Qingshan Chen1, Hua-jun Wang1, Ralph E Gay2, Jeffrey M Thompson2, Armando Manduca3, Kai-Nan An1, Richard E Ehman3, Jeffrey R Basford4. 1. Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN. 2. Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN. 3. Department of Radiology, Center for Advanced Imaging Research, Mayo Clinic, Rochester, MN. 4. Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN. Electronic address: basford.jeffrey@mayo.edu.
Abstract
OBJECTIVE: To assess the correlation of clinician-identified myofascial taut bands with their presence and characteristics on magnetic resonance elastography (MRE) imaging. DESIGN: Cross-sectional study. SETTING: A magnetic resonance imaging (MRI) research laboratory. PARTICIPANTS: A convenience sample of adults (N=65; 45 women, 20 men) identified by skilled musculoskeletal physicians as having upper trapezius myofascial pain-associated taut bands. INTERVENTIONS: Subjects had their taut bands outlined and were positioned within a 1.5T MRI machine. Shear waves were induced with a pneumatic transducer located over the belly of the involved muscle. Wave propagation was visualized with MRE images across a vibration cycle. Imaging data were assessed independently by 2 skilled MRE interpreters. MAIN OUTCOME MEASURES: The primary outcome measure was the determination of the intra- and interrater reliabilities of MRE taut band identification and their correlation with clinician identification of band presence. Secondary outcomes consisted of the elucidation of the physical characteristics of taut bands and their surrounding muscle tissue. RESULTS: MRE intra- and interrater reliability was excellent, with kappa coefficients and 95% confidence intervals (CIs) of .86 (.68-1.00) and .93 (.79-1.00), respectively. Stiffness in MRE-identified taut bands was elevated at a mean ± SD of 11.5±2.4 kPa and fell to 5.8±0.9 kPa in surrounding muscle tissue (P<.001); muscular tone in trapezius muscles without a taut band was relatively uniform at 6.6±2.1 kPa. Agreement between the physicians and the MRE raters, however, was relatively poor (63.1%; 95% CI, 50.2%-74.7%). CONCLUSIONS: Our findings suggest that while clinicians may overestimate, and current MRE techniques may underestimate, the presence of taut bands, these bands do exist, can be assessed quantitatively, and do represent localized areas of increased muscle stiffness.
OBJECTIVE: To assess the correlation of clinician-identified myofascial taut bands with their presence and characteristics on magnetic resonance elastography (MRE) imaging. DESIGN: Cross-sectional study. SETTING: A magnetic resonance imaging (MRI) research laboratory. PARTICIPANTS: A convenience sample of adults (N=65; 45 women, 20 men) identified by skilled musculoskeletal physicians as having upper trapezius myofascial pain-associated taut bands. INTERVENTIONS: Subjects had their taut bands outlined and were positioned within a 1.5T MRI machine. Shear waves were induced with a pneumatic transducer located over the belly of the involved muscle. Wave propagation was visualized with MRE images across a vibration cycle. Imaging data were assessed independently by 2 skilled MRE interpreters. MAIN OUTCOME MEASURES: The primary outcome measure was the determination of the intra- and interrater reliabilities of MRE taut band identification and their correlation with clinician identification of band presence. Secondary outcomes consisted of the elucidation of the physical characteristics of taut bands and their surrounding muscle tissue. RESULTS: MRE intra- and interrater reliability was excellent, with kappa coefficients and 95% confidence intervals (CIs) of .86 (.68-1.00) and .93 (.79-1.00), respectively. Stiffness in MRE-identified taut bands was elevated at a mean ± SD of 11.5±2.4 kPa and fell to 5.8±0.9 kPa in surrounding muscle tissue (P<.001); muscular tone in trapezius muscles without a taut band was relatively uniform at 6.6±2.1 kPa. Agreement between the physicians and the MRE raters, however, was relatively poor (63.1%; 95% CI, 50.2%-74.7%). CONCLUSIONS: Our findings suggest that while clinicians may overestimate, and current MRE techniques may underestimate, the presence of taut bands, these bands do exist, can be assessed quantitatively, and do represent localized areas of increased muscle stiffness.
Authors: Frederick Wolfe; Daniel J Clauw; Mary-Ann Fitzcharles; Don L Goldenberg; Winfried Häuser; Robert S Katz; Philip Mease; Anthony S Russell; I Jon Russell; John B Winfield Journal: J Rheumatol Date: 2011-02-01 Impact factor: 4.666