Struktur- und Funktionsdiagnostik der peripheren Muskulatur im Ultraschall

Zusammenfassung

Die nicht-invasive Ultraschalltechnologie erlaubt in Echtzeit Aussagen über die strukturelle und funktionelle Eigenschaften des Muskelgewebes. Seit der Entwicklung der dynamischen Kontraktionsanalysen im Echokardiogramm sind diese Verfahren auch für die Myosonografie interessant geworden und stoßen auf das Interesse der Wissenschaftler und Neurologen. Der Muskelultraschall wurde früh bei Untersuchungen von Sportlern eingesetzt, um Muskelverletzungen wie Blutungen oder Muskelrisse zu erkennen. In der Klinik hat die Myosonologie Einzug gehalten zur Kontrolle der Position von Nadelelektroden im EMG, zur Biopsie oder Injektion von Medikamenten – z. B. Botulinumtoxin oder Lokalanästhetika – und eröffnet damit qualitative Verbesserungen für die Behandlung von Patienten. Durch den Gewebedoppler (Tissue Velocity Imaging -TVI) sind wir in der Lage, das Kontraktionsverhalten peripherer Muskeln zu untersuchen. Die Ultraschallmethode bietet gegenüber dem EMG oder MRT/CT den Vorteil, dass Muskelbewegungen in Bezug auf Kontraktionsgeschwindigkeit und Relaxationsverhalten sowie der Phasenbeziehung zur Aktivierung mit benachbarten Muskeln quantifizierbar werden. Diese Analysen zeigen z. B. bei Schlaganfallpatienten charakteristische Muster. Insgesamt erlaubt die Myosonologie die Beurteilung atrophischer Prozesse, Effekt von pharmakologischen oder physiotherapeutischen Therapien und kann damit ein wertvolles Diagnosetool für Neurologen und Physiotherapeuten werden.

Abstract

By means of ultrasound (US) methods, structural and functional properties of the muscle tissue can be detected in patients in real time and non-invasively. Since dynamic analysis in cardioechography has become established in clinical routine, myosonolgy is moving more and more in the focus of interest of scientists and neurologists. Using high resolution B-mode the physiological and pathological structures of the muscle tissue can be visualised. US of muscles was first used during examinations of athletes to detect muscle injuries like bleeding or disruption after exercise. Even more, the positioning of needle electrodes for biopsy or injections of medications – e. g., botulinum toxins or local anaesthetics – offers new quality improvement for the treatment of patients. Using tissue velocity imaging (TVI), we are now able to investigate the dynamics of movements in identified muscles. The US method provides advantages compared to EMG or MRI/CT, since the muscle motion can be better detected and quantified in terms of velocity and accelerations as well as synchronicity of muscle contraction. This will allow not only the monitoring of muscle tissue volume during processes of atrophy or after exercise, but also for monitoring the effect of medical or physiotherapies on movements, e. g., during rehabilitation or sports. Myosonology may become a powerful tool for neurologists and physiotherapists.

Schlüsselwörter

B-Bild - Muskelkontraktion - Tisue velocity image/TVI - ultraschallgesteuerte Nadelpositionierung - Schlaganfall

Key words

B-mode image - muscle contraction - tissue velocity imaging - ultrasound-guided needle placement - stroke

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