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Ultrasound Imaging of Dorsal Neck Muscles with Speckle Tracking

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Ultrasound Imaging of Dorsal Neck Muscles with Speckle Tracking www.nature.com/scientificreports OPEN Ultrasound imaging of dorsal neck muscles with speckle tracking analyses – the relationship between Received: 29 October 2018 Accepted: 29 August 2019 muscle deformation and force Published online: 23 September 2019 Gunnel Peterson1,2, Shaun O’ Leary3,4, David Nilsson5, Katherine Moodie3, Kylie Tucker3,6, Johan Trygg5 & Anneli Peolsson2 The development of methods of non-invasive measurement of neck muscle function remains a priority in the clinical sciences. In this study, dorsal neck muscle deformation vs time curves (deformation area) were evaluated against incremental force, recorded from non-invasive real-time ultrasound measurement. The results revealed subject-specifc moderate to strong linear or non-linear relationships between deformation and force. Test-retest variability showed strong reliability for all fve neck muscles summed together and fair to good reliability for the fve muscles evaluated separately. Multivariate statistics were used to analyse the interactions between the dorsal neck muscles during diferent percentages of maximal voluntary contraction (MVC). Low force (10–20% MVC) was related to muscle shortening; higher force (40–80% MVC) showed combination of shortening and elongation deformation in the muscle interactions. The muscle interactions during isometric MVC test were subject-specifc, with diferent combinations and deformations of the fve neck muscles. Force ≥40% MVC were associated with a forward movement of the cervical spine that afected the ultrasound measurement of the dorsal neck muscles. Ultrasound with speckle-tracking analyses may be best used to detect low levels (<40% MVC) of neck muscle activity. Te neck muscle function is complex1, dysfunction of superfcial and deep muscle layers are related to persistent neck pain2–5. Te understanding of neck muscle function has improved1,5–8, but the challenge has been to develop methods to evaluate impairment in neck muscles and evaluate results of exercise interventions that can be used in research and clinical practice. Te most common method used in research is electromyography (EMG). Surface EMG and invasive fne wire EMG have shown altered dorsal neck muscle behaviour in the presence of neck pain5,9. However, invasive EMG can be uncomfortable and is not applicable in the clinical setting. In contrast, real-time ultrasound imaging can non-invasively detect and quantify skeletal muscle deformation providing information regarding local changes within the muscle during activity10,11. Speckle tracking is a method that provides information on muscle defor- mation; i.e., elongation and shortening of the muscle12–15. Tis method provides the ability to investigate both superfcial and deep muscle layers simultaneously10,12,13 and may improve diagnostics in neck pain and evaluate exercise regimens. Moreover, ultrasound investigation is a relatively low-cost technique, with no known risks or contraindications. Lopata et al.11 showed that a strain estimation method facilitated the detection of tissue motion by calculation deformation curves as a function of time. Tey measured local deformations in two directions simultaneously in the biceps brachii muscle in response to force, during both electrical stimulation and voluntary contraction. Studies have shown altered neck muscle deformation curves in individuals with whiplash-associated disorder (WAD) compared to healthy individuals12,13,16, using a speckle-tracking method calculating deformation 1Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden. 2Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping, Sweden. 3School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia. 4Physiotherapy Department, Royal Brisbane and Women’s Hospital, Queensland Health, Queensland, Australia. 5Computational Life Science Cluster (CLiC), Department of Chemistry, Umeå University, Umeå, Sweden. 6The University of Queensland, School of Biomedical Sciences, Brisbane, Australia. Correspondence and requests for materials should be addressed to G.P. (email: [email protected]) SCIENTIFIC REPORTS | (2019) 9:13688 | https://doi.org/10.1038/s41598-019-49916-1 1 www.nature.com/scientificreports/ www.nature.com/scientificreports MVC 10% 20% 40% 60% 80% 100% Test time 8.0 (0.65) 8.0 (0.58) 8.4 (1,1) 8.1 (0.57) 7.9 (0.82) 7.3 (0.84) TR 19.2 (12.9) 25.4 (8.6) 40.0 (33.1) 58.6 (48.3) 56.1 (46.8) 63.6 (46.5) SP 30.7 (22.8) 35.1 (17.1) 55.8 (32.3) 74.3 (26.4) 82.6 (39.1) 159.1 (131.6) Total area Scap 47.5 (32.89 54.8 (28.7) 93.3 (77.1) 112.3 (63.0) 130.0 (87.3) 152.9 (112.2) Scerv 57.3 (28.7) 72.3 (34.6) 116.9 (60.4) 123.6 (103.9) 131.9 (88.8) 123.1 (94.5) MF 35.8 (21.8) 61.4 (27.8) 92.6 (41.4) 116.9 (74.9) 111.8 (84.2) 124.9 (85.6) TR 4.1 (3.9) 10.4 (7.1) 9.2 (11.8) 24.6 (26.4) 34.2 (49.0) 30.6 (35.4) SP 10.1 (14.0) 12.7 (8.4) 25.9 (24.3) 39.4 (36.7) 66.0 (47.2) 149.3 (136.6) Elongation Scap 22.1 (36.3) 27.8 (32.6) 57.0 (62.8) 73.9 (55.6) 94.3 (99.5) 145.1 (119.7) Scerv 25.6 (20.7) 52.1 (42.8) 76.4 (48.5) 79.7 (56.3) 116.5 (94.4) 115.7 (100.3) MF 18.1 (22.9) 44.9 (33.8) 76.6 (50.1) 94.4 (73.2) 93.1 (88.5) 111.8 (93.9) TR 15.2 (14.9) 14.1 (10.8 25.0 (23.7) 24.8 (23.6) 21.8 (21.4) 32.9 (53.0) SP 20.6 (24.9) 20.7 (18.3) 29.7 (29.5) 32.1 (31.7) 16.6 (18.9) 9.8 (38.0) Shortening Scap 25.4 (19.9) 28.2 (25.1) 24.8 (27.1) 27.5 (35.6) 35.7 (44.4) 7.8 (14.1) Scerv 31.7 (37.0) 21.8 (31.2) 29.4 (45.4) 23.4 (44.6) 15.4 (18.1) 7.3 (12.2) MF 17.6 (17.1) 16.7 (17.4) 16.7 (18.9) 13.5 (18.0) 18.7 (21.4) 13.0 (22.4) Table 1. Deformation values for the fve neck muscles. Data are mean ± SD. Muscle deformation area (% deformation) during percent of maximal voluntary contraction in the fve dorsal neck muscles. Abbreviations; TR, trapezius; SP, splenius capitis; Scap, semispinalis capitis; Scerv, semispinalis cervicis; MF, multifdus/ rotatores; MVC, maximal voluntary contraction; 10%; 10 percent of MVC, 20%; 20 percent of MVC, 40%; 40 percent of MVC, 60%; 60 percent of MVC; 80%, 80 percent of MVC; 100%, maximal voluntary contraction. vs time curves (area under the curve) that has the capacity to distinguish between elongation and shortening deformation. However, the reliability and validity against force have not been adequately investigated. A previ- ous study conducted by our team showed that muscle deformation during isometric contractions of the cervical extensor muscles performed over a range of intensities were signifcantly related to torque, however the rela- tionship was weak (r2 = 0.03–0.18)17. Tis previous study however, utilized the average root mean square (RMS) values of deformation curves. We postulate that this method may not optimally identify deformation. Instead, we propose that cervical muscle deformation versus time curves would provide a more accurate method for evalu- ating ultrasound speckle tracking images that would be more strongly related to changes in force. Additionally, the relationship between deformation and isometric force, and specifcally the interactions between muscles and isometric force, can be investigated by means of multivariate data analysis. In general, multivariate techniques are benefciary to use for analysis of many variables18 to summarize the content in a few components or latent variables and also to fnd the relationship to a response variable, e.g. the isometric force. Te aim of this study was to further evaluate a method of quantifying deformation in fve dorsal neck muscles by calculation of muscle deformation vs time curves (area under the curve). It was hypothesised that the defor- mation vs time curves methods would more accurately refect isometric cervical extension muscle force than that shown previously17 using the average root mean square (RMS) method. Te relationship between deformation and isometric force was evaluated, as well as the interaction between the neck muscles and isometric force. A second aim was to investigate test-rest reliability among three tests. Results Te raw values for the deformation areas (before normalization) are presented in Table 1. Relationship between total deformation area for the fve neck muscles and force. Te raw data analyses showed that eleven subjects, seven men and four women, displayed a linear relationship between the %MVC and the deformation area (Table 2 and Fig. 1). Two showed moderate (R2 = 0.46 and 0.60) and nine showed strong to very strong linear relationships (R2 = 0.77 to 0.96, Table 2). Nine subjects, fve men and four women, displayed non-linear relationships between the %MVC and the deformation area. Two showed moderate (R2 = 0.39 and 0.42) and seven showed strong to very strong non-linear relationships (R2 = 0.71 to 0.98, Table 2 and Fig. 2). When analysed in groups, the association between the normalized deformation area and force was strong for those with a linear relationship (R2 = 0.68) and moderate for those with a non-linear relationship (R2 = 0.46) (Fig. 3). Relationship between the normalized deformation areas for fve neck muscles and the percent of maximal voluntary contraction. When the normalized data for all subjects (n = 20) were combined, we found that, for all fve muscles summed together, the mean normalized deformation values were signifcantly related to the %MVC: F (2.8, 53.6) = 29.2, p < 0.001.
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