In vivo assessment of the levator ani muscles using shear wave elastography: a feasibility study in women

Gachon, Bertrand; Nordez, Antoine; Pierre, Fabrice H.F.; Fradet, Laetitia; Fritel, Xavier; Desseauve, David

doi:10.1007/s00192-018-3693-4

Cited by 29 publications

(31 citation statements)

References 34 publications

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“…-Specificity for the levator ani muscle assessment For this assessment, we will use the procedure that we described for nonpregnant women in a previous publication [13]. The examination will be performed with the woman in the lithotomy position after voiding.…”

Section: Shear Wave Elastography Assessmentsmentioning

confidence: 99%

“…We will prevent levator coactivation in the same way that we described for ultrasound pelvic floor assessment [31]. With this procedure, a previous study reported that the shear modulus measured in levator ani muscle in non pregnant women is about 16 kPa at rest and 35 kPa during Valsalva maneuver [13].…”

Section: Shear Wave Elastography Assessmentsmentioning

confidence: 99%

“…To date, several techniques have been described to assess the in vivo elastic properties of the pelvic floor muscles (vaginal elastometry, tactile imaging, elastography) [13,14]. One of the most relevant techniques is shear wave elastography (SWE), which allows a direct, quantitative and noninvasive assessment of the muscles [15].…”

Section: Introductionmentioning

confidence: 99%

“…One of the most relevant techniques is shear wave elastography (SWE), which allows a direct, quantitative and noninvasive assessment of the muscles [15]. Recently, we reported the feasibility of an in vivo assessment of the elastic properties of the levator ani muscle using this technique (100% of procedures allowing a visualization of the levator ani muscle and a measure of elastic properties in women with a lower than 35Kg.m − 2 body mass index) [13].…”

Section: Introductionmentioning

confidence: 99%

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In vivo assessment of the elastic properties of women’s pelvic floor during pregnancy using shear wave elastography: design and protocol of the ELASTOPELV study

Gachon

Fritel

Pierre

et al. 2020

BMC Musculoskelet Disord

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Background: Animal studies have reported an increase in pelvic floor muscle stiffness during pregnancy, which might be a protective process against perineal trauma at delivery. Our main objective is to describe the changes in the elastic properties of the pelvic floor muscles (levator ani, external anal sphincter) during human pregnancy using shear wave elastography (SWE) technology. Secondary objectives are as follows: i) to look for specific changes of the pelvic floor muscles compared to peripheral muscles; ii) to determine whether an association between the elastic properties of the levator ani and perineal clinical and B-mode ultrasound measures exists; and iii) to provide explorative data about an association between pelvic floor muscle characteristics and the risk of perineal tears. Methods: Our prospective monocentric study will involve three visits (14-18, 24-28, and 34-38 weeks of pregnancy) and include nulliparous women older than 18 years, with a normal pregnancy and a body mass index (BMI) lower than 35 kg.m − 2. Each visit will consist of a clinical pelvic floor assessment (using the Pelvic Organ Prolapse Quantification system), an ultrasound perineal measure of the anteroposterior hiatal diameter and SWE assessment of the levator ani and the external anal sphincter muscles (at rest, during the Valsalva maneuver and during pelvic floor contraction), and SWE assessment of both the biceps brachii and the gastrocnemius medialis (at rest, extension and contraction). We will collect data about the mode of delivery and the occurrence of perineal tears. We will investigate changes in continuous variables collected using the Friedman test. We will look for an association between the elastic properties of the levator ani muscle and clinical / ultrasound measures using a Spearman test at each trimester. We will investigate the association between the elastic properties of the pelvic floor muscles and perineal tear occurrence using a multivariate analysis with logistic regression. Discussion: This study will provide original in vivo human data about the biomechanical changes of pregnant women's pelvic floor. The results may lead to an individualized risk assessment of perineal trauma at childbirth. Trial registration: This study was registered on https://clinicaltrials.gov on July 26, 2018 (NCT03602196).

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Section: Shear Wave Elastography Assessmentsmentioning

confidence: 99%

Section: Shear Wave Elastography Assessmentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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In vivo assessment of the elastic properties of women’s pelvic floor during pregnancy using shear wave elastography: design and protocol of the ELASTOPELV study

Gachon

Fritel

Pierre

et al. 2020

BMC Musculoskelet Disord

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“…Furthermore, we anticipate that SW ultrasound elastography will be used increasingly as part of the standard work-up for infertility and fertility preservation counseling since ovarian tissue stiffness has been an implication in oocyte quality. 21 SW ultrasound elastography has also been applied to other nonovarian gynecologic pathologies, such as adenomyosis, [71][72][73][74] fibroids, 72,74 endometrial cancer, 75 cervical cancer, 76,77 pelvic floor disorders, 78,79 cervical insufficiency, [80][81][82] and preterm delivery. 83 Simultaneous advances in our understanding and interpretation of SW ultrasound elastography from basic science and engineering to clinical medicine are expected to contribute to our understanding of and ability to model tissue structure and function in health and disease and to improve patient care, by improving diagnosis and prognosis in a noninvasive way.…”

Section: Clinical Applicationsmentioning

confidence: 99%

Ultrasound Shear Wave Velocity Varies Across Anatomical Region in Ex Vivo Bovine Ovaries

Gargus

Jakubowski

Arenas

et al. 2020

Tissue Engineering Part A

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The physical properties of the ovarian extracellular matrix (ECM) regulate the function of ovarian cells, specifically the ability of the ovary to maintain a quiescent primordial follicle pool while allowing a subset of follicles to grow and mature in the estrous cycle. Design of a long-term, cycling artificial ovary has been hindered by the limited information regarding the mechanical properties of the ovary. In particular, differences in the mechanical properties of the two ovarian compartments, the cortex and medulla, have never been quantified. Shear wave (SW) ultrasound elastography is an imaging modality that enables assessment of material properties, such as the mechanical properties, based on the velocity of SWs, and visualization of internal anatomy, when coupled with B-mode ultrasound. We used SW ultrasound elastography to assess whole, ex vivo bovine ovaries. We demonstrated, for the first time, a difference in mechanical properties, as inferred from SW velocity, between the cortex and medulla, as measured along the length (cortex: 2.57-0.53 m/s, medulla: 2.87-0.77 m/s, p < 0.0001) and width (cortex: 2.99-0.81 m/s, medulla: 3.24-0.97 m/s, p < 0.05) and that the spatial distribution and magnitude of SW velocity vary between these two anatomical planes. This work contributes to a larger body of literature assessing the mechanical properties of the ovary and related cells and specialized ECMs and will enable the rational design of biomimetic tissue engineered models and durable bioprostheses. Impact Statement Shear wave (SW) ultrasound elastography can be used to simultaneously assess the material properties and tissue structures when accompanied with B-mode ultrasound. We report a quantitative difference in mechanical properties, as inferred from SW velocity, between the cortex and medulla, with SW velocity being 11.4% and 8.4% higher in the medulla than the cortex when measured along the length and width, respectively. This investigation into the spatial and temporal variation in SW velocity in bovine ovaries will encourage and improve design of more biomimetic scaffolds for ovarian tissue engineering.

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Quantifying Levator Ani Muscle Elasticity Under Normal and Prolapse Conditions by Shear Wave Elastography

Tang

Chen

Wen

et al. 2020

J of Ultrasound Medicine

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ObjectivesThe primary purpose of this study was to determine whether elasticity quantification of the levator ani muscle (LAM) using shear wave elastography (SWE) is different between women with and without pelvic organ prolapse (POP) and to determine whether LAM elasticity is associated with the prolapse stage or the dimensions of the levator hiatus. The secondary aim was to evaluate the intraobserver and interobserver reliability of LAM elasticity measurements using SWE.MethodsThe study participants included 20 women with normal pelvic support and 38 women with prolapse (stages I–III). The levator hiatus was imaged by transperineal 3‐dimensional ultrasound, and LAM elasticity and the elastic modulus were measured by SWE at rest and while performing the Valsalva maneuver.ResultsThe elastic modulus increased significantly from rest to during to maximal Valsalva maneuver (29.2 versus 54.1 kPa; P < .05) in all women. Levator ani muscle elasticity was significantly higher under prolapse conditions than under normal conditions at rest (27.9 versus 31 kPa; P < .001) but was lower during the maximal Valsalva maneuver than under normal conditions (57.3 versus 53.1 kPa; P < .05). Levator ani muscle elasticity at rest was associated with the hiatus area during the Valsalva maneuver (Spearman r = 0.608; P < .001) and distensibility of the levator hiatus (r = 0.594; P < .001), and the hiatus area decreased as the LAM elastic modulus increased during the maximal Valsalva maneuver (r = –0.414; P < .05). Moreover, LAM elasticity was associated with the severity of prolapse (P < .001).ConclusionsAs a noninvasive quantitative method, SWE, may be used to assess the biomechanical properties of the pelvic floor muscle, providing some research basis for a thorough understanding of POP and its treatment and prevention.

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In vivo assessment of the levator ani muscles using shear wave elastography: a feasibility study in women

Abstract: An assessment of the elastic properties of the levator ani muscles is feasible for nonpregnant women. The reproducibility of the technique and its application in pregnant women and women with pelvic floor disorders must be investigated.

Cited by 29 publications

References 34 publications

In vivo assessment of the elastic properties of women’s pelvic floor during pregnancy using shear wave elastography: design and protocol of the ELASTOPELV study

In vivo assessment of the elastic properties of women’s pelvic floor during pregnancy using shear wave elastography: design and protocol of the ELASTOPELV study

Ultrasound Shear Wave Velocity Varies Across Anatomical Region in Ex Vivo Bovine Ovaries

Quantifying Levator Ani Muscle Elasticity Under Normal and Prolapse Conditions by Shear Wave Elastography

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