Browsing by Author "Han, Aiguo"

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    Quantitative Texture and Blob Analyses on Patellar Tendon Sonographic Images of Collegiate Basketball Athletes
    Crimmins, Sarah Ann (Virginia Tech, 2023-07-31)
    Patellar Tendinopathy (PT), commonly called "Jumper's Knee", is a condition resulting from repetitive loading of the patellar tendon that presents as anterior knee pain, which is commonly seen in basketball players due to the maneuvers in the sport. Diagnosis of PT often involves a clinical exam followed by ultrasound images for confirmation of the diagnosis to look for key factors of PT. Clinical assessment of ultrasound images of tendons is subjective and requires a high level of experience for reliable interpretation. Thus, there is a need for objective, quantitative methods to assess tendon abnormalities associated with pathology. Ultrasound image texture analysis has emerged as a reliable technique to augment the utility of conventional US imaging, and has recently been shown to distinguish healthy from abnormal tendon and myofascial tissues. The objective of the present study was to conduct image texture analysis to evaluate patellar tendons of collegiate basketball athletes over two seasons. Under an IRB-approved protocol with informed consent, a total of 33 Division 1 collegiate basketball athletes (16 male, 17 female, age 19.9 +/- 1.4 years) underwent clinical evaluation and ultrasound imaging. Four imaging sessions were collected over the course of two years (pre- and post-season). Participants were imaged using a GE LOGIQ S8 (General Electric, USA) ultrasound machine equipped with ML6-15 linear probe. At each imaging session, power Doppler images were collected in the longitudinal and transverse axis, at the proximal, central, and distal regions of the patellar tendon of both knees. Image texture analysis was performed using a custom MATLAB (Mathworks, USA) program to obtain first order (mean, median, variance, skewness, kurtosis, entropy), second order (contrast, energy, and homogeneity), and blob analysis (blob count, BC, and blob area, BA, for 5%, 25%, 50%, 75%, and 95% thresholding values) texture parameters in each image, based upon borders manually drawn by a single researcher. Statistical analysis was conducted to compare imaging sessions (JMP Pro 16, SAS). P-values <0.05 were considered statistically significant. Quantitative texture parameters are able to distinguish characteristics in patellar tendon ultrasound images to distinguish between anatomic region, gender, dominance and pre- to post- season. The 25% and 75% thresholding percentiles effectively showed characteristics of collagen fibers in the patellar tendon. The abnormal diagnosis does not greatly effect texture parameters, which needs to be investigated with more incorporation of grading criteria distinctions and a larger sample size.
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    Quantitative ultrasound assessment of fatty infiltration of the rotator cuff muscles using backscatter coefficient
    Toto-Brocchi, Marco; Wu, Yuanshan; Jerban, Saeed; Han, Aiguo; Andre, Michael; Shah, Sameer B.; Chang, Eric Y. (2024-10-22)
    Background: To prospectively evaluate ultrasound backscatter coefficients (BSCs) of the supraspinatus and infraspinatus muscles and compare with Goutallier classification on magnetic resonance imaging (MRI). Methods: Fifty-six participants had shoulder MRI exams and ultrasound exams of the supraspinatus and infraspinatus muscles. Goutallier MRI grades were determined and BSCs were measured. Group means were compared and the strength of relationships between the measures were determined. Using binarized Goutallier groups (0–2 versus 3–4), areas under the receiver operating characteristic curves (AUROCs) were calculated. The nearest integer cutoff value was determined using Youden’s index. Results: BSC values were significantly different among most Goutallier grades for the supraspinatus and infraspinatus muscles (both p < 0.001). Strong correlations were found between the BSC values and Goutallier grades for the supraspinatus (τb = 0.72, p < 0.001) and infraspinatus (τb = 0.79, p < 0.001) muscles. BSC showed excellent performance for classification of the binarized groups (0–2 versus 3–4) for both supraspinatus (AUROC = 0.98, p < 0.0001) and infraspinatus (AUROC = 0.98, p < 0.0001) muscles. Using a cutoff BSC value of −17 dB, sensitivity, specificity, and accuracy for severe fatty infiltration were 87.0%, 90.0%, and 87.5% for the supraspinatus muscle, and 93.6%, 87.5%, and 92.7% for the infraspinatus muscle. Conclusion: BSC can be applied to the rotator cuff muscles for assessment of fatty infiltration. For both the supraspinatus and infraspinatus muscles, BSC values significantly increased with higher Goutallier grades and showed strong performance in distinguishing low versus high Goutallier grades. Relevance statement: Fatty infiltration of the rotator cuff muscles can be quantified using BSC values, which are higher with increasing Goutallier grades. Key Points Ultrasound BSC measurements are reliable for the quantification of muscle fatty infiltration. BCS values increased with higher Goutallier MRI grades. BCS values demonstrated high performance for distinguishing muscle fatty infiltration groups.
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    Run Length Texture Analysis of Thoracolumbar Facia Sonographic Images: A Comparison of Subjects with And Without Low Back Pain (LBP)
    Al Khafaji, Ghaidaa Ghanim (Virginia Tech, 2023-07-06)
    Low back pain is one of the most common and disabling musculoskeletal disorders worldwide and the third most common reason for surgery in the United States. The lower back, or lumbar region, supports most of the body's weight; it controls spinal movement and stability through the interaction between bones, nerves, muscles, ligaments, and fascia within the lumbar region. Any disorder of those tissues could cause low back pain (LBP); emerging evidence indicates that the thoracolumbar fascia (TLF) is the lower back's most pain-sensitive soft tissue structure. TLF consists of dense connective tissue separated by loose connective tissue, allowing TLF layers to pass easily during torso movement. A series of foundational studies found that patients enduring long-term low back pain have different TLF structures than those without LBP. Injuries may result in adhesions and fibrosis, which may cause adjacent dense connective tissue layers to lose independent motion, limiting movement and causing pain. LBP is diagnosed by investigating the patient's medical history to identify symptoms and then examining the patient to determine the cause of the pain. If the pain persists after diagnosis and treatment, further investigation is required; an ultrasound scan is used as the next step. Ultrasound (US) imaging is a non-invasive and instantaneous method to evaluate soft, connective tissue structures such as muscles, tendons, ligaments, and fascia. Even though measuring echo intensity helps evaluate the soft tissues, this method still has limitations in diagnosing LBP; 90 % of all LBP patients are diagnosed with non-specific LBP, referred to as pain with no definitive cause . An in-depth investigation of US images could potentially provide more specificity in identifying sources of LBP. By providing information about soft tissue structure, texture analysis could increase US images' diagnostic power. The texture of an ultrasound image is the variation of pixel intensities throughout the region of interest (ROI) that produces different patterns; texture analysis is an approach that quantifies the characteristic variation of pixel intensities within ROI to describe tissue morphological characteristics. First-order texture analysis, second-order texture analysis, and grey-level run length texture analysis are types of analysis that could be applied to quantify parameters that describe the features of the texture; the grey-level analysis is usually conducted in four directions of the texture. This study has four objectives; the first objective is to use first-order and second-order analysis to determine texture parameters and determine whether those parameters can differentiate between individuals with and without LBP. The second objective is to use grey level run length analysis to quantify texture parameters in four directions (0^°,45^°,90^°,135^°) and examine whether those parameters can differentiate between individuals with and without LBP. The third objective is to determine the correlation between the first, second, and run length parameters. The fourth objective is to explore how first-order, second order and grey level run length parameters are affected by US machine settings. A custom-written MATLAB program was developed to quantify first and second-order texture parameters and grey-level run length parameters. Using JMP software, each parameter was statistically compared between individuals with and without LBP. Among nine first- and second-order texture parameters, four showed statistically significant differences between individuals with and without LBP. Among 44 run-length parameters, 9 showed statistically significant differences between individuals with and without LBP. The current study also revealed some strong correlations between first, second, and run length parameters; it also shows that the US machine setting has minor effects on the three types of parameters. Although the present study was conducted on a relatively small sample size, the results indicate that one direction of grey level run length analysis and first and second-order texture analysis can differentiate between people with and without LBP.