• Local Binary Pattern identfied the Echotexture of Stiffness Biceps Brachi Muscle in Stroke

    Peng-Ta Liu MS, Ta-Sen Wei MD, Huihau-Kenny Chiang PhD

    Institute of Biomedical Engineering. National Yang-Ming University.
    E-mail: hkchiang@ym.edu.tw
    No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan (R.O.C.).

  • The Echotexture of Spastic Muscle in Stroke Patients Using Local Binary Pattern with Sonoelastographic Imaging

    Background: Muscle properties changes early after stroke. Accurately characterizing and quantifying the stiff muscle is clinically important to better understand the altered muscle function and movement control.

    Objective: The aim of this study was to investigate the feasibility of sonoelastography to determine the muscle stiffness and the echotexture in poststroke. We also tested the relationship among sonoelastography findings, muscle echotexture features and functional performance in the spastic muscle.

    Methods: A total of 21 men with subacute stroke were studied. The intrinsic stiffness of biceps brachii muscles (BBM) on both arms were assessed at rest by shear wave velocity and echotexture features (entropy & energy) were extracted by Local Binary Pattern (LBP) of ultrasound imaging. The scanning images of BBM were acquired in both the transverse and the longitudinal planes. The Fugl-Meyer Assessment (FMA) and Functional Independence Measure (FIM) were used to assess the functional performance of upper arm.

    Results: The shear wave velocity was significantly faster in paretic BBM, compared to non-paretic BBM in the transverse and the longitudinal planes. The echotexture (entropy & energy) was more in-homogeneous in the paretic BBM than in the non-paretic side on both scanning planes. The shear wave velocity was negatively correlated to entropy (r = – 0.44, P = 0.04) and energy (r = 0.49, P = 0.02) in the longitudinal plane. The energy was correlated to FMA (r = – 0.46, P = 0.03), FIM (r = – 0.55, P < 0.01) in the longitudinal plane, and duration from stroke onset (r = 0.49, P = 0.03), age (r = – 0.53, P = 0.02) in the transverse plane.

    Conclusion: The echotexture of LBP is capable to be a useful tool for quantitative assessment of the spastic BBM in patients with early stroke.

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  • Introduction

    Background: The aim of this study was to identify the echotexture of paretic muscle in stroke patients.

    • Muscle property changes lead to echotexture change, over time, muscle get stiffer.
    • Methods to assess muscle property and limitations.
    • SWE has been used to assess stiffness, but only quantitative information.
    • Echotexture has to quantify the muscle property change and follow up indicator.
    • Correlation of SWE and echo with functions is unknown

    One way to describe the muscle properties is “stiffness”
    Methods to assess stiff, xxx


    • Muscle property change leads to muscle stiffness
    • the methods assess the property by US texture analysis
    • links between property = stiff, recently swv is a good methods
    • swv is reasonable seen as isotropic, but muscle property change may get less accuracy.
    • therefore, little know about the swv and texture.
  • Methods

    Shear wave velocity was used to measure the stiffness of biceps brachi muscle and echotexture was extracted by local binary pattern. The differences between paretic and non-paretic BBM were evaluated. The correlations among the stiffness, echotexture and functional performance were also tested.

  • Results

    1. The echotexture (entropy & energy) is different between paretic and non-paretic BBM in both plane

    2. The shear wave velocity is faster in paretic BBM. in transverse and longitudinal planes for stroke patients

    3. The energy/entropy is correlated to functions (FIM/fugl meyer) and onset duration, age. But none of echotexture is correlated to swv

    4. The shear wave velocity is negatively correlated to ENT/ENG in longitudinal plane -> concentration theory. WHY transverse no correlated?

    5. THe R of LBP is different in both plane in both plane? The optimal radius of R is 3

  • Discussions

    • Recap the main findings - ecotexture of paretic muscle is inhomogeneous, and correlated to muscle stiff.
    • Secondary findings - correlate to function
    • Clinical application

    1. 痙攣的肌肉紋理較不和諧
      ->本篇利用SWV確認痙攣的肌肉硬度較高,前人的研究一致(wu, gao 利用EI)。
      ->IMF 增加 & 痙攣後結構改變。
      ->Signal is the interaction between structure and component -> on this basis, the echotexture changed.
      ->Interactions of structure and composition
      ->Textural analysis compare the findings
    2. 肌肉的紋理與硬度成反比
      ->PDF理論 (Ex: breast cancer, Myofascia trigger pain)
    3. 紋理與功能相關性
      ->硬度與功能; high order for textrue
    4. 肌肉紋理的特徵與肌纖維方向相關 (Anisotropy)
      ->縱向-條紋;橫向-偏全黑,所以我的橫-縱結果也不一樣(ROI size / ENT or ENG)。
    5. clinical: botox / sarcopenia follow up.
  • Conclusion

    *The echotexture extracted by local binary pattern may be a useful diagnositic tool for assess and follow-up the muscle property changes after stroke.

    • Computer-aided diagnosis of paretic muscle ultrasound image is necessary, as it will contribute to the establishment of a standard method for grading muscle quality, and improve clinical diagnostic accuracy, repeatability, and efficiency.
  • Research Notes

  • Common knowledge

    Spasticity (hyperactiviity), muscle weakness (hypoactivity) and joint contracture (immobilization) are often seen consequences poststroke and cause considerable long-term motor impairments to stroke survivors.

    Over time, material properties of muscles in the impaired limbs can also change gradually, further disrupting motor function, and adversely impacting the stroke survivor’s quality of life.

    Subsequent to these impairments, morphologic changes in the architecture of the paretic muscles often occur, which affect the muscles’ functions. Previous studies have revealed a reduction in muscle volume, a shortening of muscle fiber, and a reduction in the number of motor units in the paretic muscles in people after stroke. `These muscle deformations were highly related to syndromes of paretic muscles, such as muscle weakness, spasticity, and contracture.

    Evaluating muscle property variations in people after stroke is clinically important for both diagnosis and rehabilitation treatment.

    Muscle property changes includes IMF, EMC, connective tissue accumation. Recently, sonography is using b mode and EI to assess these changes. But EI can not be compared. More recent advanced imaging, SW is an alternative tool to measure the muscle stiffness.


    Spasticity lead to chagnes in muscle including muscle stiffness and muscle property change.
    Weakness lead to loss fiber elasticiity.
    Joint contracture leads to shorten length of muscle fiber and joint stiffness.

    “The in vivo assessment of the biomechanical properties of the skeletal muscle is a complex issue because the muscle is an anisotropic, viscoelastic and dynamic medium” (Gennisson et al 2010:789)

    Examining the mechanical properties of muscle is important in monitoring the stage of the pathologic processes of muscles and for assessing efficacy of therapeutic interventions

    One of the way to descript the material property is stiffness.

    Past studies try to use MAS/myotonometr etc., to measure the muscle stiffness
    [XXXX]
    the Ashworth scale and modified Ashworth scale remain low-sensitivity instruments for distinguishing between soft tissue and neural contributions to hypertonia

    -> however it is not reliable / not handy. -> lack of diagnostic biomarkers

    Paet studies use US to assess the muscle quality, but operator dependant. [xxx]

    More recently, Echotexture features was used to test the muscle quality to minimize the operator factors. Interpreted as the uniformity of the muscle pattern, provide further information about muscle property, beside the echo intensity which is highly dependent on the ultrasound scanner setting (plane, anisotropy) and wave energy scattering i.e. the distribution of the pixel intensity.

    Recently SWE’s speed is related to stiffness (young’s modulus) -> high SWV is high stiff, SWE can assess muscel mechanincal properties (muscle stiffness) [xxx]

  • How to measure the muscle stiffness

    B mode can not provide muscle stiffness information which might be related to spasticity
    也就是說藉由量stiff然後去連結spasticity

    Many studies showed that stiffness increased in spastic muscles due to changes in fiber type transformation. Morphometric and
    histochemical investigations show changes in mechanical muscle-fiber properties that might contribute to spastic muscle tone [7-12]. Changes in biomechanical conditions of a muscle might also have an important effect on the spasticity in people with stroke.

    Shearwave (SW) ultrasound elastography,which builds upon traditional elastography, allows quantitative in vivo measurement of tissue material properties (Bercoff et al., 2004). Using the same acoustic radiation forces as B-mode ultrasound, we use the SuperSonic Shear Imagine (Bercoff et al., 2004), a method that uses multiple ultrasound push
    beams to induce the SWs and subsequently, to measure the SW speed in muscle. The speed of these SWs is related to material properties, such that SWs travel faster through stiffer tissues.

    Sonoelastography is based on the calculation of Young’s elastic modulus, a physical quantity measuring stiffness

    This technique has emerged as a reliable method to estimate material properties in a variety
    of tissues (Bouillard et al., 2012), including muscle (Bouillard et al.)
    2012; Eby et al., 2013; Lacourpaille et al., 2012).

    Recently, SW speed in the biceps brachii muscle of the paretic side was found to be
    on average 69.5% greater than the non-paretic side in stroke survivors
    (Lee et al., 2015)

    Shear waves are tracked by pulse-echo ultrasound and can be used quantitatively to calculate the tissue modulus (ie, stiffness); as the stiffness of underlying tissue increases, shear-wave speed increases.

  • How to measure the echotexture

    • traditonal EI
    • GLCM
    • Local Binary
  • Why important (Gaps)

    The stiffness is correlated to muscle tone and muscle property changes results in muscle architexture change after a stroke. Although SWV measure muscle in a in-directly way.

    Muscle plasticity (2017 Maud Creze)

    Thus, considering physical activity leading to angiogenesis and muscular fiber changes, and inactivity leading to sarcopenia and fat infiltration, we could expect that muscle plasticity would induce stiffness changes. However, SWE did not reveal the quantitative stiffness changes expected in relation to the specific muscle histology of samples extracted from females or males, athletes, juniors or seniors.

    Little known of the echotexture of stiff muscle. and echotexture related to arm functions.
    Early Intervention reference, treatments follow up

  • I want to prove and how

    Under the assumption that pathological muscle tissue appears to be diffuse and unstructured, a texture-based analysis seems adequate for detecting XXX in ultrasound images.
    1) in the past study, us was used to test the muscle quality changes, (who check the stiffness by traditional US?) what do they find? I persume that muscle get stiffer, the velocity get higher, and the echotexture changes as well.
    2) the resting muscle tone (combine neurological plasticity, and properties changned). So echotexture might help to identify the muscle properties part rather than the neurological part. So, Stiff muscle = mas + muscle property.

  • 痙攣是腦中風後常見的現象常導致功能的障礙
    痙攣是上運動神經元受損產生不正常的反射張力,用來評估功能與癒後的重要追蹤指標之一。
    (muscle stiffness = tone + biomechanical factor)
    臨床上常使用被動牽拉來評斷痙攣嚴重程度,但痙攣易受病情/情緒/溫度或人為操作等因素影響,且被動牽拉的阻力來也自於肌肉結構與內容的改變造成評估痙攣區別上的困難與不穩定性。

    過去研究顯示為區別兩者的組成,反射張力可以肌電圖偵測動作時的肌電訊號,超音波可提供客觀的肌肉組織與結構的變化,例如肌纖維縮短變型態或因肌肉脂肪滲入&結締組織堆積造成灰階值增加。由於組織與內容的改變,在肌肉影像的紋理(microstructure)自然也會造成改變,有研究已特徵方式XXX來評估肌肉疾病的分類,例如xxx,Gao 也嘗試已TAI來評估肌肉硬度??。
    隨著影像技術的進度,SWV 也是評估肌肉痙攣與硬度的一種方式,WU&xxx嘗試(check my summary notes),雖然SWV可以提供波速純量,但是SWV較受人為,壓力影響還有anisotropy的因素,在者波素與紋理特徵也沒有清楚了解,因此,本研究的目的即是探討痙攣肌肉紋理特徵與硬度的關係,並分析紋理/硬度與功能的關聯性。

  • Subject

    IRB
    Inclusion criteria

    • age
    • onset duration
    • no trauma history
    • no elbow joint contracture or ROM limitation
  • Shear wave velocity measurement

    • Acuson system
    • probe placement
    • Image taken
    • ROI
  • Local binary pattern for echotexture

    • the formula
    • the energy and entropy
    • size of R
  • Muscle tone and functions

    • MAS / Tardieu
    • Fugl Meyer
    • FIM ? (if no correlations, delete it)
  • Statistical analysis

    • Quantitative show mean +/- SD
    • Nonparamatic t and paired t test
  • Table 1: Demogrphic data

    A total of Twenty-two stroke patients finished the sonoelastograpic measurements of biceps brachii muscle and clinical evaluations. The demographic data and functional assessments are summarized in Table 1.

  • Figure 2 The muscle stiffness between paretic and nonparetic BBM in the longitudinal and transverse plane.

  • The echotexture (entropy & energy) is different between paretic and non-paretic BBM

  • Correlations between variable differnece

    Sabrina S.M. Lee, 2015 : difference of swv correlated to difference of echo intensity at biceps (check the Fig 5) and the explainations in content.

  • Recap the main findings

    ( ENT/ENG可以區辨痙攣BBM)The echotexture of spastic muscle is defined by high order statistical textual analysis with local binary patterns in energy and entropy.

  • Secondary important findings

  • Muscle fiber in shirt position, sacromere reduce, architecture change makes fiber shorten. The sound wave reflect environment changed, so the echo texture change(what changes?)
    Normal muscle scan in longitudinal plane, the perusing is clear to seen, but in myo or neuropathy become blue it is related to anisotropy

  • Local Binary Patterns merits and drawbacks

    Compared to Echo Intensity

  • Anisotropy: The variability of scan plane

    BB muscle for the transverse and longitudinal scans (Table 1)
    had similar mean values, standard deviation and CVs, but different
    ICCs between probes orientations, being the transverse
    one more reliable (r = 0!84) than the other (r = 0!39). (da Silva, 2017)

  • Unfortunately, these reviews target health care providers with a strong background in ultrasound physics and provide limited discussion of the clinical application and significance of ultrasound elastography with respect to muscle. Thus, they are of little assistance to the typical physical medicine and rehabilitation physician seeking to improve clinical practice by adding ultrasound elastography. Many rehabilitation strategies are aimed at changing the mechanical properties of muscle.

  • Muscle plasticity (2017 Maud Creze)

    Thus, considering physical activity leading to angiogenesis
    and muscular fiber changes, and inactivity leading to
    sarcopenia and fat infiltration, we could expect that muscle
    plasticity would induce stiffness changes. However, SWE
    did not reveal the quantitative stiffness changes expected in relation to the specific muscle histology of samples extracted from females or males, athletes, juniors or seniors.

  • Clinical implications:

    • botox injection follow up: Rafael Fortuna, (2011) muscle atrophy fat infiltration after inject 3 months later, and compare to normal group, only connective tissue increased. (check figure)
  • Muscle stiffness and muscle property, as indicated by SW speed and echotexture, were changed in stroke-impaired muscle at rest. These findings highlight the potential for echotexture features extracted by LBP as a tool for both investigating the fundamental changes in stroke-impaired muscle, and for evaluation of muscle mechanical properties as part of clinical examination.

  • “Proper evaluation of muscle properties is important in monitoring the progression of individuals during rehabilitation therapy, in making appropriate clinical decisions, for planning optimal treatment, and for assessing the efficacy of therapeutic interventions.” (Chuang et al 2012:533)

  • Introduction flow: (Lee, 2016)

    stroke is most common NMD -> impairement = neural (primary) + muscle property (secondary) = Quantify muscle property is challenge.
    Muscle properties changes are xxx -> impact movement.
    Measuremen are XXX -> however these prior methods have multiple limitations including

    • limited accuracy
    • muscle specificity
    • repeatability
    • ease use
    • cost-effectiveness
    • Invaluable information of stiffness mechanism at cellular and fiber livel
      SWV measure the paretic side XXX
      Building upon these results, the goal of this study was to XXX.
      We hypothesized that SWV speed would XXX
  • ?
    My results showed an odd pattern. the swv is negatively correlated to entropy. But in my findings, the paretic arm of entropy is higher than non-paretic arm. It is totally conflicts.
    the more harder (SWV) the muscle, the higher entropy has. It should be positive correlation between swv and entropy. But my result did not meet this finding when perform the spearaman correlation test. It has strong negative correlation between them.

  • Introduction flow: (Lee, 2015)

    Stroke is long term disability. Impairments include XXX. These impairements lead to muscle properites change over time -> impact QoL.
    Muscle stiffness, past studies results -> However, methods were made indirectly.
    Quickly quantify changes in muscle stiffness of specific muscles in a clinical setting remains a challenge.
    Recently, SWV have investigated the stiffness on XXX. High speed is in spastic muscle. -> indirectly estimate stiffness.
    Accordingly, we sought to determine XXX. We also assessed the echotexture of BBM and correlated our estimates of material properties with major clinical assessments in cluding, FIM FMA.

  • Spasticity = tone + stiffness

  • muscle property changes after stroke*

    • IMF ECM connetive tissue acculmation lead to further fiber shorten, visco-elasticity thxithplaticity, joint contrature. Therefore, the architecture of muscle changes and more straight the echotexture is changed,

    • Histolopathological studies have demonstrated a generalized increase in extracellular connective tissue in spastic muscles. It is known that increased connective tissue in an immobilized and contracted muscle reduces its compliance (Stecco et al 2014:121)

    • muscle mechanical properties could provide clinically viable information to follow the effects of neuromuscular disorders or potential improvements due to various treatments.

    The disruption of normal muscle architecture caused by the infiltration of fat and the development of fibrosis has been reported to increase reflections of the ultrasound beam, resulting in an increased echo intensity of spastic muscles. Based on this, the development of changes in the muscle structure has been reported to influence the echotexture.

  • Manual testing (Not measure stiffness??)

    • MAS
    • Tardieu

    MAS might not be as sensitive in detecting muscle stiffness.

  • Instruments

    • Myoton meter
  • Imaging

    • MRI
    • Ultrasound (echo?? / morphology)
    • Elastography (Recently popular)
  • Echo Intensity changes

    Enhanced echo intensity (EI) on ultrasonography images of skeletal muscle is believed to reflect muscle quality.

    EI is based on the histogram of the greyscale pixels of the ROI. The histogram provides a unidimensional analysis and classifies the tissue as hyperechoic or hypoechoic.
    To overcome XXX limitations, image texture anslsysis can be used as it is a mathematical proceduure that takes into accout the two-dimensional distribution of pixels in the ROI and can be obtained by several statistical techniques XXXX for US image texture characterization.

  • Ultrasonography can reveal morphological changes in spastic muscle architecture and is useful for assessing the properties of the muscle.

    However, B-mode ultrasonography does not provide information on muscle stiffness, which may be associated with spasticity. Use of ultrasound elastography is a recently developed, ultrasound-based method to evaluate tissue elasticity.

  • Local Binary Pattern (ENT)

    Because the texture of a tissue image reflects its scatterers’ properties, the entropy can be used to characterize the texture of an input image.
    (Turo, 2013) use ENT a measure of heterogeneity of the tissue for differentiating tissue problem such as…

    1. upper trapezius of symptomatic and asymptomatic patients
    2. normal from abnormal myocardial structure
    3. brain tissues and liver cancer.
  • SWE has been reported to be a reliable tool for detecting muscle stiffness. For example, XXXX. However, their role as diagnostic or progression biomarkers is unknown, because of the high inter-individual variability in structural parameters. Therefore, it would be XXX to find a MUS biomarker not influenced by factors other than disease factors. Echotexture has been previously reported to characterize XXX.

  • Little known the relations between stiff and echotexture

    • stiff -> muscle property change
    • muscle property change -> echotexture
    • echotexture -> muscle functional performance
  • Important for follow up

    “Quantitative elastography might help by providing a parameter that could influence the diagnosis but it could also provide a way to monitor the effectiveness of a treatment by quantifying the changes of the muscle mechanical state.” (Gennisson et al 2010:790)

  • Hypothesis, right and left are different, transverse and the longitudinal plane but is different

  • The aim of the current study is to quantify differences in shear wave velcoity and echotexture between subjects with stroke from ultrasound using Local binary pattern image analysis methods.
    We hypothesize that simple grayscale parameters estimating quantitative muscle
    echotexture parameters derived from LBP-based images would be different between paretic and non-paretic BBM.

  • The study protocol was approved by the Research Ethics Committee of a medical center hospital and written informed consent was obtained from all subjects.

    Inclusion criteria

    All subjects were recruited from a rehabilitation ward in a medical center. The Inclusion criteria were (i) age >30 years, (ii) absence of cervical radiculopathy symptoms or other central or peripheral neurologic deficits in the upper limbs, (iii) bilateral elbow range of motion flexion within 0–145 degrees, and (iV) onset duration less than 3 months. Exclusion criteria were (i) history of botulinum toxin injection; and (ii) history of upper limb surgery.

  • Subjects testing position

    All subjects were placed supine and instructed to relax his examed elbow during ultrasound imaging capture. A low-temperature premade arm splint was used to standardize the arm position and to minimize the activity of recorded muscles. The shoulder was placed so that the humerus was abducted 45°, and the elbow positioned at 90°.

    Give a photo for demostration

  • Imaging capture system

    B-mode ultrasound scanning images and SWV values were captured from both elbows using an Acuson S2000 ARFI Ultrasonography System (Siemens, Munich, Germany) equipped with a 7~9 MHz linear transducer (9 L4, Siemens).
    To ensure the applied proper pressure on the transducer during SWV acquisition, the “Quantify index” above 80 is needed for high reliable test value.

  • Probe placement

    All scans of biceps brachii muscle were acquired by placing the transducer at two thirds of the distance from the acromion to the antecubital crease (Molinari et al 2015:2521)

    “The probe was oriented parallel to the muscle fibers to obtain SWV measurements in the longitudinal axis and rotated 90 for SWV measurements in the transverse axis.” (Wu et al 2017:1106)

    “BB US images were acquired at 60% of the distance between the posterior ridge of the acromion and the olecranon of the right arm, while the subject was seated with his arms relaxed on their respective sides (Matta et al., 2011).” (da Silva Pereira Júnior et al 2017:85)

  • ROI

    The region of interest (ROI) was set to the mid portion of the BBM thickness for measuring the BBM stiffness. The scanned images were then transferred to a computer in the Digital Imaging and Communications in Medicine (DICOM) format for further extracting the echotextural features.

    The ROI size of 142 x 142 pixels for BBM on an 8-bit gray-scale was selected at which muscle SWV was measured.

    Sonoelastography was performed in both transverse
    and longitudinal planes. In each plane, three measurements of SWV and ROI were acquired from bilateral biceps brachii and averaged for further statistical analysis.

  • Times of SWV measure

    “Five measurements of SWV were acquired from bilateral biceps brachii in each elbow posture and averaged for further statistical analysis” (Wu et al 2017:1107)
    The unaffected contralateral side was examined at the same time under identical conditions and served as normal image control

  • Local binary pattern image and then calculate the Entropy and energy

    please refer to Hirvasniemi, 2017, bone texture

    “A Local Binary Pattern (LBP) (Ojala et al., 2002) is a local texture operator with powerful discrimination, low computational complexity, and less sensitivity to changes in illumination. The LBP operator is obtained by evaluating the binary difference between the gray value of a pixel x from the gray values of its P neighborhood placed on a circle radius of R” (Nanni et al 2010:7891)

    “To calculate the LBP operator the local binary difference between the gray value of a pixel x and the gray values of P pixels in a local neighborhood of x placed on a circle of radius R is evaluated. To obtain a rotation invariant descriptor [9], P 1 bitwise shift operations on the binary pattern are performed, and the smallest value is selected. A pattern is defined “uniform” if the number of transactions between “0” and “1” of the sequence is less or equal to two, with the number of different types of uniform patterns that can occur being P + 1. To describe a given image, the histogram of dimension P + 2 is extracted. It contains the occurrence of the P + 1 types of uniform patterns, and the number of non-uniform patterns.” (Nanni et al 2010:118)

  • The definition of entropy and energy

    The US image with irregular informative texture. This can be quantitfied by texture features like local binary pattern.
    Two features were extracted from each ROI.
    These features are based on statistical and transformation on the ROI.
    The textural descriptor is LBP. and the LBP features are ENT / ENG.
    “Entropy: The entropy is a measure of average information in a block.” (Brehar and Nedevschi 2013:119)

    “The entropy is high when the local binary patterns or the gradient magnitudes are distributed among many values.” (Brehar and Nedevschi 2013:119)

    “Energy: In our work we define energy as a measure that shows how the local binary patterns or the gradient magnitudes are distributed on different bins.” (Brehar and Nedevschi 2013:119)

    “The energy is low when the number of uniform patterns or the number of gray levels of the gradient magnitude are high. The energy is maximum when we have only one LBP pattern or only one gradient magnitude value in the block.” (Brehar and Nedevschi 2013:119)

    The local binary pattern image was then calculate the entropy and energy. The rodness of image is high for entroy.


    Entropy: The entropy is a measure of average information in a block. We use the following formula for computing the entropy of a block:
    H = - p(b)*log2(p(b))

    The entropy is high when the local binary patterns or the gradient magnitudes are distributed among many values.

    Energy: In our work we define energy as a measure that shows how the local binary patterns or the gradient magnitudes
    are distributed on different bins. We define the energy of a block as:
    E = (p(b))2

    The energy is low when the number of uniform patterns or the number of gray levels of the gradient magnitude are high.

    The energy is maximum when we have only one LBP pattern or only one gradient magnitude value in the block.

  • Size of R and P

    “We considered P equal to 24 pixels and R equal to 3 pixels, in order to consider a relatively large neighborhood.” (Molinari et al 2015:2532)

  • MAS

    BBM spasticity was evaluated at the paretic arm by the Modified Ashworth Scale (MAS) and the Tardieu Scale (TS).

    The MAS is a simple evaluative method to assess the spasticity with the six levels scoring. The 0 = no increase in muscle tone; 4 = affected part(s) rigid in flexion or extension.(Pandyan et al. 2003)

    measures resistance during passive soft-tissue stretching and is used as a simple measure of spasticity.[1] Scoring (taken from Bohannon and Smith, 1987):

  • Tardieu Scale

    TS evaluates the spasticity angle (the angle at which muscle reaction occurs at 3 velocities: as slow as possible (V1), falling under gravity (V2), and as fast as possible (V3).

  • Fugl Meyer Assessment

  • Functional Independent Measure (FIM)

  • Normality test

    Shapiro-will test
    If the p value is greater than alpha value:0.05, the null hypothesis is accepted
    So the tested data is normality.

  • Nonparamatric paired-t test

    Wilcoxon signed rank paired t-test were uesd to test the difference of variables bewteen paretic and non-paretic BBM.

    Wilcoxon signed-rank test was used for comparison between the hardness with the use of the two types of

    As the Shapiro – Wilk test for normal distribution of the data
    failed, non-parametric tests were used. The Wilcoxon signed
    rank sum test was used to compare muscle echo intensity and
    muscle and subcutaneous layer thickness between the two sides
    (dominant versus non-dominant).
    The relationships between the actual and
    measured hardness were examined by the least square method.

    SPSS® statistics v. 22 (IBM Corp., Tokyo, Japan; formerly SPSS Inc., Chicago, IL) was applied for statistical analysis. Values of p < 0.05 were set to indicate significance.

  • Correlation test:

    The Spearman rank correlation analysis was used to test for linear correlations between echo intensity and thickness measurements

  • R size differences

    To test the differences among R size using “Fridaman test”
    => nonparametic k-related t test

    • Figure 2 showed that the spastic BBM had signicantly higher shear wave speed (P < 0.001) in both the transverse and the longitudinal planes.

    • The ENT_r2 was higher for paretic BBM in the Longitudinal plane (p = 0.05). The ENG was non-significant difference between paretic and non-paretic BBM in the lingitudinal plane.
      In the transverse plane, The echotexture of paretic BBM was significantly in-homogeneous than non-paretic BBM in ENT_r1 and ENG_r1.


      The size of radius, less than 3 is enough to differintiate the echotexture for paretic and non-paretic BBM.

      • A coefficient of determination analysis revealed a significant relationship between XXX and B (r2 = XXX, p = 0.000).
      • Only A correlated with B in the stroke patients (r = , P = )
      • No significant correlation was found for XXX (r = , P = )
    • first paper use LBP for paretic muscle

      To our’s knowledge, no prior work has been reported on the image texture feature based quality assessment of paretic muscle ultrasound images using local binary patterns.

      In this paper, the information of image texture features are analyzed using LBP with entropy and energy, and also correlated with muscle stiffness and functional performance.

    • Recently, SW speed in the biceps brachii muscle of the paretic side was found to be on average 69.5% greater than the non-paretic side in stroke survivors (Lee et al., 2015)

    • Theoretically, increased resistance (Stiffness) to passive movement can result from neural factors such as spasticity, or peripheral factors such as changes in the mechanical properties of the muscles (for example, as a result of muscle contracture)

    • Entropy (ENT) / Energy (ENG): physics definition

      Entropy is a term derived from thermodynamics and refers to the quantity of energy that is permanently lost to heat (“chaos”) every time a reaction or a physical transformation occurs. The term is used to non-technical speech to mean “irremediable chaos or disorder”.
      Energy (ENG) is the opposite of entropy and represents orderlines in the image.

    • The ENT is higher (in-homogeneous) in paretic muscle, the muscle stiffer.

      -> In the past study, swv is positively correlated to echo intensity. It represented that the more fat infiltrated into muscle, the elasticity of muscle is lower. In this study, we choose echotexture to test the muscle properties in early stage after stroke. The onset duration get longer, it is reasonable supposed that more fat will infiltrate to muscle. According to concentration theory, the more fat in muscle, the texture of muscle get homogeneous (cite??) therefore the ENT become smaller.

    • “A combination of denervation, disuse, inflammation and remodeling contributes a complex pattern of muscle tissue phenotype change and atrophy that may factor into a decrease in muscle mass and tone” (Gao et al 2018:8)

    • ENT & ENG

      “Acharya et al. reported that two powerful descriptors of the LBP image are the energy and entropy of the LBP distribution” (Molinari et al 2015:2524)

    • Ultrasound signal is interactions between muscle structure and composition

      • All of these changes, make microstructure change results in texture changed. For the structure, muscle fiber type and archticture changes [XXX].
        For the composition, the scattering concentration changes (IMF and connective tissue accumulation).

      In our results, the paretic can prove it, the echotexture is more in-homo than health side.
      when the muscle get stiffer, the density of muscle property become high. As the fiber become more, the echo internsity is whiter. then the ENT gets smaller (homogeneous).


      To miminize the operator factor and age, gender, this (ENT/ENG) could be a follow-up biomarker.

    • Additionally, most SWE techniques assume that the underlying tissue is isotropic, elastic, and locally homogenous—such as that of breast, liver, or thyroid. Muscle, however, is anisotropic: the mechanical properties along muscle fibers differ from those across muscle fibers. This anisotropy requires orientation of the transducer for all SWE techniques to be longitudinal to muscle fibers in order to achieve accurate and reliable measurements. Despite the anisotropy, the shear modulus (a stiffness measure that assumes isotropy) measured from shear-wave speed displays good agreement with the Young modulus (a stiffness measure that assumes isotropy and incompressibility) throughout the range of normal physiologic tension of skeletal muscle. In the medical literature, the shear modulus (or shear elastic modulus) and the Young modulus have both been used in reporting outcomes.

    • Wu, 2018
      muscle stiffness only when the muscle is not stretched. All significant differences and correlations were detected only when the SWV of the biceps brachii muscle was evaluated in the longitudinal axis, not in the transverse axis. The mechanical properties along fibers differ from those across fibers (Brandenburg et al. 2014) (i.e., muscle is anisotropic), so the ultrasound transducer should be oriented longitudinally to the muscle fibers to obtain SWV values with functional relevance (Gennisson et al. 2010). Moreover, Dorado Cortez et al. (2016) reported better reproducibility of muscle SWV measurements in the longitudinal plane than the transverse plane. 2.98 6 0.11 m/s, p 5 0.529). Paretic-side SWV in the longitudinal axis was positively correlated with stroke duration at 90 elbow flexion, but not at 0 . Paretic-side SWV in the longitudinal axis correlated positively with MAS and MTS at both 90 and 0 , but the correlation coefficients were higher at 90 . There was a negative correlation between pareticside SWV in the longitudinal axis and STREAM score (Table 3). In contrast, there were no correlations between paretic-side SWV in the transverse axis and post-stroke duration, MAS, MTS and STREAM score (all p . 0.2). The ICC of inter-rater reliability for SWV measurements was 0.768 (0.373–0.927, ‘‘excellent’’) in the longitudinal axis and 0.552 (0.002–0.846, ‘‘good’’) in the transverse axis.

    • The in vivo assessment of the biomechanical properties of the skeletal muscle is a complex issue because
      the muscle is an anisotropic, viscoelastic and dynamic medium.

    • LBP is less sensitive to complex pattern

      “The resulting pattern is captured as an 8-bit binary number representing one of 256 distinct known patterns. Then, the histogram is computed for the transformed image and considered as a texture-descriptor. The LBP may fail in many cases for anisotropic phenomena since it is more complex than natural textures. Anisotropy is characterized by the global and privileged directions of the structure. The 2D local patterns are less sensitive to such characteristics, because they encode only the frequency of local structures regardless of their global orientations.” (Houam et al 2014:185)

      “Depending on the orientation analyzed, results are different, proving that non-uniform changes due to osteoporosis induce variations in the degree of anisotropy.” (Houam et al 2014:192)

    • Drawback of SWV

      “All commercially available SWE systems are based on the prerequisite that soft tissues are purely elastic, incompressible and isotropic. First, the major technical parameter that influences stiffness measurement is the anisotropic physical properties of the skeletal muscle. The tissular organization of skeletal muscle, which comprises a parallel arrangement of myofibrils, muscular fibers, collagen and elastic fibers, and fascicles, confers anisotropic, in particular orthotropic properties (which are a subset of anisotropic properties that differ along the three orthogonal axes) to the skeletal muscle. These orthotropic physical properties are responsible for the fact that shear waves travel faster along the direction of the fibers than they do when perpendicular to them [19, 21] (Fig. 1). This has a number of consequences. First, stiffness measurements are sensitive to the angle between the probe axis and the orientation of the muscular fibers. Shear modulus measurements using SWE are correlated with Young’s modulus only if the probe is oriented parallel to the muscle fibers. Another consequence is the difficulty assessing meaningful results in muscles with complex anatomy. Multipennate, conic, triangular or fusiform anatomy, which yieldsBmultiorientation^ fibers, introduces a technical difficulty in visualizing the orientation of fibers.” (Creze et al 2017:2)

      #所有商用的SWV量測時的先決條件:組織需是彈性/不可擠壓/同質性。
      主要影響的技術問題就是肌肉是”非同質性物質”,造成方向依賴,無法使用於複雜的組織。 (note on p.2)

    • sarcopenia

      The LBP is good to distingish the muscle type by echotexture analysis. therefore, may used in sarcopenia, the structure changes in the extracellular matrix (ECM), such as an increase in the collagen concentration, may be associated with the EI of skeletal muscle. It is also possible that the structural and biochemical changes in skeletal muscle ECM contribute to aging-related loss of muscle function (eg, impaired in force generation and increased stiffness).” (Watanabe et al 2013:996)

      • “Ultrasound elasticity imaging (UEI) has been developed for quantitatively estimating tissue mechanical property (stiffness) changes associated with tissue pathological conditions” (Gao et al 2016:440)

      • Ultrasound (US) is an important tool for diagnosing of many musculoskeletal tissue conditions. ‘Image texture analysis can be used to characterize the types of tissue. The morphological and textural characteristics of US images are commonly used for qualitative diagnosing (Rahbar et al., 1999; Huber et al., 2000). Quantitatively, the texture image analysis is based on the spatial variation of the pixel intensity and several parameters can be statistically defined by the probability of the pixels’ greyscale values. One example is the Entropy / Energy, which is the ruddiness and homogeneity of an image.

      • Shear wave velocity

        “US elastography is commercially available and can be employed in clinical settings. The elastic properties of muscular tissue are one way of diagnosing and evaluating degenerative myopathies, to determine the best rehabilitation program for stroke patients, and diabetes (13). It i” (Niitsu et al 2011:104)

      • B-mode and SWE measure together

        When muscle architecture and muscle hardness are measured concurrently, the B-mode ultrasound image and the ultrasound elastogram are acquired at the same time and in the same imaging plane. In addition, the time required to obtain a B-mode ultrasound image concurrently with an ultrasound elastogram is shorter than that required to obtain them separately. Thus, this combined technique offers an efficient way to objectively assess muscle architecture and muscle hardness, which are both indicators of muscle condition.

      • In ultrasound shear-wave elastography, shear modulus is calculated from the propagation velocity of shear wave inside tissues, which can be spatially variable when tissues are made of different elasticities.
        In its current application to muscles, the spatial average of shear modulus distribution across a region of interest (ROI) of a muscle has been determined using a commercially available ultrasound device with included software. The problem is that a simple spatial average of shear modulus distribution across an ROI in a muscle is not always appropriate for assessing contraction level because it can include not only shear modulus of contractile tissues (i.e. muscle fibers) that produce active force with contraction, but also non-contractile tissues (NCT, i.e., skin, adipose tissue, and connective tissue) that can be distributed within the contractile tissue region. Still, the impact of NCT inclusion in the image analysis on the assessment of muscle contraction intensity is unknown. (NCT: non-contractile tissue)

      • Shear modulus is the biomechanical parameter used to characterize stiffness” (Creze et al 2017:2)

        It is based on Hooke’s law, a relationship among strain, stress and elasticity: E = d, where the s elastic or Young’s modulus, is measured in kPa; s is the stress d or external force; d is the strain or deformation” (Creze et al 2017:2)

        Because elasticity is a critical determinant of muscle performance and force; hence, its assessment in vivo can help to improve the understanding of muscle functions” (Creze et al 2017:2)

        The elastic properties of muscular tissue are one way of diagnosing and evaluating degenerative myopathies, to determine the best rehabilitation program for stroke patients, diabetes (Niitsu et al 2011:104) , pain, such as tension-type headache, muscle belly swelled up and macro-architecture of the muscle changed. (Niitsu et al 2011:104)

        US elastography demonstrates color map of muscle hardness and can be applied to all striated muscles.

      {"cards":[{"_id":"6c9a9f147c9099abf8000058","treeId":"6c9a9efb7c9099abf8000056","seq":13877090,"position":1,"parentId":null,"content":"# Local Binary Pattern identfied the Echotexture of Stiffness Biceps Brachi Muscle in Stroke\n### *Peng-Ta Liu MS, Ta-Sen Wei MD, Huihau-Kenny Chiang PhD*\n\nInstitute of Biomedical Engineering. National Yang-Ming University. \nE-mail: hkchiang@ym.edu.tw\nNo.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan (R.O.C.). \n"},{"_id":"6c9aa1e37c9099abf800005a","treeId":"6c9a9efb7c9099abf8000056","seq":14536071,"position":1,"parentId":"6c9a9f147c9099abf8000058","content":"# Introduction\n*Background: The aim of this study was to identify the echotexture of paretic muscle in stroke patients.*\n\n* Muscle property changes lead to echotexture change, over time, muscle get stiffer.\n* Methods to assess muscle property and limitations.\n* SWE has been used to assess stiffness, but only quantitative information.\n* Echotexture has to quantify the muscle property change and follow up indicator.\n* Correlation of SWE and echo with functions is unknown\n***\n\nOne way to describe the muscle properties is \"stiffness\"\nMethods to assess stiff, xxx\n***\n* Muscle property change leads to muscle stiffness\n* the methods assess the property by US texture analysis\n* links between property = stiff, recently swv is a good methods\n* swv is reasonable seen as isotropic, but muscle property change may get less accuracy. \n* therefore, little know about the swv and texture.\n"},{"_id":"6c9aa4ab7c9099abf800005c","treeId":"6c9a9efb7c9099abf8000056","seq":14518114,"position":0.19140625,"parentId":"6c9aa1e37c9099abf800005a","content":"## Common knowledge\n\nSpasticity (hyperactiviity), muscle weakness (hypoactivity) and joint contracture (immobilization) are often seen consequences poststroke and cause considerable long-term motor impairments to stroke survivors. \n\nOver time, material properties of muscles in the impaired limbs can also change gradually, further disrupting motor function, and adversely impacting the stroke survivor's quality of life.\n\nSubsequent to these impairments, morphologic changes in the architecture of the paretic muscles often occur, which affect the muscles’ functions. Previous studies have revealed a reduction in muscle volume, a shortening of muscle fiber, and a reduction in the number of motor units in the paretic muscles in people after stroke. `These muscle deformations were highly related to syndromes of paretic muscles, such as muscle weakness, spasticity, and contracture.\n\nEvaluating muscle property variations in people after stroke is clinically important for both diagnosis and rehabilitation treatment.\n\nMuscle property changes includes IMF, EMC, connective tissue accumation. Recently, sonography is using b mode and EI to assess these changes. But EI can not be compared. More recent advanced imaging, SW is an alternative tool to measure the muscle stiffness.\n\n\n***\nSpasticity lead to chagnes in muscle including muscle stiffness and muscle property change. \nWeakness lead to loss fiber elasticiity.\nJoint contracture leads to shorten length of muscle fiber and joint stiffness.\n\n\n\"The in vivo assessment of the biomechanical properties of the skeletal muscle is a complex issue because the muscle is an anisotropic, viscoelastic and dynamic medium\" (Gennisson et al 2010:789)\n\nExamining the mechanical properties of muscle is important in monitoring the stage of the pathologic processes of muscles and for assessing efficacy of therapeutic interventions\n\nOne of the way to descript the material property is stiffness. \n\nPast studies try to use MAS/myotonometr etc., to measure the muscle stiffness\n[XXXX]\nthe Ashworth scale and modified Ashworth scale remain low-sensitivity instruments for distinguishing between soft tissue and neural contributions to hypertonia\n\n-> however it is not reliable / not handy. -> lack of diagnostic biomarkers\n\nPaet studies use US to assess the muscle quality, but operator dependant. [xxx]\n\nMore recently, Echotexture features was used to test the muscle quality to minimize the operator factors. Interpreted as the uniformity of the muscle pattern, provide further information about muscle property, beside the echo intensity which is highly dependent on the ultrasound scanner setting (plane, anisotropy) and wave energy scattering i.e. the distribution of the pixel intensity.\n\nRecently SWE’s speed is related to stiffness (young’s modulus) -> high SWV is high stiff, SWE can assess muscel mechanincal properties (muscle stiffness) [xxx]\n\n\n"},{"_id":"6f52b848c8fcbcf3f1000054","treeId":"6c9a9efb7c9099abf8000056","seq":14527975,"position":0.25,"parentId":"6c9aa4ab7c9099abf800005c","content":"## muscle property changes after stroke*\n\n* IMF ECM connetive tissue acculmation lead to further fiber shorten, visco-elasticity thxithplaticity, joint contrature. Therefore, the architecture of muscle changes and more straight the echotexture is changed,\n\n* Histolopathological studies have demonstrated a generalized increase in extracellular connective tissue in spastic muscles. It is known that increased connective tissue in an immobilized and contracted muscle reduces its compliance (Stecco et al 2014:121)\n\n* muscle mechanical properties could provide clinically viable information to follow the effects of neuromuscular disorders or potential improvements due to various treatments.\n\nThe disruption of normal muscle architecture caused by the infiltration of fat and the development of fibrosis has been reported to increase reflections of the ultrasound beam, resulting in an increased echo intensity of spastic muscles. Based on this, the development of changes in the muscle structure has been reported to influence the echotexture."},{"_id":"6c9aa6c97c9099abf800005e","treeId":"6c9a9efb7c9099abf8000056","seq":14389783,"position":0.765625,"parentId":"6c9aa1e37c9099abf800005a","content":"## How to measure the muscle stiffness\n`B mode can not provide muscle stiffness information which might be related to spasticity`\n也就是說藉由量stiff然後去連結spasticity\n\n\n\nMany studies showed that stiffness increased in spastic muscles due to changes in fiber type transformation. Morphometric and\nhistochemical investigations show changes in mechanical muscle-fiber properties that might contribute to spastic muscle tone [7-12]. Changes in biomechanical conditions of a muscle might also have an important effect on the spasticity in people with stroke.\n\n\nShearwave (SW) ultrasound elastography,which builds upon traditional elastography, allows quantitative in vivo measurement of tissue material properties (Bercoff et al., 2004). Using the same acoustic radiation forces as B-mode ultrasound, we use the SuperSonic Shear Imagine (Bercoff et al., 2004), a method that uses multiple ultrasound push\nbeams to induce the SWs and subsequently, to measure the SW speed in muscle. `The speed of these SWs is related to material properties, such that SWs travel faster through stiffer tissues.` \n\nSonoelastography is based on the calculation of Young’s elastic modulus, a physical quantity measuring stiffness\n\n\nThis technique has emerged as a reliable method to estimate material properties in a variety\nof tissues (Bouillard et al., 2012), including muscle (Bouillard et al.)\n2012; Eby et al., 2013; Lacourpaille et al., 2012).\n\nRecently, SW speed in the biceps brachii muscle of the paretic side was found to be\non average 69.5% greater than the non-paretic side in stroke survivors\n(Lee et al., 2015)\n\nShear waves are tracked by pulse-echo ultrasound and can be used quantitatively to calculate the tissue modulus (ie, stiffness); as the stiffness of underlying tissue increases, shear-wave speed increases."},{"_id":"74888cc087dc27bae6000029","treeId":"6c9a9efb7c9099abf8000056","seq":14401667,"position":1,"parentId":"6c9aa6c97c9099abf800005e","content":"### Manual testing (Not measure stiffness??)\n* MAS\n* Tardieu\n***\nMAS might not be as sensitive in detecting muscle stiffness."},{"_id":"748882c987dc27bae600002a","treeId":"6c9a9efb7c9099abf8000056","seq":12982129,"position":2,"parentId":"6c9aa6c97c9099abf800005e","content":"### Instruments\n* Myoton meter"},{"_id":"7488811187dc27bae600002b","treeId":"6c9a9efb7c9099abf8000056","seq":12982512,"position":3,"parentId":"6c9aa6c97c9099abf800005e","content":"### Imaging\n* MRI\n* Ultrasound (echo?? / morphology)\n* Elastography (Recently popular)"},{"_id":"6f07a8f06a7bbd1ebf000067","treeId":"6c9a9efb7c9099abf8000056","seq":14231473,"position":0.5,"parentId":"7488811187dc27bae600002b","content":"### \"Ultrasound elasticity imaging (UEI) has been developed for quantitatively estimating tissue mechanical property (stiffness) changes associated with tissue pathological conditions\" (Gao et al 2016:440)"},{"_id":"6e933d5c72aac64d14000071","treeId":"6c9a9efb7c9099abf8000056","seq":14327173,"position":0.75,"parentId":"7488811187dc27bae600002b","content":"Ultrasound (US) is an important tool for diagnosing of many musculoskeletal tissue conditions. 'Image texture analysis can be used to characterize the types of tissue. The morphological and textural characteristics of US images are commonly used for qualitative diagnosing (Rahbar et al., 1999; Huber et al., 2000). Quantitatively, the texture image analysis is based on the spatial variation of the pixel intensity and several parameters can be statistically defined by the probability of the pixels’ greyscale values. One example is the Entropy / Energy, which is the ruddiness and homogeneity of an image. "},{"_id":"7488618087dc27bae600002d","treeId":"6c9a9efb7c9099abf8000056","seq":14518089,"position":1,"parentId":"7488811187dc27bae600002b","content":"*Shear wave velocity*\n\n\"US elastography is commercially available and can be employed in clinical settings. The elastic properties of muscular tissue are one way of diagnosing and evaluating degenerative myopathies, to determine the best rehabilitation program for stroke patients, and diabetes (13). It i\" (Niitsu et al 2011:104)"},{"_id":"6dd7a56f9ae91b04b7000087","treeId":"6c9a9efb7c9099abf8000056","seq":14527949,"position":0.5,"parentId":"7488618087dc27bae600002d","content":"In ultrasound shear-wave elastography, shear modulus is calculated from the propagation velocity of shear wave inside tissues, which can be spatially variable when tissues are made of different elasticities. \nIn its current application to muscles, the spatial average of shear modulus distribution across a region of interest (ROI) of a muscle has been determined using a commercially available ultrasound device with included software. The problem is that a simple spatial average of shear modulus distribution across an ROI in a muscle is not always appropriate for assessing contraction level because it can include not only shear modulus of contractile tissues (i.e. muscle fibers) that produce active force with contraction, but also non-contractile tissues (NCT, i.e., skin, adipose tissue, and connective tissue) that can be distributed within the contractile tissue region. Still, the impact of NCT inclusion in the image analysis on the assessment of muscle contraction intensity is unknown. (NCT: non-contractile tissue)"},{"_id":"74883cd7f231b4772600002d","treeId":"6c9a9efb7c9099abf8000056","seq":12982483,"position":1,"parentId":"7488618087dc27bae600002d","content":"Shear modulus is the biomechanical parameter used to characterize stiffness” (Creze et al 2017:2)\n\nIt is based on Hooke’s law, a relationship among strain, stress and elasticity: E = d, where the s elastic or Young’s modulus, is measured in kPa; s is the stress d or external force; d is the strain or deformation” (Creze et al 2017:2)\n\nBecause elasticity is a critical determinant of `muscle performance and force`; hence, its assessment in vivo can help to improve the understanding of muscle functions” (Creze et al 2017:2)\n\nThe elastic properties of muscular tissue are one way of diagnosing and evaluating `degenerative myopathies`, to determine the best rehabilitation program for stroke patients, diabetes (Niitsu et al 2011:104) , pain, such as tension-type headache, muscle belly swelled up and macro-architecture of the muscle changed. (Niitsu et al 2011:104)\n\nUS elastography demonstrates color map of muscle hardness and can be applied to all striated muscles.\n"},{"_id":"6e8d75e6d9a583a089000077","treeId":"6c9a9efb7c9099abf8000056","seq":14332614,"position":2,"parentId":"7488811187dc27bae600002b","content":"### B-mode and SWE measure together \nWhen muscle architecture and muscle hardness are `measured concurrently`, the B-mode ultrasound image and the ultrasound elastogram are acquired at the same time and in the same imaging plane. In addition, the time required to obtain a B-mode ultrasound image concurrently with an ultrasound elastogram is shorter than that required to obtain them separately. Thus, this combined technique offers an efficient way to objectively assess muscle architecture and muscle hardness, which are both indicators of muscle condition. "},{"_id":"7487c96bf231b477260000b9","treeId":"6c9a9efb7c9099abf8000056","seq":12982577,"position":0.8828125,"parentId":"6c9aa1e37c9099abf800005a","content":"## How to measure the echotexture\n* traditonal EI\n* GLCM\n* Local Binary"},{"_id":"6f3c8aad05afc09ad900005b","treeId":"6c9a9efb7c9099abf8000056","seq":14518499,"position":1.5,"parentId":"7487c96bf231b477260000b9","content":"### Echo Intensity changes\nEnhanced echo intensity (EI) on ultrasonography images of skeletal muscle is believed to reflect muscle quality.\n\nEI is based on the histogram of the greyscale pixels of the ROI. The histogram provides a unidimensional analysis and classifies the tissue as hyperechoic or hypoechoic.\nTo overcome XXX limitations, image texture anslsysis can be used as it is a mathematical proceduure that takes into accout the two-dimensional distribution of pixels in the ROI and can be obtained by several statistical techniques XXXX for US image texture characterization."},{"_id":"6f0905196a7bbd1ebf000065","treeId":"6c9a9efb7c9099abf8000056","seq":14231125,"position":2,"parentId":"7487c96bf231b477260000b9","content":"### Ultrasonography can reveal morphological changes in spastic muscle architecture and is useful for assessing the properties of the muscle.\n\nHowever, B-mode ultrasonography does not provide information on muscle stiffness, which may be associated with spasticity. Use of ultrasound elastography is a recently developed, ultrasound-based method to evaluate tissue elasticity."},{"_id":"6e502eaac5c8ef2abc00007b","treeId":"6c9a9efb7c9099abf8000056","seq":14401057,"position":3,"parentId":"7487c96bf231b477260000b9","content":"### Local Binary Pattern (ENT)\nBecause the texture of a tissue image reflects its scatterers’ properties, the entropy can be used to characterize the texture of an input image.\n(Turo, 2013) use ENT a measure of heterogeneity of the tissue for differentiating tissue problem such as... \n\n\n1. upper trapezius of symptomatic and asymptomatic patients\n2. normal from abnormal myocardial structure\n3. brain tissues and liver cancer."},{"_id":"6c9aa6ec7c9099abf800005f","treeId":"6c9a9efb7c9099abf8000056","seq":14518092,"position":1.21875,"parentId":"6c9aa1e37c9099abf800005a","content":"## Why important (Gaps)\nThe stiffness is correlated to muscle tone and muscle property changes results in muscle architexture change after a stroke. Although SWV measure muscle in a in-directly way. \n## Muscle plasticity (2017 Maud Creze)\nThus, considering physical activity leading to angiogenesis and muscular fiber changes, and inactivity leading to sarcopenia and fat infiltration, we could expect that muscle plasticity would induce stiffness changes. However, `SWE did not reveal the quantitative stiffness changes expected in relation to the specific muscle histology of samples extracted from` females or males, athletes, juniors or seniors.\n\nLittle known of the echotexture of stiff muscle. and echotexture related to arm functions. \nEarly Intervention reference, treatments follow up"},{"_id":"6e93233b72aac64d14000072","treeId":"6c9a9efb7c9099abf8000056","seq":14327218,"position":0.5,"parentId":"6c9aa6ec7c9099abf800005f","content":"SWE has been reported to be a reliable tool for detecting muscle stiffness. For example, XXXX. However, their role as diagnostic or progression biomarkers is unknown, because of the high inter-individual variability in structural parameters. Therefore, it would be XXX to find a MUS biomarker not influenced by factors other than disease factors. Echotexture has been previously reported to characterize XXX."},{"_id":"74887cf987dc27bae600002c","treeId":"6c9a9efb7c9099abf8000056","seq":12982148,"position":1,"parentId":"6c9aa6ec7c9099abf800005f","content":"### Little known the relations between stiff and echotexture\n* stiff -> muscle property change\n* muscle property change -> echotexture\n* echotexture -> muscle functional performance"},{"_id":"6f04448c6a7bbd1ebf00006c","treeId":"6c9a9efb7c9099abf8000056","seq":14232295,"position":2,"parentId":"6c9aa6ec7c9099abf800005f","content":"### Important for follow up\n\n\"Quantitative elastography might help by providing a parameter that could influence the diagnosis but it could also provide a way to monitor the effectiveness of a treatment by quantifying the changes of the muscle mechanical state.\" (Gennisson et al 2010:790)"},{"_id":"6c9aa58f7c9099abf800005d","treeId":"6c9a9efb7c9099abf8000056","seq":14420970,"position":2,"parentId":"6c9aa1e37c9099abf800005a","content":"## I want to prove and how\n\nUnder the assumption that pathological muscle tissue appears to be diffuse and unstructured, a texture-based analysis seems adequate for detecting XXX in ultrasound images. \n1) in the past study, us was used to test the muscle quality changes, (who check the stiffness by traditional US?) what do they find? I persume that muscle get stiffer, the velocity get higher, and the echotexture changes as well.\n2) the resting muscle tone (combine neurological plasticity, and properties changned). So echotexture might help to identify the muscle properties part rather than the neurological part. So, Stiff muscle = mas + muscle property.\n"},{"_id":"72d9a2f896fe864d030000e9","treeId":"6c9a9efb7c9099abf8000056","seq":13326662,"position":1,"parentId":"6c9aa58f7c9099abf800005d","content":" Hypothesis, right and left are different, transverse and the longitudinal plane but is different "},{"_id":"729f4b3b774b512784000045","treeId":"6c9a9efb7c9099abf8000056","seq":14518105,"position":2,"parentId":"6c9aa58f7c9099abf800005d","content":"The aim of the current study is to quantify differences in shear wave velcoity and echotexture between subjects with stroke from ultrasound using Local binary pattern image analysis methods. \nWe hypothesize that simple grayscale parameters estimating quantitative muscle\nechotexture parameters derived from LBP-based images would be different between paretic and non-paretic BBM."},{"_id":"6ee1c244d065943ea300007a","treeId":"6c9a9efb7c9099abf8000056","seq":14288965,"position":4,"parentId":"6c9aa1e37c9099abf800005a","content":"痙攣是腦中風後常見的現象常導致功能的障礙\n痙攣是上運動神經元受損產生不正常的反射張力,用來評估功能與癒後的重要追蹤指標之一。\n(muscle stiffness = tone + biomechanical factor)\n臨床上常使用被動牽拉來評斷痙攣嚴重程度,但痙攣易受病情/情緒/溫度或人為操作等因素影響,且被動牽拉的阻力來也自於肌肉結構與內容的改變造成評估痙攣區別上的困難與不穩定性。\n\n過去研究顯示為區別兩者的組成,反射張力可以肌電圖偵測動作時的肌電訊號,超音波可提供客觀的肌肉組織與結構的變化,例如肌纖維縮短變型態或因肌肉脂肪滲入&結締組織堆積造成灰階值增加。由於組織與內容的改變,在肌肉影像的紋理(microstructure)自然也會造成改變,有研究已特徵方式XXX來評估肌肉疾病的分類,例如xxx,Gao 也嘗試已TAI來評估肌肉硬度??。\n隨著影像技術的進度,SWV 也是評估肌肉痙攣與硬度的一種方式,WU&xxx嘗試(check my summary notes),雖然SWV可以提供波速純量,但是SWV較受人為,壓力影響還有anisotropy的因素,在者波素與紋理特徵也沒有清楚了解,因此,本研究的目的即是探討痙攣肌肉紋理特徵與硬度的關係,並分析紋理/硬度與功能的關聯性。\n"},{"_id":"6c9b007d64fd300c57000061","treeId":"6c9a9efb7c9099abf8000056","seq":12984656,"position":2,"parentId":"6c9a9f147c9099abf8000058","content":"# Methods\n*Shear wave velocity was used to measure the stiffness of biceps brachi muscle and echotexture was extracted by local binary pattern. The differences between paretic and non-paretic BBM were evaluated. The correlations among the stiffness, echotexture and functional performance were also tested.*"},{"_id":"6caf114f450e2bd621000024","treeId":"6c9a9efb7c9099abf8000056","seq":14200189,"position":1,"parentId":"6c9b007d64fd300c57000061","content":"## Subject\nIRB\nInclusion criteria\n* age\n* onset duration\n* no trauma history\n* no elbow joint contracture or ROM limitation"},{"_id":"6f4aaeb7caa82e076c0000e1","treeId":"6c9a9efb7c9099abf8000056","seq":14212569,"position":1,"parentId":"6caf114f450e2bd621000024","content":"### The inform consent\nThe study protocol was approved by the Research Ethics Committee of a medical center hospital and written informed consent was obtained from all subjects.\n\n### Inclusion criteria\nAll subjects were recruited from a rehabilitation ward in a medical center. The Inclusion criteria were (i) age >30 years, (ii) absence of cervical radiculopathy symptoms or other central or peripheral neurologic deficits in the upper limbs, (iii) bilateral elbow range of motion flexion within 0–145 degrees, and (iV) onset duration less than 3 months. Exclusion criteria were (i) history of botulinum toxin injection; and (ii) history of upper limb surgery. "},{"_id":"748953f2c42e0656a7000025","treeId":"6c9a9efb7c9099abf8000056","seq":14200172,"position":1.5,"parentId":"6c9b007d64fd300c57000061","content":"## Shear wave velocity measurement\n* Acuson system\n* probe placement\n* Image taken\n* ROI"},{"_id":"6f458b89a288526635000057","treeId":"6c9a9efb7c9099abf8000056","seq":14212614,"position":0.25,"parentId":"748953f2c42e0656a7000025","content":"### Subjects testing position\n\nAll subjects were placed supine and instructed to relax his examed elbow during ultrasound imaging capture. A low-temperature premade arm splint was used to standardize the arm position and to minimize the activity of recorded muscles. The shoulder was placed so that the humerus was abducted 45°, and the elbow positioned at 90°.\n\n`Give a photo for demostration`"},{"_id":"74410cdcd8853b37bf00003c","treeId":"6c9a9efb7c9099abf8000056","seq":14212116,"position":0.3125,"parentId":"748953f2c42e0656a7000025","content":"### Imaging capture system\n\nB-mode ultrasound scanning images and SWV values were captured from both elbows using an Acuson S2000 ARFI Ultrasonography System (Siemens, Munich, Germany) equipped with a 7~9 MHz linear transducer (9 L4, Siemens). \nTo ensure the applied proper pressure on the transducer during SWV acquisition, the \"Quantify index\" above 80 is needed for high reliable test value.\n"},{"_id":"7485b8bbf231b477260000be","treeId":"6c9a9efb7c9099abf8000056","seq":14200130,"position":0.375,"parentId":"748953f2c42e0656a7000025","content":"### Probe placement\n\nAll scans of biceps brachii muscle were acquired by placing the transducer at `two thirds` of the distance from the acromion to the antecubital crease (Molinari et al 2015:2521)\n\n\"The probe was oriented parallel to the muscle fibers to obtain SWV measurements in the longitudinal axis and rotated 90 for SWV measurements in the transverse axis.\" (Wu et al 2017:1106)\n\n>\"BB US images were acquired at 60% of the distance between the posterior ridge of the acromion and the olecranon of the right arm, while the subject was seated with his arms relaxed on their respective sides (Matta et al., 2011).\" (da Silva Pereira Júnior et al 2017:85)"},{"_id":"6caf1697450e2bd621000025","treeId":"6c9a9efb7c9099abf8000056","seq":14231450,"position":0.4375,"parentId":"748953f2c42e0656a7000025","content":"### ROI\nThe region of interest (ROI) was set to the mid portion of the BBM thickness for measuring the BBM stiffness. The scanned images were then transferred to a computer in the Digital Imaging and Communications in Medicine (DICOM) format for further extracting the echotextural features. \n\nThe `ROI size` of 142 x 142 pixels for BBM on an 8-bit gray-scale was selected at which muscle SWV was measured. \n\nSonoelastography was performed in both transverse\nand longitudinal planes. In each plane, three measurements of SWV and ROI were acquired from bilateral biceps brachii and averaged for further statistical analysis."},{"_id":"6e4d0601c5c8ef2abc0000f5","treeId":"6c9a9efb7c9099abf8000056","seq":14401540,"position":1.71875,"parentId":"748953f2c42e0656a7000025","content":"### Times of SWV measure \n\"Five measurements of SWV were acquired from bilateral biceps brachii in each elbow posture and averaged for further statistical analysis\" (Wu et al 2017:1107)\nThe unaffected contralateral side was examined at the same time under identical conditions and served as normal image control\n"},{"_id":"748694d3f231b477260000ba","treeId":"6c9a9efb7c9099abf8000056","seq":14200241,"position":2.25,"parentId":"6c9b007d64fd300c57000061","content":"## Local binary pattern for echotexture\n* the formula\n* the energy and entropy\n* size of R"},{"_id":"729f4433774b512784000046","treeId":"6c9a9efb7c9099abf8000056","seq":14202733,"position":1.5,"parentId":"748694d3f231b477260000ba","content":"# Local binary pattern image and then calculate the Entropy and energy\n\nplease refer to Hirvasniemi, 2017, bone texture\n\n\"A Local Binary Pattern (LBP) (Ojala et al., 2002) is a local texture operator with powerful discrimination, low computational complexity, and less sensitivity to changes in illumination. The LBP operator is obtained by evaluating the binary difference between the gray value of a pixel x from the gray values of its P neighborhood placed on a circle radius of R\" (Nanni et al 2010:7891)\n\n\"To calculate the LBP operator the local binary difference between the gray value of a pixel x and the gray values of P pixels in a local neighborhood of x placed on a circle of radius R is evaluated. To obtain a rotation invariant descriptor [9], P 1 bitwise shift operations on the binary pattern are performed, and the smallest value is selected. A pattern is defined \"uniform\" if the number of transactions between \"0\" and \"1\" of the sequence is less or equal to two, with the number of different types of uniform patterns that can occur being P + 1. To describe a given image, the histogram of dimension P + 2 is extracted. It contains the occurrence of the P + 1 types of uniform patterns, and the number of non-uniform patterns.\" (Nanni et al 2010:118)\n"},{"_id":"6f2c03c3e220455202000064","treeId":"6c9a9efb7c9099abf8000056","seq":14569758,"position":1.75,"parentId":"748694d3f231b477260000ba","content":"### The definition of entropy and energy\nThe US image with irregular informative texture. This can be quantitfied by texture features like local binary pattern.\nTwo features were extracted from each ROI.\nThese features are based on statistical and transformation on the ROI.\nThe textural descriptor is LBP. and the LBP features are ENT / ENG. \n\"Entropy: The entropy is a measure of average information in a block.\" (Brehar and Nedevschi 2013:119)\n\n\"The entropy is high when the local binary patterns or the gradient magnitudes are distributed among many values.\" (Brehar and Nedevschi 2013:119)\n\n\"Energy: In our work we define energy as a measure that shows how the local binary patterns or the gradient magnitudes are distributed on different bins.\" (Brehar and Nedevschi 2013:119)\n\n\"The energy is low when the number of uniform patterns or the number of gray levels of the gradient magnitude are high. The energy is maximum when we have only one LBP pattern or only one gradient magnitude value in the block.\" (Brehar and Nedevschi 2013:119)\n\nThe local binary pattern image was then calculate the entropy and energy. The rodness of image is high for entroy.\n***\n`Entropy`: The entropy is a measure of average information in a block. We use the following formula for computing the entropy of a block:\nH = - p(b)*log2(p(b))\n\nThe entropy is high when the local binary patterns or the gradient magnitudes are distributed among many values.\n\n`Energy`: In our work we define energy as a measure that shows how the local binary patterns or the gradient magnitudes\nare distributed on different bins. We define the energy of a block as:\nE = (p(b))2 \n\nThe energy is low when the number of uniform patterns or the number of gray levels of the gradient magnitude are high.\n\nThe energy is maximum when we have only one LBP pattern or only one gradient magnitude value in the block."},{"_id":"6e4cfd48c5c8ef2abc0000f7","treeId":"6c9a9efb7c9099abf8000056","seq":14401568,"position":1.875,"parentId":"748694d3f231b477260000ba","content":"# Size of R and P\n\"We considered P equal to 24 pixels and R equal to 3 pixels, in order to consider a relatively large neighborhood.\" (Molinari et al 2015:2532)"},{"_id":"74866f74f231b477260000bb","treeId":"6c9a9efb7c9099abf8000056","seq":13055165,"position":2.625,"parentId":"6c9b007d64fd300c57000061","content":"## Muscle tone and functions\n* MAS / Tardieu\n* Fugl Meyer\n* FIM ? (if no correlations, delete it)"},{"_id":"6f3b2f6cbf819e3dad000061","treeId":"6c9a9efb7c9099abf8000056","seq":14214623,"position":1,"parentId":"74866f74f231b477260000bb","content":"### MAS\n`BBM spasticity was evaluated at the paretic arm by the Modified Ashworth Scale (MAS) and the Tardieu Scale (TS).`\n\nThe MAS is a simple evaluative method to assess the spasticity with the six levels scoring. The 0 = no increase in muscle tone; 4 = affected part(s) rigid in flexion or extension.(Pandyan et al. 2003)\n\n>measures resistance during passive soft-tissue stretching and is used as a simple measure of spasticity.[1] Scoring (taken from Bohannon and Smith, 1987):"},{"_id":"6f3072c01321273eb3000063","treeId":"6c9a9efb7c9099abf8000056","seq":14214919,"position":2,"parentId":"74866f74f231b477260000bb","content":"### Tardieu Scale\nTS evaluates the spasticity angle (the angle at which muscle reaction occurs at 3 velocities: as slow as possible (V1), falling under gravity (V2), and as fast as possible (V3). "},{"_id":"6f3072161321273eb3000064","treeId":"6c9a9efb7c9099abf8000056","seq":14214220,"position":3,"parentId":"74866f74f231b477260000bb","content":"Fugl Meyer Assessment\n"},{"_id":"6f3071701321273eb3000065","treeId":"6c9a9efb7c9099abf8000056","seq":14214230,"position":4,"parentId":"74866f74f231b477260000bb","content":"Functional Independent Measure (FIM)"},{"_id":"74866c31f231b477260000bc","treeId":"6c9a9efb7c9099abf8000056","seq":12984651,"position":2.8125,"parentId":"6c9b007d64fd300c57000061","content":"## Statistical analysis\n* Quantitative show mean +/- SD\n* Nonparamatic t and paired t test"},{"_id":"740898f5a335c5e2eb000075","treeId":"6c9a9efb7c9099abf8000056","seq":14200322,"position":1,"parentId":"74866c31f231b477260000bc","content":"### Normality test\nShapiro-will test \nIf the p value is greater than alpha value:0.05, the null hypothesis is accepted \nSo the tested data is normality."},{"_id":"6f3dfe3f05afc09ad900005a","treeId":"6c9a9efb7c9099abf8000056","seq":14202921,"position":1.5,"parentId":"74866c31f231b477260000bc","content":"### Nonparamatric paired-t test\nWilcoxon signed rank paired t-test were uesd to test the difference of variables bewteen paretic and non-paretic BBM. \n\nWilcoxon signed-rank test was used for comparison between the hardness with the use of the two types of \n\nAs the Shapiro – Wilk test for normal distribution of the data\nfailed, non-parametric tests were used. The Wilcoxon signed\nrank sum test was used to compare muscle echo intensity and\nmuscle and subcutaneous layer thickness between the two sides\n(dominant versus non-dominant). \nThe relationships between the actual and\nmeasured hardness were examined by the least square method. \n\nSPSS® statistics v. 22 (IBM Corp., Tokyo, Japan; formerly SPSS Inc., Chicago, IL) was applied for statistical analysis. Values of p < 0.05 were set to indicate significance."},{"_id":"7279414eb8a0ba75dd000049","treeId":"6c9a9efb7c9099abf8000056","seq":14200325,"position":2,"parentId":"74866c31f231b477260000bc","content":"### Correlation test:\nThe Spearman rank correlation analysis was used to test for linear correlations between echo intensity and thickness measurements"},{"_id":"71674389d2a38cdcbd00004c","treeId":"6c9a9efb7c9099abf8000056","seq":14200328,"position":3,"parentId":"74866c31f231b477260000bc","content":"### R size differences\nTo test the differences among R size using \"Fridaman test\"\n=> nonparametic k-related t test"},{"_id":"6c9b013564fd300c57000062","treeId":"6c9a9efb7c9099abf8000056","seq":14571202,"position":3,"parentId":"6c9a9f147c9099abf8000058","content":"# Results\n\n*1. The echotexture (entropy & energy) is different between paretic and non-paretic BBM in both plane*\n\n*2. The shear wave velocity is faster in paretic BBM. in transverse and longitudinal planes for stroke patients*\n\n*3. The energy/entropy is correlated to functions (FIM/fugl meyer) and onset duration, age. But `none of echotexture is correlated to swv` *\n\n*4. The shear wave velocity is negatively correlated to ENT/ENG in longitudinal plane -> concentration theory. WHY transverse no correlated?*\n\n*5. THe R of LBP is different in both plane in both plane? The optimal radius of R is 3*\n"},{"_id":"7489b7aa1ac51f15dd00007d","treeId":"6c9a9efb7c9099abf8000056","seq":14291577,"position":1.5,"parentId":"6c9b013564fd300c57000062","content":"### Table 1: Demogrphic data\n\n![](https://www.filepicker.io/api/file/gCYjU5a5SXemqWSwlAlG)\n\n\nA total of Twenty-two stroke patients finished the sonoelastograpic measurements of biceps brachii muscle and clinical evaluations. The demographic data and functional assessments are summarized in Table 1. "},{"_id":"6fe644e0d591fc79a1000051","treeId":"6c9a9efb7c9099abf8000056","seq":14536325,"position":1.625,"parentId":"6c9b013564fd300c57000062","content":"### Figure 2 The muscle stiffness between paretic and nonparetic BBM in the longitudinal and transverse plane. \n\n![](https://www.filepicker.io/api/file/rJ3hJ7SSTyiDIq9IsKgl)\n"},{"_id":"6dcb00956dc417f4c6000089","treeId":"6c9a9efb7c9099abf8000056","seq":14536326,"position":1,"parentId":"6fe644e0d591fc79a1000051","content":"Figure 2 showed that the spastic BBM had signicantly higher shear wave speed (P < 0.001) in both the transverse and the longitudinal planes."},{"_id":"6fe600bed591fc79a1000052","treeId":"6c9a9efb7c9099abf8000056","seq":14017198,"position":1.6875,"parentId":"6c9b013564fd300c57000062","content":"### The echotexture (entropy & energy) is different between paretic and non-paretic BBM\n \n![](https://www.filepicker.io/api/file/bSW4t9aSWaOXo9Z0GLbM)"},{"_id":"6dcafc6b6dc417f4c600008a","treeId":"6c9a9efb7c9099abf8000056","seq":14536389,"position":1,"parentId":"6fe600bed591fc79a1000052","content":"The ENT_r2 was higher for paretic BBM in the Longitudinal plane (p = 0.05). The ENG was non-significant difference between paretic and non-paretic BBM in the lingitudinal plane. \nIn the transverse plane, The echotexture of paretic BBM was significantly in-homogeneous than non-paretic BBM in ENT_r1 and ENG_r1.\n***\nThe size of radius, less than 3 is enough to differintiate the echotexture for paretic and non-paretic BBM. "},{"_id":"6d8afc3de1ff7cdfaa00008b","treeId":"6c9a9efb7c9099abf8000056","seq":14589123,"position":1.71875,"parentId":"6c9b013564fd300c57000062","content":"![](https://www.filepicker.io/api/file/DIzGvO4FTrOq9LS0eTxx)"},{"_id":"6d8af9a9e1ff7cdfaa00008c","treeId":"6c9a9efb7c9099abf8000056","seq":14589124,"position":1.734375,"parentId":"6c9b013564fd300c57000062","content":"![](https://www.filepicker.io/api/file/9geHftY1RjGNeOmE0rsi)"},{"_id":"7285e861e24e4eec44000047","treeId":"6c9a9efb7c9099abf8000056","seq":13711163,"position":8,"parentId":"6c9b013564fd300c57000062","content":"# Correlations between variable differnece\n\nSabrina S.M. Lee, 2015 : difference of swv correlated to difference of echo intensity at biceps (check the Fig 5) and the explainations in content."},{"_id":"6d870fdfd95fe8f4e600008e","treeId":"6c9a9efb7c9099abf8000056","seq":14590962,"position":1,"parentId":"7285e861e24e4eec44000047","content":"* A coefficient of determination analysis revealed a significant relationship between XXX and B (r2 = XXX, p = 0.000).\n* Only A correlated with B in the stroke patients (r = , P = )\n* No significant correlation was found for XXX (r = , P = )\n* "},{"_id":"6c9b01a064fd300c57000063","treeId":"6c9a9efb7c9099abf8000056","seq":14590971,"position":4,"parentId":"6c9a9f147c9099abf8000058","content":"# Discussions\n\n* Recap the main findings - ecotexture of paretic muscle is inhomogeneous, and correlated to muscle stiff. \n* Secondary findings - correlate to function\n* Clinical application \n***\n1. 痙攣的肌肉紋理較不和諧\n ->本篇利用SWV確認痙攣的肌肉硬度較高,前人的研究一致(wu, gao 利用EI)。\n ->IMF 增加 & 痙攣後結構改變。\n ->Signal is the interaction between structure and component -> on this basis, the echotexture changed.\n ->Interactions of structure and composition\n ->Textural analysis compare the findings \n2. 肌肉的紋理與硬度成反比\n ->PDF理論 (Ex: breast cancer, Myofascia trigger pain)\n3. 紋理與功能相關性\n ->硬度與功能; high order for textrue\n4. 肌肉紋理的特徵與肌纖維方向相關 (Anisotropy)\n ->縱向-條紋;橫向-偏全黑,所以我的橫-縱結果也不一樣(ROI size / ENT or ENG)。\n5. clinical: botox / sarcopenia follow up.\n"},{"_id":"75d575584d6d62197400001b","treeId":"6c9a9efb7c9099abf8000056","seq":14536728,"position":1.375,"parentId":"6c9b01a064fd300c57000063","content":"## Recap the main findings\n( `ENT/ENG可以區辨痙攣BBM`)The echotexture of spastic muscle is defined by high order statistical textual analysis with local binary patterns in energy and entropy.\n[ ] swv in long correlate to ENT1.\n[ ] ENT/ENG with less radius can distinguish the non vs. paretic BMM, but in correlation, the radius become large. and why? \n=> the large radius, more information, but loss the correlate with central pixel. good or bad??\n","deleted":false},{"_id":"6f2c3385e220455202000063","treeId":"6c9a9efb7c9099abf8000056","seq":14218271,"position":1,"parentId":"75d575584d6d62197400001b","content":"### first paper use LBP for paretic muscle\n\nTo our's knowledge, no prior work has been reported on the image texture feature based quality assessment of paretic muscle ultrasound images using local binary patterns. \n\nIn this paper, the information of image texture features are analyzed using LBP with entropy and energy, and also correlated with muscle stiffness and functional performance. "},{"_id":"6f0546fd6a7bbd1ebf000069","treeId":"6c9a9efb7c9099abf8000056","seq":14231896,"position":2,"parentId":"75d575584d6d62197400001b","content":"Recently, SW speed in the biceps brachii muscle of the paretic side was found to be on average 69.5% greater than the non-paretic side in stroke survivors (Lee et al., 2015)"},{"_id":"6f05f08b6a7bbd1ebf000068","treeId":"6c9a9efb7c9099abf8000056","seq":14390461,"position":3,"parentId":"75d575584d6d62197400001b","content":"Theoretically, increased resistance (`Stiffness`) to passive movement can result from neural factors such as spasticity, or peripheral factors such as changes in the mechanical properties of the muscles (for example, as a result of muscle contracture)"},{"_id":"7488b2ffc42e0656a7000028","treeId":"6c9a9efb7c9099abf8000056","seq":13318296,"position":1.5,"parentId":"6c9b01a064fd300c57000063","content":"## Secondary important findings"},{"_id":"6e32b5e10890d54d49000084","treeId":"6c9a9efb7c9099abf8000056","seq":14421787,"position":0.5,"parentId":"7488b2ffc42e0656a7000028","content":"### Entropy (ENT) / Energy (ENG): physics definition\n\nEntropy is a term derived from thermodynamics and refers to the quantity of energy that is permanently lost to heat (\"chaos\") every time a reaction or a physical transformation occurs. The term is used to non-technical speech to mean \"irremediable chaos or disorder\". \nEnergy (ENG) is the opposite of entropy and represents orderlines in the image."},{"_id":"71550bdffc0924c13700004d","treeId":"6c9a9efb7c9099abf8000056","seq":14518106,"position":1,"parentId":"7488b2ffc42e0656a7000028","content":"### The ENT is higher (in-homogeneous) in paretic muscle, the muscle stiffer.\n\n-> In the past study, swv is positively correlated to echo intensity. It represented that the more fat infiltrated into muscle, the elasticity of muscle is lower. In this study, we choose echotexture to test the muscle properties in early stage after stroke. The onset duration get longer, it is reasonable supposed that more fat will infiltrate to muscle. According to concentration theory, the more fat in muscle, the texture of muscle get homogeneous (cite??) therefore the ENT become smaller."},{"_id":"72d973b296fe864d030000ea","treeId":"6c9a9efb7c9099abf8000056","seq":14337592,"position":1.625,"parentId":"6c9b01a064fd300c57000063","content":"Muscle fiber in shirt position, sacromere reduce, architecture change makes fiber shorten. The sound wave reflect environment changed, so the echo texture change(what changes?)\nNormal muscle scan in longitudinal plane, the perusing is clear to seen, but in myo or neuropathy become blue it is related to anisotropy"},{"_id":"6e66e567f92257bd55000078","treeId":"6c9a9efb7c9099abf8000056","seq":14390405,"position":1,"parentId":"72d973b296fe864d030000ea","content":"\"A combination of denervation, disuse, inflammation and remodeling contributes a complex pattern of muscle tissue phenotype change and atrophy that may factor into a decrease in muscle mass and tone\" (Gao et al 2018:8)"},{"_id":"72e5cebec16b7c7bf1000041","treeId":"6c9a9efb7c9099abf8000056","seq":13501423,"position":1.75,"parentId":"6c9b01a064fd300c57000063","content":"## Local Binary Patterns merits and drawbacks\nCompared to Echo Intensity"},{"_id":"6e4d01a5c5c8ef2abc0000f6","treeId":"6c9a9efb7c9099abf8000056","seq":14401553,"position":1,"parentId":"72e5cebec16b7c7bf1000041","content":"# ENT & ENG \n\"Acharya et al. reported that two powerful descriptors of the LBP image are the energy and entropy of the LBP distribution\" (Molinari et al 2015:2524)"},{"_id":"729f934e774b512784000044","treeId":"6c9a9efb7c9099abf8000056","seq":14183838,"position":1.875,"parentId":"6c9b01a064fd300c57000063","content":"## Anisotropy: The variability of scan plane\n\nBB muscle for the transverse and longitudinal scans (Table 1)\nhad similar mean values, standard deviation and CVs, but different\nICCs between probes orientations, being the transverse\none more reliable (r = 0!84) than the other (r = 0!39). (da Silva, 2017)"},{"_id":"6e66daf4f92257bd550001dd","treeId":"6c9a9efb7c9099abf8000056","seq":14390418,"position":0.25,"parentId":"729f934e774b512784000044","content":"### Ultrasound signal is interactions between muscle structure and composition\n\n* All of these changes, make microstructure change results in texture changed. For the structure, muscle fiber type and archticture changes [XXX].\nFor the composition, the scattering concentration changes (IMF and connective tissue accumulation). \n\nIn our results, the paretic can prove it, the echotexture is more in-homo than health side. \nwhen the muscle get stiffer, the density of muscle property become high. As the fiber become more, the echo internsity is whiter. then the ENT gets smaller (homogeneous).\n***\nTo miminize the operator factor and age, gender, this (ENT/ENG) could be a follow-up biomarker."},{"_id":"6e8e307fd9a583a089000075","treeId":"6c9a9efb7c9099abf8000056","seq":14332282,"position":0.5,"parentId":"729f934e774b512784000044","content":"Additionally, most SWE techniques `assume that the underlying tissue is isotropic, elastic, and locally homogenous—such as that of breast, liver, or thyroid. Muscle, however, is anisotropic`: the mechanical properties along muscle fibers differ from those across muscle fibers. This anisotropy requires orientation of the transducer for all SWE techniques to be longitudinal to muscle fibers in order to achieve accurate and reliable measurements. Despite the anisotropy, the shear modulus (a stiffness measure that assumes isotropy) measured from shear-wave speed displays good agreement with the Young modulus (a stiffness measure that assumes isotropy and incompressibility) throughout the range of normal physiologic tension of skeletal muscle. In the medical literature, the shear modulus (or shear elastic modulus) and the Young modulus have both been used in reporting outcomes."},{"_id":"70906503218cf533a9000050","treeId":"6c9a9efb7c9099abf8000056","seq":13883323,"position":1,"parentId":"729f934e774b512784000044","content":"Wu, 2018\nmuscle stiffness only when the muscle is not stretched. All significant differences and correlations were detected only when the SWV of the biceps brachii muscle was evaluated in the longitudinal axis, not in the transverse axis. The mechanical properties along fibers differ from those across fibers (Brandenburg et al. 2014) (i.e., muscle is anisotropic), so the ultrasound transducer should be oriented longitudinally to the muscle fibers to obtain SWV values with functional relevance (Gennisson et al. 2010). Moreover, Dorado Cortez et al. (2016) reported better reproducibility of muscle SWV measurements in the longitudinal plane than the transverse plane. 2.98 6 0.11 m/s, p 5 0.529). Paretic-side SWV in the longitudinal axis was positively correlated with stroke duration at 90 elbow flexion, but not at 0 . Paretic-side SWV in the longitudinal axis correlated positively with MAS and MTS at both 90 and 0 , but the correlation coefficients were higher at 90 . There was a negative correlation between pareticside SWV in the longitudinal axis and STREAM score (Table 3). In contrast, there were no correlations between paretic-side SWV in the transverse axis and post-stroke duration, MAS, MTS and STREAM score (all p . 0.2). The ICC of inter-rater reliability for SWV measurements was 0.768 (0.373–0.927, ‘‘excellent’’) in the longitudinal axis and 0.552 (0.002–0.846, ‘‘good’’) in the transverse axis. "},{"_id":"6f07bf306a7bbd1ebf000066","treeId":"6c9a9efb7c9099abf8000056","seq":14231456,"position":2,"parentId":"729f934e774b512784000044","content":"The in vivo assessment of the biomechanical properties of the skeletal muscle is a complex issue because\nthe muscle is an anisotropic, viscoelastic and dynamic medium."},{"_id":"6f04f1eb6a7bbd1ebf00006a","treeId":"6c9a9efb7c9099abf8000056","seq":14231917,"position":3,"parentId":"729f934e774b512784000044","content":"### LBP is less sensitive to complex pattern\n\"The resulting pattern is captured as an 8-bit binary number representing one of 256 distinct known patterns. Then, the histogram is computed for the transformed image and considered as a texture-descriptor. The LBP may fail in many cases for anisotropic phenomena since it is more complex than natural textures. Anisotropy is characterized by the global and privileged directions of the structure. The 2D local patterns are less sensitive to such characteristics, because they encode only the frequency of local structures regardless of their global orientations.\" (Houam et al 2014:185)\n\n\"Depending on the orientation analyzed, results are different, proving that non-uniform changes due to osteoporosis induce variations in the degree of anisotropy.\" (Houam et al 2014:192)"},{"_id":"6f04010a6a7bbd1ebf00006d","treeId":"6c9a9efb7c9099abf8000056","seq":14232377,"position":4,"parentId":"729f934e774b512784000044","content":"### Drawback of SWV\n\n\"All commercially available SWE systems are based on the prerequisite that soft tissues are purely elastic, incompressible and isotropic. First, the major technical parameter that influences stiffness measurement is the anisotropic physical properties of the skeletal muscle. The tissular organization of skeletal muscle, which comprises a parallel arrangement of myofibrils, muscular fibers, collagen and elastic fibers, and fascicles, confers anisotropic, in particular orthotropic properties (which are a subset of anisotropic properties that differ along the three orthogonal axes) to the skeletal muscle. These orthotropic physical properties are responsible for the fact that shear waves travel faster along the direction of the fibers than they do when perpendicular to them [19, 21] (Fig. 1). This has a number of consequences. First, stiffness measurements are sensitive to the angle between the probe axis and the orientation of the muscular fibers. Shear modulus measurements using SWE are correlated with Young's modulus only if the probe is oriented parallel to the muscle fibers. Another consequence is the difficulty assessing meaningful results in muscles with complex anatomy. Multipennate, conic, triangular or fusiform anatomy, which yieldsBmultiorientation^ fibers, introduces a technical difficulty in visualizing the orientation of fibers.\" (Creze et al 2017:2)\n\n#所有商用的SWV量測時的先決條件:組織需是彈性/不可擠壓/同質性。\n主要影響的技術問題就是肌肉是\"非同質性物質\",造成方向依賴,無法使用於複雜的組織。 (note on p.2)"},{"_id":"6e8e41f1d9a583a089000074","treeId":"6c9a9efb7c9099abf8000056","seq":14332187,"position":1.890625,"parentId":"6c9b01a064fd300c57000063","content":"Unfortunately, these reviews target health care providers `with a strong background in ultrasound physics and provide limited discussion` of the clinical application and significance of ultrasound elastography with respect to muscle. Thus, they are of little assistance to the typical physical medicine and rehabilitation physician seeking to improve clinical practice by adding ultrasound elastography. Many rehabilitation strategies are aimed at changing the mechanical properties of muscle."},{"_id":"71de942d45773f2d5800004b","treeId":"6c9a9efb7c9099abf8000056","seq":14184484,"position":1.90625,"parentId":"6c9b01a064fd300c57000063","content":"## Muscle plasticity (2017 Maud Creze)\nThus, considering physical activity leading to angiogenesis\nand muscular fiber changes, and inactivity leading to\nsarcopenia and fat infiltration, we could expect that muscle\nplasticity would induce stiffness changes. However, SWE\ndid not reveal the quantitative stiffness changes expected in relation to the specific muscle histology of samples extracted from females or males, athletes, juniors or seniors."},{"_id":"72133be88c2332ba2200004a","treeId":"6c9a9efb7c9099abf8000056","seq":13501420,"position":1.9375,"parentId":"6c9b01a064fd300c57000063","content":"## Clinical implications:\n\n* botox injection follow up: Rafael Fortuna, (2011) muscle atrophy fat infiltration after inject 3 months later, and compare to normal group, only connective tissue increased. (check figure)\n"},{"_id":"6d7ae6abda055a9f2000008e","treeId":"6c9a9efb7c9099abf8000056","seq":14611191,"position":1,"parentId":"72133be88c2332ba2200004a","content":"### sarcopenia\nThe LBP is good to distingish the muscle type by echotexture analysis. therefore, may used in sarcopenia, the structure changes in the extracellular matrix (ECM), such as an increase in the collagen concentration, may be associated with the EI of skeletal muscle. It is also possible that the structural and biochemical changes in skeletal muscle ECM contribute to aging-related loss of muscle function (eg, impaired in force generation and increased stiffness).\" (Watanabe et al 2013:996) "},{"_id":"6c9b021464fd300c57000064","treeId":"6c9a9efb7c9099abf8000056","seq":14217977,"position":5,"parentId":"6c9a9f147c9099abf8000058","content":"# Conclusion\n*The echotexture extracted by local binary pattern may be a useful diagnositic tool for assess and follow-up the muscle property changes after stroke.\n\n* Computer-aided diagnosis of paretic muscle ultrasound image is necessary, as it will contribute to the establishment of a standard method for grading muscle quality, and improve clinical diagnostic accuracy, repeatability, and efficiency."},{"_id":"6e9122c872aac64d14000073","treeId":"6c9a9efb7c9099abf8000056","seq":14390407,"position":1,"parentId":"6c9b021464fd300c57000064","content":"Muscle stiffness and muscle property, as indicated by SW speed and echotexture, were changed in stroke-impaired muscle at rest. These findings highlight the potential for echotexture features extracted by LBP as a tool for both investigating the fundamental changes in stroke-impaired muscle, and for evaluation of muscle mechanical properties as part of clinical examination."},{"_id":"6e66dd5bf92257bd550001dc","treeId":"6c9a9efb7c9099abf8000056","seq":14390409,"position":2,"parentId":"6c9b021464fd300c57000064","content":"\"Proper evaluation of muscle properties is important in monitoring the progression of individuals during rehabilitation therapy, in making appropriate clinical decisions, for planning optimal treatment, and for assessing the efficacy of therapeutic interventions.\" (Chuang et al 2012:533)"},{"_id":"6f2ca90be220455202000061","treeId":"6c9a9efb7c9099abf8000056","seq":14217973,"position":5.5,"parentId":"6c9a9f147c9099abf8000058","content":"# Research Notes\n"},{"_id":"6e1c006e364159d241000085","treeId":"6c9a9efb7c9099abf8000056","seq":14464641,"position":0.5,"parentId":"6f2ca90be220455202000061","content":"### Introduction flow: (Lee, 2016)\nstroke is most common NMD -> impairement = neural (primary) + muscle property (secondary) = Quantify muscle property is challenge.\nMuscle properties changes are xxx -> impact movement.\nMeasuremen are XXX -> however these prior methods have multiple limitations including \n* limited accuracy\n* muscle specificity\n* repeatability\n* ease use\n* cost-effectiveness\n* `Invaluable information of stiffness mechanism at cellular and fiber livel`\nSWV measure the paretic side XXX\nBuilding upon these results, the goal of this study was to XXX. \nWe hypothesized that SWV speed would XXX"},{"_id":"7285e348e24e4eec44000048","treeId":"6c9a9efb7c9099abf8000056","seq":14217998,"position":1,"parentId":"6f2ca90be220455202000061","content":"?\nMy results showed an odd pattern. the swv is negatively correlated to entropy. But in my findings, the paretic arm of entropy is higher than non-paretic arm. It is totally conflicts.\nthe more harder (SWV) the muscle, the higher entropy has. It should be positive correlation between swv and entropy. But my result did not meet this finding when perform the spearaman correlation test. It has strong negative correlation between them."},{"_id":"6e1be4b7364159d241000086","treeId":"6c9a9efb7c9099abf8000056","seq":14500798,"position":1.5,"parentId":"6f2ca90be220455202000061","content":"### Introduction flow: (Lee, 2015)\nStroke is long term disability. Impairments include XXX. These impairements lead to muscle properites change over time -> impact QoL.\nMuscle stiffness, past studies results -> However, methods were made indirectly.\nQuickly quantify changes in muscle stiffness of specific muscles in a clinical setting remains a challenge.\nRecently, SWV have investigated the stiffness on XXX. High speed is in spastic muscle. -> indirectly estimate stiffness.\nAccordingly, we sought to determine XXX. We also assessed the echotexture of BBM and correlated our estimates of material properties with major clinical assessments in cluding, FIM FMA."},{"_id":"6f2c4a4ee220455202000062","treeId":"6c9a9efb7c9099abf8000056","seq":14351166,"position":2,"parentId":"6f2ca90be220455202000061","content":"## Spasticity = tone + stiffness\n[ ] The main topic is for stiff or spasticity?"},{"_id":"709fb7d80110a6327b00004f","treeId":"6c9a9efb7c9099abf8000056","seq":13877092,"position":1.5,"parentId":null,"content":"# The Echotexture of Spastic Muscle in Stroke Patients Using Local Binary Pattern with Sonoelastographic Imaging\n\nBackground: Muscle properties changes early after stroke. Accurately characterizing and quantifying the stiff muscle is clinically important to better understand the altered muscle function and movement control.\n\nObjective: The aim of this study was to investigate the feasibility of sonoelastography to determine the muscle stiffness and the echotexture in poststroke. We also tested the relationship among sonoelastography findings, muscle echotexture features and functional performance in the spastic muscle.\n\nMethods: A total of 21 men with subacute stroke were studied. The intrinsic stiffness of biceps brachii muscles (BBM) on both arms were assessed at rest by shear wave velocity and echotexture features (entropy & energy) were extracted by Local Binary Pattern (LBP) of ultrasound imaging. The scanning images of BBM were acquired in both the transverse and the longitudinal planes. The Fugl-Meyer Assessment (FMA) and Functional Independence Measure (FIM) were used to assess the functional performance of upper arm. \n\nResults: The shear wave velocity was significantly faster in paretic BBM, compared to non-paretic BBM in the transverse and the longitudinal planes. The echotexture (entropy & energy) was more in-homogeneous in the paretic BBM than in the non-paretic side on both scanning planes. The shear wave velocity was negatively correlated to entropy (r = – 0.44, P = 0.04) and energy (r = 0.49, P = 0.02) in the longitudinal plane. The energy was correlated to FMA (r = – 0.46, P = 0.03), FIM (r = – 0.55, P < 0.01) in the longitudinal plane, and duration from stroke onset (r = 0.49, P = 0.03), age (r = – 0.53, P = 0.02) in the transverse plane. \n\nConclusion: The echotexture of LBP is capable to be a useful tool for quantitative assessment of the spastic BBM in patients with early stroke."},{"_id":"6c9b135f64fd300c57000067","treeId":"6c9a9efb7c9099abf8000056","seq":13922539,"position":3.625,"parentId":null,"content":"Log files:\n2018/03/31\n * it seems a good writing tool, espeically the initial stage.\n [ ] data clean and imputatation the missing values\n\nhttps://app.ithenticate.com/zh_tw/login\n105546@cch.org.tw\ne2"},{"_id":"74894e74c42e0656a7000026","treeId":"6c9a9efb7c9099abf8000056","seq":14184500,"position":3.75,"parentId":null,"content":"shortcut of Ginko:cmd + M\n= / -:Focus mode\nfull screen: F\n#: header (#, ##, ### 中間空一格)\ntag: #tag (#連在一起)\n粗體:**Bold**. cmd+B\n斜體:* ltalic text *. cmd+I\n紅字:`Red text`\n列點:* item. cmd+I then space\n圖片:cmd + shift + I\n新增卡片:cmd + arrow key\n確認:cmd + enter\n修改:enter\n刪除:cmd + delete\n分隔線: 三個*連在一起(如下)\n***\n設定欄位寬度\n# Style\n\n<style>\n.column{\n width:450px !important;\n}\n</style>\n\n匯入outline當卡片\n# Part I\nsome text\n\n## Chapter 1\nother\n\n## Chapter 2\nmore"}],"tree":{"_id":"6c9a9efb7c9099abf8000056","name":"Stiff Paretic muscle with Local binary pattern echotexture","publicUrl":"stiff-paretic-muscle-with-local-binary-pattern-echotexture"}}