[Ultrasound in the assessment of muscle mass. The GLIM (Global Leadership Initiative on Malnutrition) criteria called into question (I)]. / Ecografía en la valoración de la masa muscular. Criterios GLIM (Global Leadership Initiative on Malnutrition) a cuestión (I).

Introduction: Ultrasound in the assessment of muscle mass. The GLIM (Global Leadership Initiative on Malnutrition) criteria called into question (I).

Introducción: Ecografía en la valoración de la masa muscular. Criterios GLIM (Global Leadership Initiative on Malnutrition) a cuestión (I).

[Ultrasound in the assessment of muscle mass. The GLIM (Global Leadership Initiative on Malnutrition) criteria called into question (II)]. / Ecografía en la valoración de la masa muscular. Criterios GLIM (Global Leadership Initiative on Malnutrition) a cuestión (II).

Introduction: Ultrasound in the assessment of muscle mass. The GLIM (Global Leadership Initiative on Malnutrition) criteria called into question (II).

Introducción: Ecografía en la valoración de la masa muscular. Criterios GLIM (Global Leadership Initiative on Malnutrition) a cuestión (II).

Assessment of flow within developing chicken vasculature and biofabricated vascularized tissues using multimodal imaging techniques.

Fluid flow shear stresses are strong regulators for directing the organization of vascular networks. Knowledge of structural and flow dynamics information within complex vasculature is essential for tuning the vascular organization within engineered tissues, by manipulating flows. However, reported investigations of vascular organization and their associated flow dynamics within complex vasculature over time are limited, due to limitations in the available physiological pre-clinical models, and the optical inaccessibility and aseptic nature of these models. Here, we developed laser speckle contrast imaging (LSCI) and side-stream dark field microscopy (SDF) systems to map the vascular organization, spatio-temporal blood flow fluctuations as well as erythrocytes movements within individual blood vessels of developing chick embryo, cultured within an artificial eggshell system. By combining imaging data and computational simulations, we estimated fluid flow shear stresses within multiscale vasculature of varying complexity. Furthermore, we demonstrated the LSCI compatibility with bioengineered perfusable muscle tissue constructs, fabricated via molding techniques. The presented application of LSCI and SDF on perfusable tissues enables us to study the flow perfusion effects in a non-invasive fashion. The gained knowledge can help to use fluid perfusion in order to tune and control multiscale vascular organization within engineered tissues.

Transperineal ultrasound shear-wave elastography is a reliable tool for assessment of the elastic properties of the levator ani muscle in women.

Our main objective was to assess the intraoperator intersession reproducibility of transperineal ultrasound Shear Wave Elastography (SWE) to measure the levator ani muscle (LAM) elastic properties. Secondary objective was to compare reproducibility when considering the mean of three consecutives measurements versus one. In this prospective study involving non-pregnant nulliparous women, two visits were planned, with a measurement of the shear modulus (SM) on the right LAM at rest, during Valsalva maneuver and maximal contraction. Assessments were done with a transperineal approach, using an AIXPLORER device with a linear SL 18-5 (5-18 MHz) probe. For each condition, 3 consecutive measures were performed at each visit. The mean of the three measures, then the first one, were considered for the reproducibility by calculating intraclass correlation coefficient (ICC), and coefficient of variation (CV). Twenty women were included. Reproducibility was excellent when considering the mean of the 3 measures at rest (ICC = 0.90; CV = 15.7%) and Valsalva maneuver (ICC = 0.94; CV = 10.6%), or the first of the three measures at rest (ICC = 0.87; CV = 18.6%) and Valsalva maneuver (ICC = 0.84; CV = 19.9%). Reproducibility was fair for measurement during contraction. Transperineal ultrasound SWE is a reliable tool to investigate LAM elastic properties at rest and during Valsalva maneuver.

MRI-Based Assessment of the Pharyngeal Constrictor Muscle as a Predictor of Surgical Margin after Transoral Robotic Surgery in HPV-Positive Tonsillar Cancer.

BACKGROUND AND PURPOSE: Transoral robotic surgery is an emerging strategy for treating human papillomavirus-positive cancers, but the role of MR imaging in predicting the surgical outcome has not been established. We aimed to identify preoperative MR imaging characteristics that predispose the outcome of transoral robotic surgery toward an insecure (positive or close) surgical margin in human papillomavirus-positive tonsillar squamous cell carcinoma. MATERIALS AND METHODS: Between December 2012 and May 2019, sixty-nine patients underwent transoral robotic surgery at our institution. Among these, 29 who were diagnosed with human papillomavirus-positive tonsillar squamous cell carcinoma, did not receive neoadjuvant treatment, underwent preoperative 3T MR imaging, and had postoperative pathologic reports and were included in this retrospective study. Two neuroradiologists evaluated the preoperative MR imaging scans to determine the tumor spread through the pharyngeal constrictor muscle using a 5-point scale: 1, normal constrictor; 2, bulging constrictor; 3, thinning constrictor; 4, obscured constrictor; and 5, tumor protrusion into the parapharyngeal fat. The risk of an insecure surgical margin (involved or <1 mm) according to the MR imaging scores was predicted using logistic regression with the Firth correction. RESULTS: The interobserver agreement for the MR imaging scores was excellent (κ = 0.955, P < .001). A score of ≥4 could predict an insecure margin with 87.5% sensitivity and 92.3% specificity (area under the curve = 0.899) and was the only significant factor associated with an insecure margin in the multivariable analysis (OR, 6.59; 95% CI, 3.11-22.28; P < .001). CONCLUSIONS: The pre-transoral robotic surgery MR imaging scoring system for the pharyngeal constrictor muscle is a promising predictor of the surgical margin in human papillomavirus-positive tonsillar squamous cell carcinoma.

Exploration of New Contrasts, Targets, and MR Imaging and Spectroscopy Techniques for Neuromuscular Disease - A Workshop Report of Working Group 3 of the Biomedicine and Molecular Biosciences COST Action BM1304 MYO-MRI.

Neuromuscular diseases are characterized by progressive muscle degeneration and muscle weakness resulting in functional disabilities. While each of these diseases is individually rare, they are common as a group, and a large majority lacks effective treatment with fully market approved drugs. Magnetic resonance imaging and spectroscopy techniques (MRI and MRS) are showing increasing promise as an outcome measure in clinical trials for these diseases. In 2013, the European Union funded the COST (co-operation in science and technology) action BM1304 called MYO-MRI (www.myo-mri.eu), with the overall aim to advance novel MRI and MRS techniques for both diagnosis and quantitative monitoring of neuromuscular diseases through sharing of expertise and data, joint development of protocols, opportunities for young researchers and creation of an online atlas of muscle MRI and MRS. In this report, the topics that were discussed in the framework of working group 3, which had the objective to: Explore new contrasts, new targets and new imaging techniques for NMD are described. The report is written by the scientists who attended the meetings and presented their data. An overview is given on the different contrasts that MRI can generate and their application, clinical needs and desired readouts, and emerging methods.

Patient-specific mobility assessment to monitor recovery after total hip arthroplasty.

Total hip arthroplasty is a ubiquitously successful orthopedic surgical procedure, whose prevalence is rising worldwide. While many investigations focus on characterizing periprosthetic pathophysiology, the objective of our research is to develop and describe multi-metric assemblies as a first step toward creating a patient-specific mobility index that rehabilitators and orthopedic surgeons can utilize for prescribing their respective procedures. In total, 48 total hip arthroplasty patients (both cemented and uncemented) undergoing unilateral, primary surgery went through computed tomographic scans and gait analysis measurements both before and 1 year following their surgery. Altogether, the reported quantitative metrics include 11 spatial and temporal gait parameters, muscle density, and electromyography signals from the rectus femoris, vastus lateralis, and vastus medialis, and bone mineral density values from bioimage analysis around the implant stem. We found that measured parameters from a subgroup were sensitive to changes observed during patient recovery, implicating the predictive sensitivity of these patient conditions. Most post-operative gait parameters changed significantly, while electromyography data indicated few significant differences. Moreover, results from bioimage analyses indicate a general reduction of periprosthetic bone mineral density after 1 year, in association with increasing density of the quadriceps muscles. Furthermore, this work identifies which quantitative metrics undergo the greatest variation after total hip arthroplasty and demonstrates the clinical feasibility of a multimodal approach to mobility assessment that may ultimately support decision-making for post-surgical rehabilitation protocols.

Deep tissue imaging with acousto-optical tomography and spectral hole burning with slow light effect: a theoretical study.

Biological tissue is a highly scattering medium that prevents deep imaging of light. For medical applications, optical imaging offers a molecular sensitivity that would be beneficial for diagnosing and monitoring of diseases. Acousto-optical tomography has the molecular sensitivity of optical imaging with the resolution of ultrasound and has the potential for deep tissue imaging. Here, we present a theoretical study of a system that combines acousto-optical tomography and slow light spectral filters created using spectral hole burning methods. Using Monte Carlo simulations, a model to obtain the contrast-to-noise ratio (CNR) deep in biological tissue was developed. The simulations show a CNR > 1 for imaging depths of ∼5 cm in a reflection mode setup, as well as, imaging through ∼12 cm in transmission mode setups. These results are promising and form the basis for future experimental studies.

Diffusion in hierarchical systems: A simulation study in models of healthy and diseased muscle tissue.

PURPOSE: To investigate the sensitivity of diffusion-MR signal to microstructural change in muscle tissue associated with pathology, and recommend optimal acquisition parameters. METHODS: We employ Monte-Carlo simulation of diffusing spins in hierarchical tissue to generate synthetic diffusion-weighted signal curves over a wide range of scan parameters. Curves are analyzed using entropy-a measure of curve complexity. Entropy change between a baseline and various microstructural scenarios is investigated. We find acquisitions that optimize entropy difference in each scenario. RESULTS: Permeability changes have a large effect on the diffusion-weighted signal curve. Muscle fiber atrophy is also important, although differentiating between mechanisms is challenging. Several acquisitions over a range of diffusion times is optimal for imaging microstructural change in muscle tissue. Sensitivity to permeability is optimized for high gradient strengths, but sensitivity to other scenarios is optimal at other values. CONCLUSIONS: The diffusion-attenuated signal is sensitive to the microstructural changes, but the changes are subtle. Taking full advantage of the changes to the overall curve requires a set of acquisitions over a range of diffusion times. Permeability causes the largest changes, but even the very subtle changes associated with fiber radius distribution change the curves more than noise alone. Magn Reson Med 78:1187-1198, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Penetration depth of photons in biological tissues from hyperspectral imaging in shortwave infrared in transmission and reflection geometries.

Measurement of photon penetration in biological tissues is a central theme in optical imaging. A great number of endogenous tissue factors such as absorption, scattering, and anisotropy affect the path of photons in tissue, making it difficult to predict the penetration depth at different wavelengths. Traditional studies evaluating photon penetration at different wavelengths are focused on tissue spectroscopy that does not take into account the heterogeneity within the sample. This is especially critical in shortwave infrared where the individual vibration-based absorption properties of the tissue molecules are affected by nearby tissue components. We have explored the depth penetration in biological tissues from 900 to 1650 nm using Monte­Carlo simulation and a hyperspectral imaging system with Michelson spatial contrast as a metric of light penetration. Chromatic aberration-free hyperspectral images in transmission and reflection geometries were collected with a spectral resolution of 5.27 nm and a total acquisition time of 3 min. Relatively short recording time minimized artifacts from sample drying. Results from both transmission and reflection geometries consistently revealed that the highest spatial contrast in the wavelength range for deep tissue lies within 1300 to 1375 nm; however, in heavily pigmented tissue such as the liver, the range 1550 to 1600 nm is also prominent.

Technical note: Implementation of biological washout processes within GATE/GEANT4--a Monte Carlo study in the case of carbon therapy treatments.

PURPOSE: The imaging of positron emitting isotopes produced during patient irradiation is the only in vivo method used for hadrontherapy dose monitoring in clinics nowadays. However, the accuracy of this method is limited by the loss of signal due to the metabolic decay processes (biological washout). In this work, a generic modeling of washout was incorporated into the GATE simulation platform. Additionally, the influence of the washout on the ß(+) activity distributions in terms of absolute quantification and spatial distribution was studied. METHODS: First, the irradiation of a human head phantom with a (12)C beam, so that a homogeneous dose distribution was achieved in the tumor, was simulated. The generated (11)C and (15)O distribution maps were used as ß(+) sources in a second simulation, where the PET scanner was modeled following a detailed Monte Carlo approach. The activity distributions obtained in the presence and absence of washout processes for several clinical situations were compared. RESULTS: Results show that activity values are highly reduced (by a factor of 2) in the presence of washout. These processes have a significant influence on the shape of the PET distributions. Differences in the distal activity falloff position of 4 mm are observed for a tumor dose deposition of 1 Gy (Tini = 0 min). However, in the case of high doses (3 Gy), the washout processes do not have a large effect on the position of the distal activity falloff (differences lower than 1 mm). The important role of the tumor washout parameters on the activity quantification was also evaluated. CONCLUSIONS: With this implementation, GATE/GEANT4 is the only open-source code able to simulate the full chain from the hadrontherapy irradiation to the PET dose monitoring including biological effects. Results show the strong impact of the washout processes, indicating that the development of better models and measurement of biological washout data are essential.

Viscoelastic response (VisR) imaging for assessment of viscoelasticity in Voigt materials.

Viscoelastic response (VisR) imaging is presented as a new acoustic radiation force (ARF)-based elastographic imaging method. Exploiting the Voigt model, VisR imaging estimates displacement in only the ARF region of excitation from one or two successive ARF impulses to estimate τσ, the relaxation time for constant stress. Double-push VisR τσ estimates were not statistically significantly different (p < 0.02) from those of shearwave dispersion ultrasound vibrometry (SDUV) or monitored steady-state excitation recovery (MSSER) ultrasound in six homogeneous viscoelastic tissue mimicking phantoms with elastic moduli ranging from 3.92 to 15.34 kPa and coefficients of viscosity ranging from 0.87 to 14.06 Pa·s. In two-dimensional imaging, double-push VisR τσ images discriminated a viscous spherical inclusion in a structured phantom with higher CNR over a larger axial range than single-push VisR or conventional acoustic radiation force impulse (ARFI) ultrasound. Finally, 2-D in vivo double-push VisR images in normal canine semitendinosus muscle were compared with spatially matched histochemistry to corroborate lower double-push VisR τσ values in highly collagenated connective tissue than in muscle, suggesting double-push VisR's in vivo relevance to diagnostic imaging, particularly in muscle. The key advantages and disadvantages to VisR, including lack of compensation for inertial terms, are discussed.

Temporal muscle activation assessment by ultrasound imaging during flexor withdrawal reflex and voluntary contraction.

Activating flexor reflexes by electrical stimulation has been used as a mechanism to initiate the swing phase or to enhance it for spinal cord injured patients. However, it is necessary to know their contraction dynamics in order to artificially induce them at the right moment of a walking cycle. This requires understanding the temporal activation pattern of both surface and deep muscles simultaneously. This study aimed at developing a system to measure and analyze the temporal activation of both surface and deep muscles during voluntary contraction and flexor reflexes (also called withdrawal reflexes) using ultrasound imaging. A set of experiments were done to verify the validity of the system, while exploring the temporal pattern of muscle activation during flexor reflexes. As a result, we were able to quantify the surface and deep muscle activity by measuring the muscle thickness, pennation angle and long-axis displacement, from the ultrasound images.

Monitoring of muscle and bone recovery in spinal cord injury patients treated with electrical stimulation using three-dimensional imaging and segmentation techniques: methodological assessment.

Muscle tissue composition accounting for the relative content of muscle fibers and intramuscular adipose and loose fibrous tissues can be efficiently analyzed and quantified using images from spiral computed tomography (S-CT) technology and the associated distribution of Hounsfield unit (HU) values. Muscle density distribution, especially when including the whole muscle volume, provides remarkable information on the muscle condition. Different physiological and pathological scenarios can be depicted using the muscle characterization technique based on the HU values and the definition of appropriate intervals and the association of such intervals to different colors. Using this method atrophy, degeneration, and restoration in denervated muscle undergoing electrical stimulation treatments can be clearly displayed and monitored. Moreover, finite element methods are employed to calculate Young's modulus on the patella bone and to analyze correlation between muscle contraction and bone strength changes. The reliability of this tool though depends on S-CT assessment and calibration. To assess imaging quality and the use of HU values to display muscle composition, different S-CT devices are compared using a Quasar body scanner. Density distributions and volumes of various calibration elements such as lung, polyethylene, water equivalent, and trabecular and dense bone are measured with different scanning protocols and at different points of time. The results show that every scanned element undergoes HU variations, which are greater for materials at the extremes of the HU scale, such as dense bone and lung inhale. Moreover, S-CT scanning with low tube voltages (80 KV) produces inaccurate HU values especially in bones. In conclusion, 3-D modeling techniques based on S-CT scanning is a powerful follow-up tool that may provide structural information at the millimeter scale, and thus may drive choice and timing to validate rehabilitation protocols.

Influence of a fat layer on the near infrared spectra of human muscle: quantitative analysis based on two-layered Monte Carlo simulations and phantom experiments.

The influence of fat thickness on the diffuse reflectance spectra of muscle in the near infrared (NIR) region is studied by Monte Carlo simulations of a two-layer structure and with phantom experiments. A polynomial relationship was established between the fat thickness and the detected diffuse reflectance. The influence of a range of optical coefficients (absorption and reduced scattering) for fat and muscle over the known range of human physiological values was also investigated. Subject-to-subject variation in the fat optical coefficients and thickness can be ignored if the fat thickness is less than 5 mm. A method was proposed to correct the fat thickness influence.

Monte Carlo calculation of radiation dose in CT examinations using phantom and patient tomographic models.

By using a voxel-based Monte Carlo simulation technique, we developed and validated a method to calculate radiation-absorbed dose in the computed tomography (CT) examinations from the images of phantoms and patients. The ionising radiation transport was simulated using the EGS4 code system. The geometry of the X-ray beam (focus-to-axis distance, field of view, collimation, and primary and beam-shaper filtration) and the X-ray spectral distribution (HiSpeed LX/i) were included in the simulation. Each axial CT image was reduced to a 256 x 256 matrix and stacked in a volume. The patient images were segmented before the simulation of radiation transport by using four categories of materials, such as air, lung, muscle and bone. To test the voxel-based method, the values of the radiation dose derived from a simulated CT exposure were calculated and compared with those obtained from the measurements performed within the dosimetry phantoms. To complete the scope of the work, series of CT scans of the trunk of an anthropomorphic phantom and patients were simulated to calculate the average dose in each 1-cm-wide transverse slice (ADS). The comparison between the simulated and measured dose data for the CT indices showed a difference of <5% in all the cases. The estimated mean values of ADS from the chest, abdomen and pelvis of the anthropomorphic phantom were approximately 1.7-2 times the weighted CT dose index (CTDI(w)) value, whereas the mean ADS values for these anatomical areas were 1.3-2 times the CTDI(w) of patients. The voxel-based simulation method provided a technique for estimating the individual patient doses in the CT examinations.

Ultrasonic assessment of tissue hydration status.

Tissue water content is an important diagnostic parameter that can be used for estimation of water loss in muscles such as common dehydration during high endurance exercises. It could be also applied for evaluation of the increased fluids content in the tissue caused by the variety of pathological conditions or edemas. Ultrasonic method for tissue water content monitoring is based on the premise that the speed of a bulk or compression sound wave is determined mainly by the molecular content of the tissue. Most soft tissues, including muscles that consist of about 70-80% water, exhibit shift of the ultrasound velocity associated with the change in their water content. In the present paper, we tested the feasibility of assessing changes in tissue water content by measurements of ultrasound velocity in ex vivo animal muscle tissues. An increase in the ultrasound velocity correlated with the volumetric water loss in the tissue was observed when other tissue components (proteins, fat) remained constant. Possibility to assess muscle dehydration with 1% accuracy was confirmed in model dehydration experiments, where ultrasound velocity slope of about 3 m/s per 1% of water loss was revealed at measurement error less than 2 m/s. Hence, the ultrasonic approach can provide basis for a convenient, lightweight system in sports medicine for monitoring total body hydration during long-term endurance exercise in hot conditions, as well as for edemas monitoring and other medical applications.

Assessment of peripheral arterial vascular disease with radionuclide techniques.

Various radioisotopic imaging techniques for noninvasive detection of vessel stenosis and for functional investigation of reduced blood flow and follow-up have been developed during the last decade in peripheral vascular disease (PVD), with the aim of replacing invasive techniques and complementing standardized methods. Radionuclide assessment of PVD is divided into 2 major groups: imaging of perfusion and metabolic investigations. The measurement of arterial blood flow and muscle perfusion is intended to show the morphology, to evaluate the functional consequences of PVD, and to quantify the latter. The application of radiolabeled tracers was developed as a noninvasive alternative to angiography in morphologic imaging. Treadmill testing has been used to assess the functional effects of reduced blood flow in PVD where the onset of pain indicates the stage of disease, but the results can be confused by other symptoms. Scintigraphic measurement of muscle perfusion should detect insufficient nutritional blood flow in peripheral muscle and thus have a higher specificity for PVD than treadmill testing alone. Although there are very promising theoretical and experimental data in animals, the clinical use of radionuclide investigations is limited by different technical problems, such as methodologic differentiation between skin and muscle perfusion, the lack of controlled and prospective studies, and incomplete correlation with other standardized routine techniques. Among the great number of radioisotopic metabolic imaging techniques, only radiolabeled platelets and lipoproteins, to some extent, have shown a limited potential clinical use. Some other approaches seem to have a high potential from a theoretical point of view. They are limited, however, by a great number of problems. Correlation with sonographic or magnetic resonance imaging (MRI) findings may identify a potential metabolic value. Correlation with angiography reflecting the extent of the disease makes no sense. So far with PVD, neither radioisotopic perfusion studies nor metabolic imaging techniques are able to achieve a level of routine application or wider meaningful interpretation of the clinical condition of a specific patient. Competing techniques are easier to perform, less expensive, faster, more widely available, and do not carry the radiation burden. Positron emission tomography is still in its early stages of application, with great theoretical potential but at a high price. A great deal of work is still required to transform in vitro and experimental experience into more meaningful routine radioisotopic investigations in patients with PVD.