An ultrasound elastography method for examining the anterior cruciate ligament
Affiliation(s)
Center for Applied Mathematics, Cornell University, Ithaca, USA. Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, USA.
Center for Applied Mathematics, Cornell University, Ithaca, USA. Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, USA.
ABSTRACT
We introduce an ultrasound elastography method for examining the ACL. It consisted of imaging the distal ACL while applying a drawer test and analyzing the resulting displacement and strain maps, where a map refers to how a variable is distributed spatially throughout an image. Our method was applied to healthy knees of cadaveric sheep to determine whether 1) our method can consistently generate displacements and strain maps in healthy ACLs; 2) displacement and strain maps are repeatable; and 3) healthy ACLs experience similar maps. We found that our method could consistently provide displacements and strain maps of the distal ACL region. Moreover, these ACLs experienced displacement and strain maps that were positively-correlated between trials, knees, and specimens. This correlation was statistically significant between pairs of trials and between left and right knees (p < 0.05). These results suggest that the maps are indeed repeatable and similar for healthy ACLs.
Cite this paper
Cochran, A. and Gao, Y. (2013) An ultrasound elastography method for examining the anterior cruciate ligament. Natural Science, 5, 23-31. doi: 10.4236/ns.2013.58A2004.
Cochran, A. and Gao, Y. (2013) An ultrasound elastography method for examining the anterior cruciate ligament. Natural Science, 5, 23-31. doi: 10.4236/ns.2013.58A2004.
References
[1] Jacobson, J.A. (2005) Musculoskeletal ultrasound and MRI: Which do I choose? Seminars in Musculoskeletal Radiology, 9, 135-149. doi:10.1055/s-2005-872339 [2] Larsen, L.P.S. and Rasmussen, O.S. (2000) Diagnosis of acute rupture of the anterior cruciate ligament of the knee by sonography. European Journal of Ultrasound, 12, 163-167. doi:10.1016/S0929-8266(00)00109-9 [3] Palm, H.-G., Bergenthal, G., Ehry, P., Schwarz, W., Sch midt, R. and Friemert, B. (2009) Functional ultrasono graphy in the diagnosis of acute anterior cruciate ligament injuries: A field study. The Knee, 16, 441-446. doi:10.1016/j.knee.2009.04.012 [4] Fuchs, S. and Chylarecki, C. (2002) Sonographic evalua tion of ACL rupture signs compared to arthroscopic find ings in acutely injured knees. Ultrasound in Medicine & Biology, 28, 149-154. doi:10.1016/S0301-5629(01)00507-5 [5] Ptasznik, R., Feller, J., Bartlett, J., Fitt, G., Mitchell, A. and Hennessy, O. (1995) The value of sonography in the diagnosis of traumatic rupture of the anterior cruciate ligament of the knee. American Journal of Roentgenology, 164, 1461-1463. doi:10.2214/ajr.164.6.7754893 [6] Chylarecki, C., Hierholzer, G. and Klose, R. (1996) Sono graphische diagnostik der frischen rupturen des vorderen kreuzbands. Eine experimentelle und klinische studie. Unfallchirurg, 99, 24-30. [7] Suzuki, S., Kasahara, K., Futami, T., Iwasaki, R., Ueo, T. and Yamamuro, T. (1991) Ultrasound diagnosis of pathol ogy of the anterior and posterior cruciate ligaments of the knee joint. Archives of Orthopaedic and Trauma Surgery, 110, 200-203. doi:10.1007/BF00571059 [8] Khan, Z., Faurqui, Z., Ogyunbiyi, O., Rosset, G. and Iqbal, J. (2006) Ultrasound assessment of internal derangement of the knee. Acta Orthopaedica Belgica, 72, 72-76. [9] Crawford, R., Walley, G., Bridgman, S. and Maffulli, N. (2007) Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on menis cal lesions and ACL tears: A systematic review. British Medical Bulletin, 84, 5-23. doi:10.1093/bmb/ldm022 [10] Grobbelaar, N. and Bouffard, J. (2000) Sonography of the knee, a pictorial review. Seminars in Ultrasound, CT, and MRI, 21, 231-274. doi:10.1016/S0887-2171(00)90045-3 [11] Ceulemans, R. and Holsbeeck, M. (2001) Sonography of the knee. In: van Holsbeeck, M. and Introcaso, J., Eds., Musculoskeletal Ultrasound, Mosby, 587-604. [12] Ophir, J., Céspedes, I., Ponnekanti, H., Yazdi, Y. and Li, X. (1991) Elastography: A quantitative method for imag ing the elasticity of biological tissues. Ultrasonic Imaging, 13, 111-134. [13] Ophir, J., Alam, S., Garra, B., Kallel, F., Konofagou, E., Krouskop, T. and Varghese, T. (2002) Elastography: Im aging the elastic properties of soft tissues with ultrasound. Journal of Medical Ultrasonics, 29, 155-171. doi:10.1007/BF02480847 [14] De Zordo, T., Lill, S., Fink, C., Feuchtner, G., Jaschke, W., Bellmann-Weiler, R. and Klauser, A. (2009) Real-time sonoelastography of lateral epicondylitis: Comparison of findings between patients and healthy volunteers. Ameri can Journal of Roentgenology, 193, 180-185. doi:10.2214/AJR.08.2020 [15] De Zordo, T., Fink, C., Feuchtner, G., Smekal, V., Reindl, M. and Klauser, A. (2009) Real-time sonoelastography findings in healthy achilles tendons. American Journal of Roentgenology, 193, W134-W138. doi:10.2214/AJR.08.1843 [16] De Zordo, T., Chhem, R., Smekal, V., Feuchtner, G., Reindl, M., Fink, C. and Klauser, S.A. (2010) Real-time sonoelastography: Findings in patients with symptomatic achilles tendons and comparison to healthy volunteers. Ultraschall in der Medizin, 31, 394-400. doi:10.1055/s-0028-1109809 [17] Drakonaki, E.E, Allen, G. and Wilson, D. (2009) Real time ultrasound elastography of the normal achilles ten don: Reproducibility and pattern description. Clinical Radiology, 64, 1196-1202. doi:10.1016/j.crad.2009.08.006 [18] Drakonaki, E.E., Allen, G.M. and Wilson, D.J. (2012) Ultrasound elastography for musculoskeletal applications. British Journal of Radiology, 85, 1435-1445. doi:10.1259/bjr/93042867 [19] Kapoor, A., Sandhu, H.S., Sandhu, P.S., Kapoor, A., Ma hajan, G. and Kumar, A. (2010) Realtime elastography in plantar fasciitis: Comparison with ultrasonography and MRI. Current Orthopedic Practice, 21, 600-608. doi:10.1097/BCO.0b013e3181f4a8d9 [20] Kuo, P.-L., Li, P.-C., Shun, C.-T. and Lai, J.-S. (1999) Strain measurements of rabbit achilles tendons by ultra sound. Ultrasound in Medicine & Biology, 25, 1241-1250. doi:10.1016/S0301-5629(99)00078-2 [21] Wu, C.-H., Chang, K.-V., Mio, S., Chen, W.-S. and Wang, T.-G. (2011) Sonoelastography of the plantar fascia. Ra diology, 259, 502-507. doi:10.1148/radiol.11101665 [22] Radford, W., Amis, A., Kempson, S., Stead, A. and Camburn, M. (1994) A comparative study of single-and double-bundle acl reconstructions in sheep. Knee Surgery, Sports Traumatology, Arthroscopy, 2, 94-99. doi:10.1007/BF01476480 [23] Chen, L., Housden, R., Treece, G., Gee, A. and Prager, R. (2010) A hybrid displacement estimation method for ultrasonic elasticity imaging. IEEE Transactions on Ultra sonics Ferroelectrics and Frequency Control, 57, 866-882. doi:10.1109/TUFFC.2010.1491 [24] Chen, H., Shi, H. and Varghese, T. (2007) Improvement of eleastographic displacement estimation using a two step cross-correlation method. Ultrasound in Medicine & Biology, 33, 48-56. doi:10.1016/j.ultrasmedbio.2006.07.022 [25] Chen, L., Treece, G.M., Lindop, J.E., Gee, A.H. and Prager, R.W. (2009) A quality-guided displacement track ing algorithm for ultrasonic elasticity imaging. Medical Image Analysis, 13, 286-296. doi:10.1016/j.media.2008.10.007 [26] Pesavento, A., Perrey, C., Krueger, M. and Ermert, H. (1999) A time-efficient and accurate strain estimation concept for ultrasonic elastography using iterative phase zero estimation. IEEE Transactions on Ultrasonics Ferro electrics and Frequency Control, 46, 1057-1067. doi:10.1109/58.796111 [27] Pellot-Barakat, C., Frouin, F., Insana, M. and Herment, A. (2004) Ultrasound elastography based on multiscale esti mations of regularized displacement fields. IEEE Trans actions on Medical Imaging, 23, 153-163. doi:10.1109/TMI.2003.822825 [28] Doyley, M.M., Bamber, J.C., Fuechsel, F. and Bush, N.L. (2001) A freehand elastographic imaging approach for clinical breast imaging: System development and per formance evaluation. Ultrasound in Medicine & Biology, 27, 1347-1357. doi:10.1016/S0301-5629(01)00429-X [29] Bresson, X. and Chan, T. (2007) Fast minimization of the vectorial total variation norm and applications to color image processing. UCLA CAM Report. [30] Chambolle, A. (2004) An algorithm for total variation minimization and applications. Journal of Mathematical Imaging and Vision, 20, 89-97. doi:10.1023/B:JMIV.0000011321.19549.88 [31] Kallel, F. and Ophir, J. (1997) A least-squares strain esti mator for elastography. Ultrasonic Imaging, 19, 195-208. doi:10.1177/016173469701900303 [32] Brown, L.G. (1992) A survey of image registration tech niques. ACM Computing Surveys, 24, 325-376. doi:10.1145/146370.146374 [33] Rogers, G., Milthorpe, B., Muratore, A. and Schindhelm, K. (1990) Measurement of the mechanical properties of the ovine anterior cruciate ligament bone-ligament-bone complex: A basis for prosthetic evaluation. Biomaterials, 11, 89-96. doi:10.1016/0142-9612(90)90122-7 [34] Spalazzi, J.P., Gallina, J., Fung-Kee-Fung, S.D., Kono fagou, E.E. and Lu, H.H. (2006) Elastographic imaging of strain distribution in the anterior cruciate ligament and at the ligament bone insertions. Journal of Orthopaedic Re search, 24, 2001-2010. doi:10.1002/jor.20260 [35] Arms, S., Pope, M., Johnson, R., Fischer, R., Arvidsson, I. and Eriksson, E. (1984) The biomechanics of anterior cruciate ligament rehabilitation and reconstruction. Ame rican Journal of Sports Medicine, 12, 8-18. doi:10.1177/036354658401200102 [36] Weiss, J.A. and Gardiner, J.C. (2001) Computational mo deling of ligament mechanics. Critical Reviews in Bio medical Engineering, 29, 303-371. doi:10.1615/CritRevBiomedEng.v29.i3.20 [37] Tan, S., Kuda, S., Zcan, A., Pek, A., Karaolanolu, M., Arslan, H. and Bozkurt, M. (2012) Real-time sonoelasto graphy of the achilles tendon: Pattern description in healthy subjects and patients with surgically repaired complete ruptures. Skeletal Radiology, 41, 1067-1072. doi:10.1007/s00256-011-1339-4 [38] Srinivasan, S., Kallel, F. and Ophir, J. (2002) Estimating the elastographic signal-to-noise ratio using correlation coefficients. Ultrasound in Medicine & Biology, 28, 359-368. doi:10.1016/S0301-5629(01)00510-5 [39] Ottensmeyer, M.P., Kerdok, A.E., Howe, R.D. and Daw son, S.L. (2004) The effects of testing environment on the viscoelastic properties of soft tissues. In: Cotin, S. and Metaxas, D., Eds., Medical Simulation, Vol. 3078, Springer, Berlin Heidelberg, 9-18. doi:10.1007/978-3-540-25968-8_2
[1] Jacobson, J.A. (2005) Musculoskeletal ultrasound and MRI: Which do I choose? Seminars in Musculoskeletal Radiology, 9, 135-149. doi:10.1055/s-2005-872339 [2] Larsen, L.P.S. and Rasmussen, O.S. (2000) Diagnosis of acute rupture of the anterior cruciate ligament of the knee by sonography. European Journal of Ultrasound, 12, 163-167. doi:10.1016/S0929-8266(00)00109-9 [3] Palm, H.-G., Bergenthal, G., Ehry, P., Schwarz, W., Sch midt, R. and Friemert, B. (2009) Functional ultrasono graphy in the diagnosis of acute anterior cruciate ligament injuries: A field study. The Knee, 16, 441-446. doi:10.1016/j.knee.2009.04.012 [4] Fuchs, S. and Chylarecki, C. (2002) Sonographic evalua tion of ACL rupture signs compared to arthroscopic find ings in acutely injured knees. Ultrasound in Medicine & Biology, 28, 149-154. doi:10.1016/S0301-5629(01)00507-5 [5] Ptasznik, R., Feller, J., Bartlett, J., Fitt, G., Mitchell, A. and Hennessy, O. (1995) The value of sonography in the diagnosis of traumatic rupture of the anterior cruciate ligament of the knee. American Journal of Roentgenology, 164, 1461-1463. doi:10.2214/ajr.164.6.7754893 [6] Chylarecki, C., Hierholzer, G. and Klose, R. (1996) Sono graphische diagnostik der frischen rupturen des vorderen kreuzbands. Eine experimentelle und klinische studie. Unfallchirurg, 99, 24-30. [7] Suzuki, S., Kasahara, K., Futami, T., Iwasaki, R., Ueo, T. and Yamamuro, T. (1991) Ultrasound diagnosis of pathol ogy of the anterior and posterior cruciate ligaments of the knee joint. Archives of Orthopaedic and Trauma Surgery, 110, 200-203. doi:10.1007/BF00571059 [8] Khan, Z., Faurqui, Z., Ogyunbiyi, O., Rosset, G. and Iqbal, J. (2006) Ultrasound assessment of internal derangement of the knee. Acta Orthopaedica Belgica, 72, 72-76. [9] Crawford, R., Walley, G., Bridgman, S. and Maffulli, N. (2007) Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on menis cal lesions and ACL tears: A systematic review. British Medical Bulletin, 84, 5-23. doi:10.1093/bmb/ldm022 [10] Grobbelaar, N. and Bouffard, J. (2000) Sonography of the knee, a pictorial review. Seminars in Ultrasound, CT, and MRI, 21, 231-274. doi:10.1016/S0887-2171(00)90045-3 [11] Ceulemans, R. and Holsbeeck, M. (2001) Sonography of the knee. In: van Holsbeeck, M. and Introcaso, J., Eds., Musculoskeletal Ultrasound, Mosby, 587-604. [12] Ophir, J., Céspedes, I., Ponnekanti, H., Yazdi, Y. and Li, X. (1991) Elastography: A quantitative method for imag ing the elasticity of biological tissues. Ultrasonic Imaging, 13, 111-134. [13] Ophir, J., Alam, S., Garra, B., Kallel, F., Konofagou, E., Krouskop, T. and Varghese, T. (2002) Elastography: Im aging the elastic properties of soft tissues with ultrasound. Journal of Medical Ultrasonics, 29, 155-171. doi:10.1007/BF02480847 [14] De Zordo, T., Lill, S., Fink, C., Feuchtner, G., Jaschke, W., Bellmann-Weiler, R. and Klauser, A. (2009) Real-time sonoelastography of lateral epicondylitis: Comparison of findings between patients and healthy volunteers. Ameri can Journal of Roentgenology, 193, 180-185. doi:10.2214/AJR.08.2020 [15] De Zordo, T., Fink, C., Feuchtner, G., Smekal, V., Reindl, M. and Klauser, A. (2009) Real-time sonoelastography findings in healthy achilles tendons. American Journal of Roentgenology, 193, W134-W138. doi:10.2214/AJR.08.1843 [16] De Zordo, T., Chhem, R., Smekal, V., Feuchtner, G., Reindl, M., Fink, C. and Klauser, S.A. (2010) Real-time sonoelastography: Findings in patients with symptomatic achilles tendons and comparison to healthy volunteers. Ultraschall in der Medizin, 31, 394-400. doi:10.1055/s-0028-1109809 [17] Drakonaki, E.E, Allen, G. and Wilson, D. (2009) Real time ultrasound elastography of the normal achilles ten don: Reproducibility and pattern description. Clinical Radiology, 64, 1196-1202. doi:10.1016/j.crad.2009.08.006 [18] Drakonaki, E.E., Allen, G.M. and Wilson, D.J. (2012) Ultrasound elastography for musculoskeletal applications. British Journal of Radiology, 85, 1435-1445. doi:10.1259/bjr/93042867 [19] Kapoor, A., Sandhu, H.S., Sandhu, P.S., Kapoor, A., Ma hajan, G. and Kumar, A. (2010) Realtime elastography in plantar fasciitis: Comparison with ultrasonography and MRI. Current Orthopedic Practice, 21, 600-608. doi:10.1097/BCO.0b013e3181f4a8d9 [20] Kuo, P.-L., Li, P.-C., Shun, C.-T. and Lai, J.-S. (1999) Strain measurements of rabbit achilles tendons by ultra sound. Ultrasound in Medicine & Biology, 25, 1241-1250. doi:10.1016/S0301-5629(99)00078-2 [21] Wu, C.-H., Chang, K.-V., Mio, S., Chen, W.-S. and Wang, T.-G. (2011) Sonoelastography of the plantar fascia. Ra diology, 259, 502-507. doi:10.1148/radiol.11101665 [22] Radford, W., Amis, A., Kempson, S., Stead, A. and Camburn, M. (1994) A comparative study of single-and double-bundle acl reconstructions in sheep. Knee Surgery, Sports Traumatology, Arthroscopy, 2, 94-99. doi:10.1007/BF01476480 [23] Chen, L., Housden, R., Treece, G., Gee, A. and Prager, R. (2010) A hybrid displacement estimation method for ultrasonic elasticity imaging. IEEE Transactions on Ultra sonics Ferroelectrics and Frequency Control, 57, 866-882. doi:10.1109/TUFFC.2010.1491 [24] Chen, H., Shi, H. and Varghese, T. (2007) Improvement of eleastographic displacement estimation using a two step cross-correlation method. Ultrasound in Medicine & Biology, 33, 48-56. doi:10.1016/j.ultrasmedbio.2006.07.022 [25] Chen, L., Treece, G.M., Lindop, J.E., Gee, A.H. and Prager, R.W. (2009) A quality-guided displacement track ing algorithm for ultrasonic elasticity imaging. Medical Image Analysis, 13, 286-296. doi:10.1016/j.media.2008.10.007 [26] Pesavento, A., Perrey, C., Krueger, M. and Ermert, H. (1999) A time-efficient and accurate strain estimation concept for ultrasonic elastography using iterative phase zero estimation. IEEE Transactions on Ultrasonics Ferro electrics and Frequency Control, 46, 1057-1067. doi:10.1109/58.796111 [27] Pellot-Barakat, C., Frouin, F., Insana, M. and Herment, A. (2004) Ultrasound elastography based on multiscale esti mations of regularized displacement fields. IEEE Trans actions on Medical Imaging, 23, 153-163. doi:10.1109/TMI.2003.822825 [28] Doyley, M.M., Bamber, J.C., Fuechsel, F. and Bush, N.L. (2001) A freehand elastographic imaging approach for clinical breast imaging: System development and per formance evaluation. Ultrasound in Medicine & Biology, 27, 1347-1357. doi:10.1016/S0301-5629(01)00429-X [29] Bresson, X. and Chan, T. (2007) Fast minimization of the vectorial total variation norm and applications to color image processing. UCLA CAM Report. [30] Chambolle, A. (2004) An algorithm for total variation minimization and applications. Journal of Mathematical Imaging and Vision, 20, 89-97. doi:10.1023/B:JMIV.0000011321.19549.88 [31] Kallel, F. and Ophir, J. (1997) A least-squares strain esti mator for elastography. Ultrasonic Imaging, 19, 195-208. doi:10.1177/016173469701900303 [32] Brown, L.G. (1992) A survey of image registration tech niques. ACM Computing Surveys, 24, 325-376. doi:10.1145/146370.146374 [33] Rogers, G., Milthorpe, B., Muratore, A. and Schindhelm, K. (1990) Measurement of the mechanical properties of the ovine anterior cruciate ligament bone-ligament-bone complex: A basis for prosthetic evaluation. Biomaterials, 11, 89-96. doi:10.1016/0142-9612(90)90122-7 [34] Spalazzi, J.P., Gallina, J., Fung-Kee-Fung, S.D., Kono fagou, E.E. and Lu, H.H. (2006) Elastographic imaging of strain distribution in the anterior cruciate ligament and at the ligament bone insertions. Journal of Orthopaedic Re search, 24, 2001-2010. doi:10.1002/jor.20260 [35] Arms, S., Pope, M., Johnson, R., Fischer, R., Arvidsson, I. and Eriksson, E. (1984) The biomechanics of anterior cruciate ligament rehabilitation and reconstruction. Ame rican Journal of Sports Medicine, 12, 8-18. doi:10.1177/036354658401200102 [36] Weiss, J.A. and Gardiner, J.C. (2001) Computational mo deling of ligament mechanics. Critical Reviews in Bio medical Engineering, 29, 303-371. doi:10.1615/CritRevBiomedEng.v29.i3.20 [37] Tan, S., Kuda, S., Zcan, A., Pek, A., Karaolanolu, M., Arslan, H. and Bozkurt, M. (2012) Real-time sonoelasto graphy of the achilles tendon: Pattern description in healthy subjects and patients with surgically repaired complete ruptures. Skeletal Radiology, 41, 1067-1072. doi:10.1007/s00256-011-1339-4 [38] Srinivasan, S., Kallel, F. and Ophir, J. (2002) Estimating the elastographic signal-to-noise ratio using correlation coefficients. Ultrasound in Medicine & Biology, 28, 359-368. doi:10.1016/S0301-5629(01)00510-5 [39] Ottensmeyer, M.P., Kerdok, A.E., Howe, R.D. and Daw son, S.L. (2004) The effects of testing environment on the viscoelastic properties of soft tissues. In: Cotin, S. and Metaxas, D., Eds., Medical Simulation, Vol. 3078, Springer, Berlin Heidelberg, 9-18. doi:10.1007/978-3-540-25968-8_2