Carraro Ugo, Edmunds Kyle J, Gargiulo Paolo
IRRCS Fondazione Ospedale San Camillo , Venezia, Italy.
Institute for Biomedical and Neural Engineering, Reykjavik University; Landspítali, Reykjavík, Iceland.
Eur J Transl Myol. 2015 Mar 17;25(2):5133. doi: 10.4081/ejtm.2015.5133. eCollection 2015 Mar 11.
This report outlines the use of a customized false-color 3D computed tomography (CT) protocol for the imaging of the rectus femoris of spinal cord injury (SCI) patients suffering from complete and permanent denervation, as characterized by complete Conus and Cauda Equina syndrome. This muscle imaging method elicits the progression of the syndrome from initial atrophy to eventual degeneration, as well as the extent to which patients' quadriceps could be recovered during four years of home-based functional electrical stimulation (h-b FES). Patients were pre-selected from several European hospitals and functionally tested by, and enrolled in the EU Commission Shared Cost Project RISE (Contract n. QLG5-CT-2001-02191) at the Department of Physical Medicine, Wilhelminenspital, Vienna, Austria. Denervated muscles were electrically stimulated using a custom-designed stimulator, large surface electrodes, and customized progressive stimulation settings. Spiral CT images and specialized computational tools were used to isolate the rectus femoris muscle and produce 3D and 2D reconstructions of the denervated muscles. The cross sections of the muscles were determined by 2D Color CT, while muscle volumes were reconstructed by 3D Color CT. Shape, volume, and density changes were measured over the entirety of each rectus femoris muscle. Changes in tissue composition within the muscle were visualized by associating different colors to specified Hounsfield unit (HU) values for fat, (yellow: [-200; -10]), loose connective tissue or atrophic muscle, (cyan: [-9; 40]), and normal muscle, fascia and tendons included, (red: [41; 200]). The results from this analysis are presented as the average HU values within the rectus femoris muscle reconstruction, as well as the percentage of these tissues with respect to the total muscle volume. Results from this study demonstrate that h-b FES induces a compliance-dependent recovery of muscle volume and size of muscle fibers, as evidenced by the gain and loss in muscle mass. These results highlight the particular utility of this modality in the quantitative longitudinal assessment of the responses of skeletal muscle to long-term denervation and h-b FES recovery.
本报告概述了一种定制的伪彩色三维计算机断层扫描（CT）方案的应用，该方案用于对患有完全性和永久性去神经支配的脊髓损伤（SCI）患者的股直肌进行成像，其特征为完全性圆锥和马尾综合征。这种肌肉成像方法可以揭示该综合征从最初的萎缩到最终退化的进展情况，以及患者的股四头肌在四年家庭功能性电刺激（h-b FES）期间能够恢复的程度。患者是从几家欧洲医院预先挑选出来的，并在奥地利维也纳威廉明嫩医院物理医学科进行了功能测试，随后被纳入欧盟委员会共同成本项目RISE（合同编号：QLG5-CT-2001-02191）。使用定制设计的刺激器、大表面电极和定制的渐进刺激设置对去神经支配的肌肉进行电刺激。利用螺旋CT图像和专门的计算工具分离股直肌，并生成去神经支配肌肉的三维和二维重建图像。肌肉的横截面由二维彩色CT确定，而肌肉体积则通过三维彩色CT重建。在每块股直肌的整体范围内测量形状、体积和密度变化。通过将不同颜色与脂肪的特定亨氏单位（HU）值（黄色：[-200；-10]）、疏松结缔组织或萎缩肌肉（青色：[-9；40]）以及正常肌肉（包括筋膜和肌腱，红色：[41；200]）相关联，来可视化肌肉内组织成分的变化。该分析结果以股直肌重建内的平均HU值以及这些组织相对于总肌肉体积的百分比呈现。本研究结果表明，h-b FES可诱导肌肉体积和肌纤维大小的依从性恢复，肌肉质量的增减证明了这一点。这些结果突出了这种方法在定量纵向评估骨骼肌对长期去神经支配和h-b FES恢复反应方面的特殊效用。
