Piriformis sendromu tanısında Shear Wave Elastografi ve Superbb Microvascular Imaging yöntemlerinin etkinliğinin değerlendirilmesi
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Dosyalar
Tarih
2020
Yazarlar
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Yayıncı
Trakya Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Piriformis sendromu, piriformis kasındaki hipertrofi, inflamasyon ya da anatomik varyasyonlara bağlı olarak siyatik sinirin kompresyonu sonucunda görülen nöromusküler bir hastalıktır. Siyatalji ile prezente olan piriformis sendromu tanısında altın standart görüntüleme yöntemi bulunmamakta olup çalışmamızda shear wave elastografi ve superb microvascular imaging gibi yenilikçi yöntemlerin piriformis sendromunda tanısal etkinliğininin değerlendirilmesi amaçlanmıştır. Prospektif dizayn edilen çalışmamızda tek taraflı piriformis sendromu tanısı alan 32 hasta istatistik aşamasına kabul edilmiştir. Hastaların semptom olmayan tarafı normal kabul edilerek bilateral piriformis kaslarından ultrasonografi aracılığı ile gri skalada kas kalınlığı, shear wave elastografi ile sertlik, power Doppler ve superb microvascular imaging incelemeleri ile vaskülarite özellikleri bağımsız 2 radyolog tarafından incelendi. İstatistiksel değerlendirme sonucunda patolojik taraftaki piriformis kas sertliği normal taraf ile karşılaştırıldığında istatistiksel olarak anlamlı derecede yüksek bulunmuştur (p<0.05). Hastada piriformis sendromu tanısı olmasıyla shear wave elastografide ölçülen sertlik değerleri arasında pozitif korelasyon izlenmiştir. Shear wave elastografide sertlik değerlerinin yüksek olması ile superb microvascular imaging ve power Doppler’de vaskülarite artışı arasında da istatistiksel olarak anlamlı korelasyon izlendi (p<0.01). Superb microvascular imaging ve power Doppler etkinlikleri karşılaştırıldığında superb microvascular imaging yönteminin duyarlılığı (%47) power Doppler’e göre yüksek (%25) saptanmıştır. Bunlar dışında patolojik tarafta piriformis kas kalınlığı normal taraftaki kas kalınlığından genel olarak yüksek olsa da istatistiksel ölçümlerde anlamlı farklılık saptanmadı. Piriformis kasında shear wave elastografi ile değerlendirmede anlamlı düzeyde yüksek sertlik değerleri elde edilmiş olup elastografi ile superb microvascular imaging yöntemi kombine edildiğinde kantitatif olarak piriformis sendromu tanısı desteklenebilir. Genel olarak ultrasonografide patolojik tarafta yüksek piriformis kas kalınlığı değerleri elde edilmekle birlikte, istatistiksel anlamda desteklemek için daha geniş vaka serileriyle gerçekleştirilecek çalışmalara ihtiyaç bulunmaktadır. Konvansiyonel ultrasonografi yöntemlerinin yanı sıra shear wave elastografi ve superb microvascular imaging gibi yenilikçi yöntemleri günlük pratiğimiz ve araştırmalar içerisinde olabildiğince kullanarak ultrasonografinin piriformis sendromu tanı aşamasındaki etkinliğini arrtırabilir ve hastaların daha erken uygun klinik yaklaşımla yönetilmelerine imkan sağlanabilir.
Piriformis syndrome is a neuromuscular disease seen as a result of compression of the sciatic nerve due to hypertrophy, inflammation or anatomical variations in the piriformis muscle. There is no gold standard imaging method in the diagnosis of piriformis syndrome, which is generally presented with sciatica. In our study, we aimed to evaluate the diagnostic effectiveness of innovative methods such as shear wave elastography and superb microvascular imaging in piriformis syndrome. In our prospectively designed study, 32 patients diagnosed with unilateral piriformis syndrome were accepted to the statistical stage. The non-symptom side of the patients was considered normal, and bilateral piriformis muscles were examined by ultrasonography; muscle thickness on gray scale, stiffness on shear wave elastography, , for vascularity characteristics power Doppler and superb microvascular imaging were examined by two independent radiologists. As a result of statistical evaluation, piriformis muscle stiffness in the pathological side was found to be statistically significantly higher compared to the normal side (p <0.05). There was a positive correlation between the patient with diagnosis of PS and the stiffness values measured in SWE. In shear wave elastography, statistically significant correlation was observed between high stiffness values and increased vascularity in superb microvascular imaging and power Doppler (p <0.01). When the superb microvascular imaging and power Doppler efficiency were compared, the sensitivity of the superb microvascular imaging method (47%) was higher (25%) than the power Doppler. Apart from these, although the piriformis muscle thickness on the pathological side was generally higher than the muscle thickness on the normal side, there was no significant difference in statistical measurements. In the evaluation of piriformis muscle by shear wave elastography, significantly higher stiffness values were obtained and when the elastography with superb microvascular imaging methods are combined,to the diagnosis of piriformis syndrome can be supported quantitatively. In generaly, high piriformis muscle thickness values are obtained on the pathological side in ultrasonography, but studies with larger case series are needed to support statistically. By using innovative methods such as shear wave elastography and superb microvascular imaging in addition to conventional ultrasonography as much as possible in our daily practice and research, we can increase the effectiveness of ultrasonography in the diagnosis of piriformis syndrome and enable patients to be managed earlier with appropriate clinical approach.
Piriformis syndrome is a neuromuscular disease seen as a result of compression of the sciatic nerve due to hypertrophy, inflammation or anatomical variations in the piriformis muscle. There is no gold standard imaging method in the diagnosis of piriformis syndrome, which is generally presented with sciatica. In our study, we aimed to evaluate the diagnostic effectiveness of innovative methods such as shear wave elastography and superb microvascular imaging in piriformis syndrome. In our prospectively designed study, 32 patients diagnosed with unilateral piriformis syndrome were accepted to the statistical stage. The non-symptom side of the patients was considered normal, and bilateral piriformis muscles were examined by ultrasonography; muscle thickness on gray scale, stiffness on shear wave elastography, , for vascularity characteristics power Doppler and superb microvascular imaging were examined by two independent radiologists. As a result of statistical evaluation, piriformis muscle stiffness in the pathological side was found to be statistically significantly higher compared to the normal side (p <0.05). There was a positive correlation between the patient with diagnosis of PS and the stiffness values measured in SWE. In shear wave elastography, statistically significant correlation was observed between high stiffness values and increased vascularity in superb microvascular imaging and power Doppler (p <0.01). When the superb microvascular imaging and power Doppler efficiency were compared, the sensitivity of the superb microvascular imaging method (47%) was higher (25%) than the power Doppler. Apart from these, although the piriformis muscle thickness on the pathological side was generally higher than the muscle thickness on the normal side, there was no significant difference in statistical measurements. In the evaluation of piriformis muscle by shear wave elastography, significantly higher stiffness values were obtained and when the elastography with superb microvascular imaging methods are combined,to the diagnosis of piriformis syndrome can be supported quantitatively. In generaly, high piriformis muscle thickness values are obtained on the pathological side in ultrasonography, but studies with larger case series are needed to support statistically. By using innovative methods such as shear wave elastography and superb microvascular imaging in addition to conventional ultrasonography as much as possible in our daily practice and research, we can increase the effectiveness of ultrasonography in the diagnosis of piriformis syndrome and enable patients to be managed earlier with appropriate clinical approach.
Açıklama
Anahtar Kelimeler
Piriformis Sendromu, Tanı, Ultrasonografi, Shear Wave Elastografi, Superb Microvascular İmaging, Power Doppler, Piriformis Syndrome, Diagnosis, Ultrasonography, Shear Wave Elastography, Superb Microvascular Imaging, Power Doppler
