Measurement of large strain properties in calf muscles in vivo using magnetic resonance elastography and spatial modulation of magnetization.

It is important to measure the large deformation properties of skeletal muscle in vivo in order to understand and model movement and the force-producing capabilities of muscle. As muscle properties are non-linear, an understanding of how the deformation state affects the measured shear moduli is also useful for clinical applications of magnetic resonance elastography (MRE) to muscle disorders. MRE has so far only been used to measure the linear viscoelastic (small strain) properties of muscles. This study aims to measure the shear moduli of human calf muscles under varying degrees of strain using MRE. Nine healthy adults (four males; age range, 25-38 years) were recruited, and the storage modulus G' was measured at three ankle angle positions: P0 (neutral), P15 (15° plantarflexed) and P30 (30° plantarflexed). Spatial modulation of magnetization (SPAMM) was used to measure the strain in the calf associated with the ankle rotations between P0 to P15 and P0 to P30. SPAMM results showed that, with plantarflexion, there was a shortening of the medial gastrocnemius and soleus muscles, which resulted in an expansion of both muscles in the transverse direction. Strains for each ankle rotation were in the range 3-9% (in compression). MRE results showed that this shortening during plantarflexion resulted in a mean decrease in G' in the medial gastrocnemius (p = 0.013, linear mixed model), but not in the soleus (p = 0.47). This study showed that MRE is a viable technique for the measurement of large strain deformation properties in vivo in soft tissues by inducing physiological strain within the muscle during imaging.

Diffusion tensor imaging and ventricle volume quantification in patients with chronic shunt-treated hydrocephalus: a matched case-control study.

OBJECTIVEThe object of this study was to use diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS) to characterize the long-term effects of hydrocephalus and shunting on white matter integrity and to investigate the relationship of ventricular size and alterations in white matter integrity with headache and quality-of-life outcome measures.METHODSPatients with shunt-treated hydrocephalus and age- and sex-matched healthy controls were recruited into the study and underwent anatomical and DTI imaging on a 3-T MRI scanner. All patients were clinically stable, had undergone CSF shunt placement before 2 years of age, and had a documented history of complaints of headaches. Outcome was scored based on the Headache Disability Inventory and the Hydrocephalus Outcome Questionnaire. Fractional anisotropy (FA) and other DTI-based measures (axial, radial, and mean diffusivity; AD, RD, and MD, respectively) were extracted in the corpus callosum and internal capsule with manual region-of-interest delineation and in other regions with TBSS. Paired t-tests, corrected with a 5% false discovery rate, were used to identify regions with significant differences between patients and controls. Within the patient group, linear regression models were used to investigate the relationship between FA or ventricular volume and outcome, as well as the effect of shunt-related covariates.RESULTSTwenty-one hydrocephalus patients and 21 matched controls completed the study, and their data were used in the final analysis. The authors found significantly lower FA for patients than for controls in 20 of the 48 regions, mostly posterior white matter structures, in periventricular as well as more distal tracts. Of these 20 regions, 17 demonstrated increased RD, while only 5 showed increased MD and 3 showed decreased AD. No areas of increased FA were observed. Higher FA in specific periventricular white matter tracts, tending toward FA in controls, was associated with increased ventricular size, as well as improved clinical outcome.CONCLUSIONSThe study shows that TBSS-based DTI is a sensitive technique for elucidating changes in white matter structures due to hydrocephalus and chronic CSF shunting and provides preliminary evidence that DTI may be a valuable tool for tailoring shunt procedures to monitor ventricular size following shunting and achieve optimal outcome, as well as for guiding the development of alternate therapies for hydrocephalus.

Effect of endoscopic third ventriculostomy on cerebrospinal fluid pressure in the cerebral ventricles.

We aimed to show how endoscopic third ventriculostomy (ETV) treatment may affect cerebrospinal fluid (CSF) flow dynamics in hydrocephalus, with and without aqueductal stenosis. Hydrocephalus is a neurological disorder which is characterized by enlarged brain ventricles. The periodic motion of CSF flow as a function of the cardiac cycle was prescribed as the inlet boundary condition at the foramen of Monro, and ETV was modeled as a 5mm diameter hole in the anterior wall of the third ventricle. The results show that ETV reduces the pressure in the ventricles by nine-fold in the model with aqueductal stenosis, and three-fold in the model without aqueductal stenosis. More importantly, ETV changes the temporal characteristics of the CSF pressure waveform in the model without aqueductal stenosis, such that there is higher pressure in the ventricle during diastole. This study suggests that changes in the temporal characteristics of the CSF pressure waveform in the ventricles may be the reason why ETV treatment is not effective for hydrocephalus without aqueductal stenosis.

Characterising skeletal muscle under large strain using eccentric and Fourier Transform-rheology.

Characterising the passive anisotropic properties of soft tissues has been largely limited to the linear viscoelastic regime and shear loading is rarely done in the large deformation regime, despite the physiological significance of such properties. This paper demonstrates the use of eccentric rheology, which allows the anisotropy of skeletal muscle to be investigated. The large amplitude oscillatory strain properties of skeletal muscle were also investigated using Fourier Transform-rheology. Histology was used to qualitatively assess the microstructure changes induced by large strain. Results showed that skeletal muscle was strongly anisotropic in the linear regime. The storage and loss moduli were found to be significantly different (p<0.05) between the three fibre alignment groups; for the group tested with fibres perpendicular to plane of shear was 12.3±1.3 kPa and 3.0±0.35 kPa, parallel to shear direction was 10.6±1.2 kPa and 2.4±0.23 kPa, and perpendicular to shear direction was 5.5±0.90 kPa and 1.3±0.21 kPa. The appearance and growth of higher order harmonics at large strain was different in the three testing directions indicating that the anisotropy of muscle affects skeletal muscle behaviour in the nonlinear regime. Histological analysis showed an increasing destruction of extracellular matrix and the rearrangement of fibres with increasing strain indicating mechanical damage at strains of larger than 10%. These microstructural changes could contribute to the complex nonlinear behaviour in skeletal muscle. This paper demonstrates a method of characterising the anisotropic properties in skeletal muscle under large strain whilst giving meaningful information on the physical response of tissue at various strains.

Measurement of passive skeletal muscle mechanical properties in vivo: recent progress, clinical applications, and remaining challenges.

The ability to measure and quantify the properties of skeletal muscle in vivo as a method for understanding its complex physiological and pathophysiological behavior is important in numerous clinical settings, including rehabilitation. However, this remains a challenge to date due to the lack of a "gold standard" technique. Instead, there are a myriad of measuring techniques each with its own set of pros and cons. This review discusses the current state-of-the-art in elastography imaging techniques, i.e., ultrasound and magnetic resonance elastography, as applied to skeletal muscle, and briefly reviews other methods of measuring muscle mechanical behavior in vivo. While in vivo muscle viscoelastic properties can be measured, these techniques are largely limited to static or quasistatic measurements. Emerging elastography techniques are able to quantify muscle anisotropy and large deformation effects on stiffness, but, validation and optimization of these newer techniques is required. The development of reliable values for the mechanical properties of muscle across the population using these techniques are required to enable them to become more useful in rehabilitation and other clinical settings.

Characterising soft tissues under large amplitude oscillatory shear and combined loading.

Characterising soft biological tissues outside the linear viscoelastic regime is challenging due to their complex behaviour. In addition, the viscoelastic properties of tissues have been shown to be sensitive to sample preparation and loading regime resulting in inconsistent data varying by orders magnitude in the literature. This paper presents a novel technique to characterise the non-linear behaviour of tissues which uses Fourier Transformation to decompose the stress output waveform under large amplitude oscillatory shear (LAOS) into harmonic contributions. The effect of varying preload, the compressive strain exerted on a liver tissue specimen prior to shear testing to minimise slip, was also investigated. Results showed that in the linear regime, preload affects the viscoelastic response of liver. Histological analysis indicated that there were structural changes as a result of the preload that may be linked to the differences in observed behaviour. Fourier analysis was used to extract the first and third harmonic components of the shear moduli at large strain. At 50% shear strain, a change in the third harmonic component of the shear moduli was accompanied by a marked change in the micro-structural arrangement of the sinusoids. This paper demonstrates a method of efficiently characterising soft biological tissues under large amplitude oscillatory shear under combined loading.

The effects of the interthalamic adhesion position on cerebrospinal fluid dynamics in the cerebral ventricles.

The interthalamic adhesion is a unique feature of the third ventricle in the brain. It differs in shape and size and its location varies between individuals. In this study, computational fluid dynamics was performed on 4 three-dimensional models of the cerebral ventricular system with the interthalamic adhesion modeled in different locations in the third ventricle. Cerebrospinal fluid (CSF) was modeled as incompressible Newtonian fluid and flow was assumed laminar. The periodic motion of CSF flow as a function of the cardiac cycle starting from diastole was prescribed as the inlet boundary condition at the foramen of Monroe. Results from this study show how the location of the interthalamic adhesion influences the pattern of pressure distribution in the cerebral ventricles. In addition, the highest CSF pressure in the third ventricle can vary by approximately 50% depending on the location of the interthalamic adhesion. We suggest that the interthalamic adhesion may have functional implications on the development of hydrocephalus and it is important to model this anatomical feature in future studies.