve the results of BW prediction by showing a higher precision than conventional models, especially in small and large fetuses. Further studies are needed to investigate the clinical usefulness of the new models.

Lifting and Toning of Arms and Calves Using High-Intensity Focused Electromagnetic Field (HIFEM) Procedure Documented by Ultrasound Assessment.

OBJECTIVE: The HIFEM procedure demonstrates positive outcomes on abdomen and buttock. This multi-center study aims to investigate its effect on adipose tissue and muscle mass located in upper arms and calves. MATERIALS AND METHODS: Twenty subjects (45.10±15.19 years, 24.44±3.22 kg/m2) who underwent a HIFEM procedure (4 sessions; 20 minutes per muscle group) on arms and calves were evaluated. Overall, 7 patients were treated over biceps and triceps, 4 patients over calves, and 9 patients underwent treatment of both upper arms and calves. The changes in adipose and muscle tissue of musculus biceps brachii, triceps brachii, and gastrocnemius were evaluated by using ultrasound. The results from a 1-month, 3-month, and 6-month follow-up were compared to the baseline. Digital photographs, weight measurements, satisfaction, and comfort questionnaires were assessed at baseline and follow-ups. RESULTS: Ultrasound images revealed a significant (P<0.05) increase in the muscle mass of all studied muscles, with the most noticeable improvement in biceps brachii (+16.13% at 3 months). The fat deposits over arms and calves showed significant improvement (P<0.05), reaching -15.12% at 3 months. The results peaked at 3 months and were sustained up to 6 months with a slight but insignificant decline. Aesthetic enhancement of treated areas was documented while patients were highly satisfied. CONCLUSIONS: The achieved outcomes showed that the HIFEM procedure is effective for muscle toning and fat reduction in arms and calves. The results suggest that the use of the HIFEM procedure is not limited only to abdominal and buttock shaping but is also effective for toning of arms and calves. J Drugs Dermatol. 2021;20(7):755-759. doi:10.36849/JDD.5878.

Quantitative assessment of normal middle deltoid muscle elasticity at various arm abduction using ultrasound shear wave elastography.

The objective of this study is to assess the change in the normal MD elasticity using shear wave elastography (SWE) through measuring the middle deltoid (MD) elasticity in healthy participants at various arm abduction (with bilateral arms at 0 degrees abduction and 90 degrees active abduction) and analyzing the factors affecting normal MD elasticity. Mean shear wave velocity (SWV) of the MD in healthy right-handed participants were evaluated using SWE at different arm abduction, and potential factors (gender, MD thickness, age, body mass index) affecting MD elasticity were analyzed. Different arm abduction positions of each participant were as follows: (i) 0° abduction of bilateral arm (L0° and R0°), (ii) 90° active abduction of bilateral arm (L90° and R90°). Mean SWV was significantly higher at L90° than L0°, higher at R90° than R0°, higher at R0° than L0°, and higher at R90° than L90° (all P < 0.0001). SWV was significantly higher in males at both L0° (P < 0.05) and R0° (P < 0.01) than in females. Neither MD thickness, age nor body mass index influenced MD elasticity. Reference ranges of normal MD elasticity were 2.4-3.1 m/s in males and 2.2-2.9 m/s in females at L0° and 2.5-3.3 m/s in males and 2.4-3.2 m/s in females at R0°, and were 4.9-6.7 m/s at L90°, 5.2-7.1 m/s at R90° for both males and females. SWE is a feasible technique to assess normal MD elasticity at various arm abduction. Our results suggest that normal MD elasticity at L0°, R0°, L90°, and R90° with SWE are different. Moreover, these reference ranges may serve as quantitative baseline measurements for assessment of normal MD elasticity in the future.

Quantitative assessment of change in upper extremity muscle stiffness following fluid injection using shear wave elastography.

OBJECTIVE: To quantitatively assess changes in muscle stiffness following intramuscular saline injection using shear wave elastography (SWE). MATERIALS AND METHODS: Thirty muscles (lateral deltoid (LD), biceps brachii (BB), brachialis, pronator teres (PT), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU)) from fresh-frozen cadaveric specimens were injected with saline under ultrasound guidance. Pre- and post-injection muscle thickness (MT) (mm) and SWE (kPa) measurements were recorded. RESULTS: All muscles demonstrated a decrease in the mean SWE value post-injection, with the largest differences ± standard error noted in the LD (14.76 ± 3.55 kPa, p = 0.021) and brachialis muscles (12.02 ± 2.51 kPa, p = 0.013). Muscle thickness increased following injection, although the degree of changes poorly correlated with the change in SWE. CONCLUSION: In summary, following intramuscular injection of saline injection, a decrease in upper extremity muscle stiffness is detected using SWE. It is important to note that if performing a longitudinal assessment of muscle stiffness after intramuscular injection, saline will likely contribute to a decrease in muscle stiffness in the immediate post-injection time period.

Assessment of the skin tissue structure using an ultrasonic diagnostic imaging device in patients undergoing open surgery.

BACKGROUND: Perioperative skin injury is a major issue; therefore, several preventative measures have been developed. However, no previous studies have visualized the effects of stromal edema caused by surgical invasion of skin tissue, and therefore, the details remain unknown. We used an ultrasonic diagnostic imaging device to clarify changes in the skin tissue structure of patients after open surgery. MATERIALS AND METHODS: Twenty subjects who underwent open hepatectomy were enrolled. We selected the lateral abdomen, upper arms, and lower legs as ultrasonic imaging measurement sites. We performed measurements on the day before surgery and on postoperative days 1, 3, and 5. We calculated the epidermal/dermal tissue thickness, subcutaneous tissue thickness, and skin tissue thickness. We performed a one-way analysis of variance with repeated measurements for each of the postoperatively measured values on the basis of the preoperative values. Significantly different variables were subjected to the Bonferroni method. We evaluated ultrasonic imaging findings and skin injury. RESULTS: Epidermal/dermal tissue thickness at all measurement sites exhibited sustained thickening on postoperative day 5 compared to that preoperatively. The lateral abdomen exhibited thickening of the subcutaneous tissue and skin tissue on postoperative day 1. In addition, increased echogenicity, increased opacity of the layer structure, and a cobblestone appearance occurred during the postoperative course. Postoperatively, 80% of subjects exhibited skin injury. CONCLUSION: We evaluated the effects of surgical invasion on skin tissue over time. Continual observation and protective skincare are necessary near the surgical wound, where significant invasiveness occurs. Prevention of skin injury due to skin tissue thickening requires further study.

Muscle mass assessment by computed tomography in chronic kidney disease patients: agreement with surrogate methods.

BACKGROUND/OBJECTIVES: Patients with chronic kidney disease (CKD) are subjected to muscle wasting. Therefore, it is important to investigate surrogate methods that enable the assessment of muscle mass loss in the clinical setting. We aimed to analyze the agreement between computed tomography (CT) and surrogate methods for the assessment of muscle mass in non-dialysis CKD patients. SUBJECTS/METHODS: Cross-sectional study including 233 non-dialysis patients on CKD stages 3 to 5 (61 ± 11 years; 64% men; glomerular filtration rate 22 (14-33) mL/min/1.73 m2). The muscle mass was evaluated by CT and bioelectrical impedance, skinfold thicknesses, midarm muscle circumference (MAMC), the predictive equations of Janssen and Baumgartner and the physical examination of muscle atrophy from the subjective global assessment. RESULTS: In males, the MAMC showed the best agreement with CT as indicated by the kappa test (k = 0.57, P < 0.01), sensitivity (S = 68%), specificity (S = 89%) and accuracy (area under the curve-AUC = 0.78), followed by the Baumgartner equation (kappa = 0.46, P < 0.01; sensitivity = 60%; specificity = 87% and AUC = 0.73). In female, the Baumgartner equation showed the best agreement with CT (kappa = 0.43, P < 0.01; sensitivity = 57%; specificity = 86% and AUC = 0.71). CONCLUSIONS: The MAMC and Baumgartner equation showed the best agreement with CT for the assessment of muscle mass in non-dialysis CKD patients.

Assessment of Subfascial Muscle/Water and Fat Accumulation in Lymphedema Patients Using Magnetic Resonance Imaging.

Background: In patients with arm or leg lymphedema, more fat has been found in the epifascial compartment of the edematous limb compared to the healthy limb. However, not much is known about subfascial fat accumulation in these patients. This study aims to investigate the intramuscular and intermuscular fat and muscle/water volume in lymphedema patients. The excess of intramuscular and intermuscular fat volume was also compared to the excess epifascial fat volume, the excess limb volume, and the duration of lymphedema. Methods and Results: Data from 13 patients (seven arm and six leg lymphedemas) were acquired using a 1.5 T magnetic resonance imaging (MRI) scanner before liposuction and at five time points (4 days, 4 weeks, 3 months, 6 months, and 1 year) after liposuction. From water-fat imaging, fat and muscle/water volumes within the intramuscular and intermuscular compartments were calculated. The relative excess volume was defined as (volume of edematous limb-volume of healthy limb)/volume of healthy limb. Elevated relative excess volumes of intramuscular and intermuscular fat were found at all time points. A decrease in the relative excess volume of muscle/water over time was found. This decrease was not correlated to the relative excess of epifascial fat volume, the relative excess of limb volume, or the duration of lymphedema. Conclusions: An excess fat volume was found in the intramuscular and intermuscular compartments in lymphedema patients. The results suggest that the subfascial compartment needs to be studied separately as no correlation between intramuscular/intermuscular fat accumulation and other measured parameters was found.

Assessment of Mechanical Properties of Tissue in Breast Cancer-Related Lymphedema Using Ultrasound Elastography.

Breast cancer-related lymphedema is a consequence of a malfunctioning lymphatic drainage system resulting from surgery or some other form of treatment. In the initial stages, minor and reversible increases in the fluid volume of the arm are evident. As the stages progress over time, the underlying pathophysiology dramatically changes with an irreversible increase in arm volume most likely due to a chronic local inflammation leading to adipose tissue hypertrophy and fibrosis. Clinicians have subjective ways to stage the degree and severity such as the pitting test which entails manually comparing the elasticity of the affected and unaffected arms. Several imaging modalities can be used but ultrasound appears to be the most preferred because it is affordable, safe, and portable. Unfortunately, ultrasonography is not typically used for staging lymphedema, because the appearance of the affected and unaffected arms is similar in B-mode ultrasound images. However, novel ultrasound techniques have emerged, such as elastography, which may be able to identify changes in mechanical properties of the tissue related to detection and staging of lymphedema. This paper presents a novel technique to compare the mechanical properties of the affected and unaffected arms using quasi-static ultrasound elastography to provide an objective alternative to the current subjective assessment. Elastography is based on time delay estimation (TDE) from ultrasound images to infer displacement and mechanical properties of the tissue. We further introduce a novel method for TDE by incorporating higher order derivatives of the ultrasound data into a cost function and propose a novel optimization approach to efficiently minimize the cost function. This method works reliably with our challenging patient data. We collected radio frequency ultrasound data from both arms of seven patients with stage 2 lymphedema, at six different locations in each arm. The ratio of strain in skin, subcutaneous fat, and skeletal muscle divided by strain in the standoff gel pad was calculated in the unaffected and affected arms. The p -values using a Wilcoxon sign-rank test for the skin, subcutaneous fat, and skeletal muscle were 1.24×10-5 , 1.77×10-8 , and 8.11×10-7 respectively, showing differences between the unaffected and affected arms with a very high level of significance.

Body fat percentage assessment by ultrasound subcutaneous fat thickness measurements in middle-aged and older adults.

BACKGROUND & AIMS: B-mode ultrasound accurately measures both muscle mass, body density and percent body fat (% BF) in younger adults, but how well it can estimate % BF in middle-aged and older adults using DXA-derived %BF as the criterion is unclear. We sought to develop % BF prediction equations for middle-aged and older adults using ultrasound subcutaneous fat thickness (SFT). METHODS: A cross-sectional study of Japanese adults (n = 414, 50-79 years) where 276 subjects were randomly assigned to a model development group and the other 138 subjects were assigned to a cross-validation group. B-mode ultrasound measured SFT at nine sites. Dual energy X-ray absorptiometry (DXA) measured % BF, arm fat mass (FM) and leg FM. Stepwise multiple linear regression developed prediction equations from anthropometric data (body mass, height, waist and hip circumference) and ultrasound SFT sites. Bland-Altman plots assessed validity of the prediction equations to measure % BF in the cross-validation group. RESULTS: The best prediction equation for % BF was the following: [% BF = 15.709 + (1.753*anterior trunk SFT) + (5.626*Sex) + (3.635*posterior upper arm SFT) - (4.428*anterior lower leg SFT) - (0.170*height) + (0.264*waist) + (anterior thigh SFT*2.241); r2 = 0.809, standard error of the estimate (SEE) = 3.3 kg]. Arm FM and leg FM prediction equations had r2 values ranging from 0.690 to 0.812 and SEEs of 0.29 and 0.75 kg. A small mean bias was noted for estimating % BF (-0.14%), but large limits of agreement were found (-8.0-7.7%) and systematic error was noted in all of the equations (r = 0.275 to 0.515, p < 0.05). CONCLUSIONS: Despite high r2 values and a small mean bias found between predicted and DXA % BF, wide limits of agreement were found with some systematic error present. Therefore, these prediction equations for middle-aged and older adults may not be sufficiently accurate to use in a clinical setting.

An Objective and Child-friendly Assessment of Arm Function by Using a 3-D Sensor.

Progressive and irreversible muscle atrophy characterizes Spinal Muscular Atrophy (SMA) and other similar muscle disorder diseases. Objective assessment of muscle functions is an essential and important, although challenging, prerequisite for successful clinical trials. Current clinical rating scales restrain the movement abnormalities to certain predefined coarse-grained individual items. The Kinect 3-D sensor has emerged as a low-cost and portable motion sensing technology used to capture and track people's movement in many medical and research fields. A novel approach using this 3-D sensor was developed and a game-like test was designed to objectively measure the upper limb function of patients with SMA. The prototype test targeted joint movement capability. While sitting in a virtual scene, the patient was instructed to extend, flex, and lift the whole arm in order to reach and place some objects. Both kinematic and spatiotemporal characteristics of upper limb movement were extracted and analyzed, e.g., elbow extension and flexion angles, hand velocity, and acceleration. The first study included a small cohort of 18 ambulant SMA patients and 19 age- and gender-matched healthy controls. A comprehensive analysis of arm movement was achieved; however, no significant difference between the groups were found due to the mismatch of patient's capability and the test difficulty. Based on this experience, a second version of the test consisting of a modified version of the first game with increased difficulties and a second game targeting muscle endurance were designed and implemented. The new test has not been conducted in any patient groups yet. Our work has demonstrated the potential capability of the 3-D sensor in assessing such muscle function and suggested an objective approach to complement the clinical rating scales.

Reference Values for Assessment of Unilateral Limb Lymphedema with Dual-Energy X-Ray Absorptiometry.

INTRODUCTION: The clinical assessment of unilateral limb lymphedema is commonly based on measurements of interlimb volume differences. Reference values for interlimb percentage differences of the volume, fat mass, and lean mass measured with dual-energy X-ray absorptiometry (DXA) scan are, however, not established. The aim of the study was to establish and categorize these reference values in normal limbs. METHODS AND RESULTS: DXA scans of the normal arms of 167 and normal legs of 196 melanoma patients (aged 18-75 years, body mass index <40), respectively, were performed. The interlimb percentage difference is calculated as follows: ("Limb-of-interest"-contralateral)/contralateral × 100. The interlimb percentage differences for the limb-of-interest were stratified to upper (according to handedness) and lower limbs and categorized as none/mild, moderate, or severe, respectively, based on whether the value is below, in between, or above the two prediction limits. The prediction limits for interlimb total volume percentage difference were 6% and 10%, 0% and 4%, and 3% and 6% for the dominant arm, nondominant arm, and leg, respectively. Further data are given for interlimb percentage differences of regional (upper arm, lower arm, hand, thigh, lower leg, and foot) and total volume, fat mass, and lean mass, respectively. CONCLUSIONS: The provided clinical reference values allow for identifying and categorizing pathophysiological differences of limbs-of-interest and evaluating tissue composition.

Application of the L-Dex Score for the Assessment of Bilateral Leg Edema.

BACKGROUND: We evaluated a modified L-Dex score by using the right arm as a reference (LDSrarm), to determine whether it could be used for the assessment of leg edema in place of the usual L-Dex score calculated by using the contralateral normal leg as a reference (LDScont). METHODS: Bioimpedance analysis was performed in the legs and right arms of 38 patients with unilateral leg edema and in 42 healthy volunteers by using a standard equipotential electrode arrangement. RESULTS: The impedance ratio in the right arms of patients (2.6 ± 0.4) was lower than that in their contralateral normal legs (3.0 ± 0.8, p < 0.05), but it was similar to that in the legs (right: 2.4 ± 0.7, left 2.5 ± 0.8) of normal subjects. There was a significant correlation between LDScont and LDSrarm in legs with edema (right: r = 0.80, left: r = 0.93). No such correlation was found in the legs of normal subjects, but the mean ± 2 standard deviation of their LDSrarm ranged from -3 to 37, which was similar to LDSrarm values in legs with edema corresponding to the normal range of LDScont (-10 to 10), that is, from 1 to 34. CONCLUSIONS: LDSrarm could be used as an alternative for LDScont in the assessment of leg edema.

Magnetic Resonance Imaging-Based Assessment of Breast Cancer-Related Lymphoedema Tissue Composition.

OBJECTIVES: The aim of this study was to propose a magnetic resonance imaging acquisition and analysis protocol that uses image segmentation to measure and depict fluid, fat, and muscle volumes in breast cancer-related lymphoedema (BCRL). This study also aims to compare affected and control (unaffected) arms of patients with diagnosed BCRL, providing an analysis of both the volume and the distribution of the different tissue components. MATERIALS AND METHODS: The entire arm was imaged with a fluid-sensitive STIR and a 2-point 3-dimensional T1W gradient-echo-based Dixon sequences, acquired in sagittal orientation and covering the same imaging volume. An automated image postprocessing procedure was developed to simultaneously (1) contour the external volume of the arm and the muscle fascia, allowing separation of the epifacial and subfascial volumes; and to (2) separate the voxels belonging to the muscle, fat, and fluid components. The total, subfascial, epifascial, muscle (subfascial), fluid (epifascial), and fat (epifascial) volumes were measured in 13 patients with unilateral BCRL. Affected versus unaffected volumes were compared using a 2-tailed paired t test; a value of P < 0.05 was considered to be significant. Pearson correlation was used to investigate the linear relationship between fat and fluid excess volumes. The distribution of fluid, fat, and epifascial excess volumes (affected minus unaffected) along the arm was also evaluated using dedicated tissue composition maps. RESULTS: Total arm, epifascial, epifascial fluid, and epifascial fat volumes were significantly different (P < 0.0005), with greater volume in the affected arms. The increase in epifascial volume (globally, 94% of the excess volume) constituted the bulk of the lymphoedematous swelling, with fat comprising the main component. The total fat excess volume summed over all patients was 2.1 times that of fluid. Furthermore, fat and fluid excess volumes were linearly correlated (Pearson r = 0.75), with the fat excess volume being greater than the fluid in 11 subjects. Differences in muscle compartment volume between affected and unaffected arms were not statistically significant, and contributed only 6% to the total excess volume. Considering the distribution of the different tissue excess volumes, fluid accumulated prevalently around the elbow, with substantial involvement of the upper arm in only 3 cases. Fat excess volume was generally greater in the upper arm; however, the relative increase in epifascial volume, which considers the total swelling relative to the original size of the arm, was in 9 cases maximal within the forearm. CONCLUSIONS: Our measurements indicate that excess of fat within the epifascial layer was the main contributor to the swelling, even when a substantial accumulation of fluid was present. The proposed approach could be used to monitor how the internal components of BCRL evolve after presentation, to stratify patients for treatment, and to objectively assess treatment response. This methodology provides quantitative metrics not currently available during the standard clinical assessment of BCRL and shows potential for implementation in clinical practice.

Ultrasound Strain Imaging in Assessment of Biceps Muscle Stiffness and Dynamic Motion in Healthy Adults.

We prospectively evaluated the feasibility of using ultrasound strain imaging (USI) to assess biceps brachii muscle (BBM) stiffness and dynamic motion in 10 healthy adults. The BBM axial deformation was produced by external compression with a sandbag (1.0 kg) tied onto the transducer. The BBM lateral movement was produced by manual passive elbow flexion and extension. By use of 2-D speckle tracking, captured 5-s real-time ultrasound data of BBM were processed to estimate axial strain, representing muscle stiffness, and lateral strain and tissue velocity, representing muscle dynamic motion. Axial (lateral) strain ratio was defined as BBM strain divided by subcutaneous soft tissue strain. There was no significant difference in lateral strain or tissue velocity between the left and right BBM (lateral strain ratio: 4.69 ± 0.07 vs. 4.51 ± 0.08 for extension, 4.82 ± 0.09 vs. 4.69 ± 0.11 for flexion; tissue velocity: 1.58 ± 0.32 cm/s vs. 1.78 ± 0.85 cm/s for extension, -2.03 ± 0.63 vs. -2.03 ± 0.59 for flexion; all p values > 0.05) or between men and women (lateral strain ratio: 4.52 ± 0.06 vs. 4.67 ± 0.1 for extension, 4.71 ± 0.11 vs. 4.83 ± 0.09 for flexion; tissue velocity, cm/s: 1.76 ± 0.76 vs. 1.66 ± 0.65 for extension, -2.21 ± 0.65 vs. -1.88 ± 0.52 for flexion, all p values > 0.05). The difference in axial stain between men and women was significant (axial strain ratio: 3.09 ± 0.43 vs. 3.52 ± 0.26, p = 0.02). Inter- and intra-observer reliability in performing USI of the BBM was good (all intra-class correlation coefficients [ICCs] >0.75). Our results suggest that USI seems to be feasible for and reproducible in estimating BBM mechanical properties and motion dynamics in healthy adults.

Assessment of advanced glycated end product accumulation in skin using auto fluorescence multispectral imaging.

Several studies have shown that advanced glycation end products (AGE) play a role in both the microvascular and macrovascular complications of diabetes and are closely linked to inflammation and atherosclerosis. AGEs accumulate in skin and can be detected using their auto fluorescence (AF). A significant correlation exists between AGE AF and the levels of AGEs as obtained from skin biopsies. A commercial device, the AGE Reader, has become available to assess skin AF for clinical purposes but, while displaying promising results, it is limited to single-point measurements performed in contact to skin tissue. Furthermore, in vivo imaging of AGE accumulation is virtually unexplored. We proposed a non-invasive, contact-less novel technique for quantifying fluorescent AGE deposits in skin tissue using a multispectral imaging camera setup (MSI) during ultraviolet (UV) exposure. Imaging involved applying a region-of-interest mask, avoiding specular reflections and a simple calibration. Results of a study conducted on 16 subjects with skin types ranging from fair to deeply pigmented skin, showed that AGE measured with MSI in forearm skin was significantly correlated with the AGE reference method (AGE Reader on forearm skin, R=0.68, p=0.005). AGE measured in facial skin was borderline significantly related to AGE Reader on forearm skin (R=0.47, p=0.078). These results support the use of the technique in devices for non-touch measurement of AGE content in either facial or forearm skin tissue over time.

Ultrasound shear wave elastography in assessment of muscle stiffness in patients with Parkinson's disease: a primary observation.

OBJECTIVE: The aim of this study was to assess the capability of ultrasound shear wave elastography (SWE) in evaluating the muscle stiffness in patients with Parkinson's diseases (PD). METHODS: Ultrasound SWE of the longitudinal biceps brachii was performed on 46 patients with PD and 31 healthy controls from May 2013 to October 2013. The stiffness of the biceps brachii muscles measured with quantitative Young's modulus (kPa) was compared between the remarkably symptomatic arms and mildly symptomatic arms in the PD and between PD and controls with unpaired t test. The correlation between the Young's modulus of the biceps brachii measured by SWE and motion scores assessed by unified Parkinson's disease rating scale (UPDRS) part III was analyzed by Pearson's correlation coefficient. The reliability of SWE in assessment of biceps brachii stiffness was tested using intraclass correlation coefficient (ICC). RESULTS: The mean Young's modulus of biceps brachii in remarkably symptomatic arms, mildly symptomatic arms, and healthy controls was 59.94±20.91 kPa, 47.77±24.00 kPa, and 24.28±5.09 kPa, respectively. A significant difference in Young's modulus of biceps brachii was found between healthy controls and all PD patients (all P<.05); however, it was not between remarkably symptomatic and mildly symptomatic arms. A positive linear correlation was found between the Young's modulus of the biceps brachii and the motion score by UPDRS in patients with PD (r=0.646, P=.000). The ICC for interobserver and intraobserver variation in measuring Young's modulus of the biceps brachii with SWE was 0.74 (95% confidence interval 0.68-0.78) and 0.78 (95% confidence interval 0.75-0.82), respectively. CONCLUSIONS: SWE of the biceps brachii can be used as a quantitative assessment of muscle stiffness in the patients with PD.

A Novel Semiautomated Fractional Limb Volume Tool for Rapid and Reproducible Fetal Soft Tissue Assessment.

The purpose of this study was to document the reproducibility and efficiency of a semiautomated image analysis tool that rapidly provides fetal fractional limb volume measurements. Fifty pregnant women underwent 3-dimensional sonographic examinations for fractional arm and thigh volumes at a mean menstrual age of 31.3 weeks. Manual and semiautomated fractional limb volume measurements were calculated, with the semiautomated measurements calculated by novel software (5D Limb Vol; Samsung Medison, Seoul, Korea). The software applies an image transformation method based on the major axis length, minor axis length, and limb center coordinates. A transformed image is used to perform a global optimization technique for determination of an optimal limb soft tissue boundary. Bland-Altman analysis defined bias with 95% limits of agreement (LOA) between methods, and timing differences between manual versus automated methods were compared by a paired t test. Bland-Altman analysis indicated an acceptable bias with 95% LOA between the manual and semiautomated methods: mean arm volume ± SD, 1.7% ± 4.6% (95% LOA, -7.3% to 10.7%); and mean thigh volume, 0.0% ± 3.8% (95% LOA, -7.5% to 7.5%). The computer-assisted software completed measurements about 5 times faster compared to manual tracings. In conclusion, semiautomated fractional limb volume measurements are significantly faster to calculate when compared to a manual procedure. These results are reproducible and are likely to reduce operator dependency. The addition of computer-assisted fractional limb volume to standard biometry may improve the precision of estimated fetal weight by adding a soft tissue component to the weight estimation process.

Ultrasound strain elastography in assessment of resting biceps brachii muscle stiffness in patients with Parkinson's disease: a primary observation.

The aim of this study was to evaluate the feasibility of ultrasound strain elastography (SE) for the assessment of resting biceps brachii muscle (BBM) stiffness in patients with Parkinson's diseases (PD). From May 2014 to December 2014, we prospectively performed SE of BBM in 14 patients with PD and 10 healthy controls. Based on the Unified Parkinson's Disease Rating Scale for scoring muscle rigidity (UPDRS, part III), muscle rigidity scores in 14 patients with PD included 3 patients with high rigidity (UPDRS III-IV) and 11 patients with low rigidity (UPDRS I-II). Ultrasound strain was represented by the deformation of the BBM and subcutaneous soft tissues that was produced by external compression with a sand bag (1.5 kg) tied onto an ultrasound transducer. Deformation was estimated with two-dimensional speckle tracking. The difference in strain ratio (SR, defined as mean BBM strain divided by mean subcutaneous soft tissue strain) between PD and healthy controls was tested by unpaired t test. The correlation between SR and muscle rigidity score was analyzed by Pearson correlation coefficient. The reliability of SR in assessment of BBM stiffness was tested using intraclass correlation coefficient. In our result, the SR in PD and healthy controls measured 2.65±0.36 and 3.30±0.27, respectively. A significant difference in SR was noted between the healthy controls and PD (P=.00011). A negative correlation was found between SR and UPDRS rigidity score (r=-0.78). Our study suggests that the SR of BBM to reference tissue can be used as a quantitative biomarker in assessing resting muscle stiffness associated with muscle rigidity in PD.