Evaluation of Post-Stroke Spastic Muscle Stiffness Using Shear Wave Ultrasound Elastography

Abstract

Current clinical evaluations of post-stroke upper limb spasticity are subjective and qualitative. We proposed a quantitative measurement of post-stroke spastic muscle stiffness by using shear-wave ultrasound elastography and tested its reliability. Acoustic radiation force impulse with shear wave velocity (SWV) detection was used to evaluate stiffness of the biceps brachii muscles at 90° and 0° elbow flexion. In 21 control subjects, SWV did not significantly differ between dominant and non-dominant sides at either flexion angle (0°: p = 0.311, 90°: p = 0.436). In 31 patients who had recent stroke, SWV was significantly greater on the paretic side than on the non-paretic side at both 90° (2.23 ± 0.15 m/s vs. 1.88 ± 0.08 m/s, p = 0.036) and 0° (3.28 ± 0.11 m/s vs. 2.93 ± 0.06 m/s, p = 0.002). The physical appearance of arms and forearms of our patients and controls prevented blinding of the rater to paretic or non-paretic side. At 90°, SWV on the paretic side correlated positively with modified Ashworth scale and modified Tardieu scale (spasticity severity) and negatively with Stroke Rehabilitation Assessment of Movement score (motor function impairment). The intra-class correlation coefficients of intra-rater and inter-rater reliability for SWV measurements were classified as excellent. In conclusion, high SWV was associated with high spasticity and poor function of the post-stroke upper limb, suggesting possible use as a reliable quantitative measure for disease progression and treatment follow-up.

Keywords: Elastography; Muscle; Neurophysiologic; Shear wave; Spasticity; Stroke; Ultrasound.