Ultrasound of the Biceps Muscle in Idiopathic Parkinson’s Disease with Deep Brain Stimulation: Rigidity Can Be Quantified by Shear Wave Elastography

Abstract

Rigidity in Parkinson’s disease (PD) is assessed by clinical scales, mostly the Unified Parkinson’s Disease Rating Scale of the Movement Disorders Society (MDS-UPDRS). While the MDS-UPDRS-III ranges on an integer from 0 to 4, we investigated whether muscle ultrasound shear wave elastography (SWE) offers a refined assessment. Ten PD patients (five treated with deep brain stimulation (DBS) and levodopa, five with levodopa only) and ten healthy controls were included. Over a period of 80 min, both the SWE value and the item 22b-c of the MDS-UPDRS-III were measured at 5 min intervals. The measurements were performed bilaterally at the biceps brachii muscle (BB) and flexor digitorum profundus muscle in flexion and passive extension. Rigidity was modified and tracked under various therapeutic conditions (with and without medication/DBS). The feasibility of SWE for objective quantification was evaluated by correlation with the UPDRS-III: considering all positions and muscles, there was already a weak correlation (r = 0.01, p < 0.001)—in a targeted analysis, the BB in passive extension showed a markedly higher correlation (r = 0.494, p < 0.001). The application of dopaminergic medication and DBS resulted in statistically significant short-term changes in both clinical rigidity and SWE measurements in the BB (p < 0.001). We conclude that rigidity is reflected in the SWE measurements, indicating that SWE is a potential non-invasive quantitative assessment tool for PD.

Real-Time Speed-of-Sound Estimation In Vivo via Steered Plane Wave Ultrasound

“…For example, in Movie 3, the estimated SoS can be associated with the state of the biceps muscle as it transitions from one state to another. Recently, it has been shown that ultrasound of the biceps using shear wave elastography can help assess rigidity in Parkinson's disease [43]; SoS estimation, like elastography, quantitatively measures a biomechanical property of the muscle tissue. Our work can aid in the clinical translation work for relating tissue SoS with muscle health and function.…”

In Vivo Assessment of Shear Wave Propagation in Pennate Muscles Using an Automatic Ultrasound Probe Alignment System

“…In vivo characterization of skeletal muscles is crucial for understanding musculoskeletal diseases and improving treatment strategies. For this, the non-invasive ultrasound shear wave elastography (SWE) has recently been shown to represent both passive [1] , [2] , [3] , [4] and active muscle mechanics [5] , [6] , [7] , [8] in healthy cohorts and several studies have demonstrated the clinical potential for SWE, for example for patients diagnosed with myotonia [9] , Duchenne muscular dystrophy [10] , myasthenia gravis [11] or Parkinson [12] . However, applying SWE on skeletal muscles poses challenges due to the muscles' complex and heterogeneous architecture.…”