Estudo exploratório da elastografia 'Acoustic Radiation Force Impulse (ARFI)' sobre estruturas flexoras da porção distal dos membros torácicos de equinos
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Data
2017-02-03
Autores
Bernardi, Nara Saraiva [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A elastografia ARFI é uma técnica de imagem por ultrassom capaz de avaliar qualitativa e quantitativamente a rigidez dos tecidos. Não existe até o momento aplicação dessa técnica aos tendões e ligamentos de equinos e sob este aspecto o trabalho é inédito. Objetivou-se avaliar a rigidez dos tendões flexores digitais superficial (TFDS) e profundo (TFDP), ligamento acessório (LA) e ligamento suspensor do boleto (LSB) de equinos hígidos por meio da elastografia ARFI (“Acoustic Radiation Force Impulse”), determinando os padrões quantitativos (velocidade de cisalhamento - VC) ainda não descritos na espécie equina. Para tal, utilizou-se 24 animais, nos quais se avaliou ambos os membros torácicos. Após a realização de exames prévios e verificada a higidez, estes foram submetidos ao exame ultrassonográfico convencional e elastografia (método ARFI quantitativo) dos tendões e ligamentos, em diferentes regiões anatômicas. O delineamento experimental foi inteiramente casualizado e utilizou-se nível de significância de 5% para todos os testes realizados. Os elastogramas em escala de cor mostraram que as estruturas estudadas são não deformáveis, apresentam coloração alaranjada ou tendendo ao vermelho e as estruturas adjacentes, os tecidos moles, apresentaram tonalidades esverdeadas a azuis, indicando menor rigidez em relação aos tendões e ligamentos. Não houve diferenças em relação ao membro avaliado (esquerdo ou direito), e a velocidade de cisalhamento foi maior nos cortes longitudinais em relação aos transversais. No corte transversal a VC do LSB foi significativamente maior em comparação às demais estruturas avaliadas e o LA apresentou menor VC em relação ao TFDS. No corte longitudinal as estruturas ligamentares foram mais rígidas que as estruturas tendíneas, dentre estas o TFDP apresentou maior rigidez em relação ao TFDS. A VC não diferiu entre as regiões para os cortes transversais em todas as estruturas. No corte longitudinal, o TFDS é mais rígido na região proximal, bem como o TFDP. A VC do LA e LSB não diferiu nos cortes longitudinais. Em relação à profundidade observada na avaliação elastográfica houve semelhança entre os lados e cortes. E variou com relação à estrutura avaliada, sendo, na ordem crescente, TFDS, TFDP, LA e LSB. As estruturas mostraram-se mais rígidas nos machos do que nas fêmeas e houve uma tendência a maior rigidez nos animais mais velhos. A elastografia ARFI é um método viável, repetível e reprodutível para avaliação dos tendões e ligamentos dos membros torácicos de equinos. As características qualiquantitativas obtidas da rigidez destas estruturas poderão ser utilizadas para ensaios em equinos com afecções musculo-esqueléticas e também em outras espécies animais.
ARFI elastography is an ultrasound imaging technique capable of qualitatively and quantitatively evaluate tissue stiffness. At the moment, there is no application of this technique to horse’s tendons and ligaments. The aim of the present study was to evaluate the stiffness of the superficial (SDFT) and deep digital flexor tendons (DDFT), accessory ligament of the deep digital flexor tendon (AL) and suspensory ligament (SL) of the forelimb in healthy horses through ARFI (Acoustic Radiation Force Impulse) elastography imaging, determining the quantitative patterns (shear velocity - SV) which have not yet been described in equine veterinary medicine. Twenty four animals were used, after conducting preliminary tests to verify absence of musculoskeletal disorders, they were subjected to conventional ultrasonographic examination and elastography imaging (quantitative ARFI method) of tendons and ligaments in nine different anatomical regions. The experimental design was completely randomized with a level of significance of 5%. The color scale elastograms showed that the studied structures are non-deformable, being orange or tending to red and the adjacent structures had greenish-blue tones, indicating less stiffness in relation to tendons and ligaments. There were no differences in relation to the evaluated limb (left or right), shear velocities were higher in longitudinal versus transversal planes. In the transveral plane, SV of the evaluated structures differed significantly being higher for the SL in comparison to the others and the AL presented lower SV in relation to the SDFT. In the longitudinal plane, SV of the structures also differed being the SL and AL higher than the flexor tendons, and the DDFT higher than the SDFT. SV did not differ between regions in transversal plane for all evaluated structures. In the longitudinal plane, the SDFT at the distal region was stiffer than in the middle region, for the DDFT, the proximal region was stiffer, followed by the middle region and finally the distal region. The SV of AL and SL did not differ in longitudinal sections. Regarding depth of elastographic evaluation there was similarity between sides and planes. And there was a variation in relation to the evaluated structure, being, in order of the superficial to the deeper structure, SDFT, DDFT, AL and SL, as expected. Structures were more rigid in males than in females and there was a tendency for greater stiffness in older animals. ARFI elastography is a viable, repeatable and reproducible method for evaluating tendons and ligaments of the thoracic limbs of horses. The qualitative characteristics obtained from the rigidity of these structures can be used for tests on horses with musculoskeletal disorders and also on other animal species.
ARFI elastography is an ultrasound imaging technique capable of qualitatively and quantitatively evaluate tissue stiffness. At the moment, there is no application of this technique to horse’s tendons and ligaments. The aim of the present study was to evaluate the stiffness of the superficial (SDFT) and deep digital flexor tendons (DDFT), accessory ligament of the deep digital flexor tendon (AL) and suspensory ligament (SL) of the forelimb in healthy horses through ARFI (Acoustic Radiation Force Impulse) elastography imaging, determining the quantitative patterns (shear velocity - SV) which have not yet been described in equine veterinary medicine. Twenty four animals were used, after conducting preliminary tests to verify absence of musculoskeletal disorders, they were subjected to conventional ultrasonographic examination and elastography imaging (quantitative ARFI method) of tendons and ligaments in nine different anatomical regions. The experimental design was completely randomized with a level of significance of 5%. The color scale elastograms showed that the studied structures are non-deformable, being orange or tending to red and the adjacent structures had greenish-blue tones, indicating less stiffness in relation to tendons and ligaments. There were no differences in relation to the evaluated limb (left or right), shear velocities were higher in longitudinal versus transversal planes. In the transveral plane, SV of the evaluated structures differed significantly being higher for the SL in comparison to the others and the AL presented lower SV in relation to the SDFT. In the longitudinal plane, SV of the structures also differed being the SL and AL higher than the flexor tendons, and the DDFT higher than the SDFT. SV did not differ between regions in transversal plane for all evaluated structures. In the longitudinal plane, the SDFT at the distal region was stiffer than in the middle region, for the DDFT, the proximal region was stiffer, followed by the middle region and finally the distal region. The SV of AL and SL did not differ in longitudinal sections. Regarding depth of elastographic evaluation there was similarity between sides and planes. And there was a variation in relation to the evaluated structure, being, in order of the superficial to the deeper structure, SDFT, DDFT, AL and SL, as expected. Structures were more rigid in males than in females and there was a tendency for greater stiffness in older animals. ARFI elastography is a viable, repeatable and reproducible method for evaluating tendons and ligaments of the thoracic limbs of horses. The qualitative characteristics obtained from the rigidity of these structures can be used for tests on horses with musculoskeletal disorders and also on other animal species.
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Palavras-chave
Cavalos, Imaginologia, Ligamento, Tendão, Tendinopatias, Ultrassonografia