PDF(Pubmed)
Abstract：
There is a growing interest in muscle characteristics of the lumbar multifidus related to low back pain, but findings between studies are inconsistent. One of the issues explaining these conflicting findings might be the use of two-dimensional measures of cross-sectional area and thickness of the lumbar multifidus in most studies, which might be a suboptimal representation of the entire muscle volume. A three-dimensional volumetric assessment, combined with standardized imaging and processing measurement protocols, is highly recommended to quantify spinal muscle morphology. Three-dimensional freehand ultrasonography is a technique with large potential for daily clinical practice. It is achieved by combining conventional two-dimensional ultrasound with a motion-tracking system, recording the position and orientation of the ultrasound transducer during acquisition, resulting in a three-dimensional reconstruction. This study investigates intra- and interprocessor reliability for the quantification of muscle volume of the lumbar multifidus based on three-dimensional freehand ultrasound and its validity, in 31 patients with low back pain and 20 healthy subjects. Two processors manually segmented the lumbar multifidus on three-dimensional freehand ultrasound images using Stradwin software following a well-defined method. We assessed the concurrent validity of the measurement of multifidus muscle volume using three-dimensional freehand ultrasound compared with magnetic resonance imaging in 10 patients with low back pain. Processing reliability and agreement were determined using intraclass correlation coefficients, Bland-Altman plots, and calculation of the standard error of measurement and minimal detectable change, while validity was defined based on correlation analysis. The processing of three-dimensional freehand ultrasound images to measure lumbar multifidus volume was reliable. Good to excellent intraclass correlation coefficients were found for intraprocessor reliability. For interprocessor reliability, the intraclass correlation coefficients were moderate to good, emphasizing the importance of processing guidelines and training. A single processor analysis is preferred in clinical studies or when small differences in muscle volume are expected. The correlation between magnetic resonance imaging and three-dimensional freehand ultrasound measurements of lumbar multifidus volume was moderate to good but with a systematically smaller multifidus volume measured on three-dimensional freehand ultrasound. These results provide opportunities for both researchers and clinicians to reliably assess muscle structure using three-dimensional freehand ultrasound in patients with low back pain and to monitor changes related to pathology or interventions. To allow implementation in both research and clinical settings, guidelines on three-dimensional freehand ultrasound processing and training were provided.
摘要：
与腰背痛相关的腰椎多裂的肌肉特征越来越受到关注，但是研究之间的发现是不一致的。解释这些矛盾的发现的问题之一可能是在大多数研究中使用二维测量腰椎多裂的横截面积和厚度，这可能是整个肌肉体积的次优表示。三维体积评估，结合标准化的成像和处理测量协议，强烈建议量化脊髓肌肉形态。三维徒手超声检查是一种在日常临床实践中具有巨大潜力的技术。它是通过将传统的二维超声与运动跟踪系统相结合来实现的，在采集过程中记录超声换能器的位置和方向，导致三维重建。这项研究调查了基于三维徒手超声量化腰椎多裂肌体积的处理器内和处理器间可靠性及其有效性，在31例腰背痛患者和20例健康受试者中。两个处理器使用Stradwin软件按照明确定义的方法在三维徒手超声图像上手动分割腰椎多裂。在10例腰背痛患者中，我们评估了使用三维徒手超声与磁共振成像测量多裂肌体积的同时有效性。使用组内相关系数确定处理可靠性和一致性，Bland-Altman阴谋,以及测量的标准误差和最小可检测变化的计算，而有效性是根据相关分析定义的。三维徒手超声图像处理测量腰椎多裂体积是可靠的。对于处理器内可靠性，发现了良好到出色的组内相关系数。对于处理器间的可靠性，组内相关系数中等到良好，强调加工指南和培训的重要性。在临床研究中或当预期肌肉体积的微小差异时,单处理器分析是优选的。磁共振成像与腰椎多裂体积的三维徒手超声测量之间的相关性中等到良好，但在三维徒手超声上测得的多裂体积系统地较小。这些结果为研究人员和临床医生提供了机会，可以使用三维徒手超声对腰痛患者进行可靠的肌肉结构评估，并监测与病理或干预相关的变化。为了允许在研究和临床环境中实施，提供了三维徒手超声处理和训练指南。
