Reproducibility of Anterior Scalene Stiffness Measurement with Shear Wave Elastography: An Inter-Examiner Reliability Study

Abstract

Purpose Although previous studies have highlighted the clinical relevance of the anterior scalene muscle (AS) in patients with neck pain or nerve compressive syndromes, evidence reporting the diagnostic accuracy of shear wave elastography (SWE) for assessing the AS stiffness properties is lacking. This study aimed to analyze the SWE inter-examiner reliability for calculating the Young’s modulus and shear wave speed of the AS muscle in asymptomatic subjects.

Materials and Methods Using a linear transducer, ultrasound images of the antero-lateral neck region at the C7 level were acquired in 35 healthy volunteers by one experienced examiner and one novice examiner. After codifying the images to blind the participants’ identity, the trial, and the side, Young’s modulus and shear wave speed were obtained by an independent experienced rater in randomized order. Intra-class correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable changes (MDC), and coefficient of variation (CV%) were calculated.

Results The assessed AS metrics showed no side-to-side differences (p>0.05). Sex differences were found for muscle size (p=0.002), but muscle brightness and stiffness were similar (p>0.05). Inter-examiner reliability was good for determining the AS muscle stiffness (ICC = 0.881 for Young’s modulus and 0.850 for shear wave speed).

Conclusion The obtained results suggest that assessing the AS stiffness properties in asymptomatic subjects is a reliable procedure. Further studies should verify the SWE capacity for discriminating healthy and clinical populations and identify potential factors contributing to the variance of measurement errors.

Zusammenfassung

Ziel Obwohl frühere Studien die klinische Relevanz des M. scalenus anterior (AS) bei Patienten mit Nackenschmerzen oder Nervenkompressionssyndromen hervorgehoben haben, fehlt es an Belegen für die diagnostische Genauigkeit der Scherwellen-Elastografie (SWE) zur Beurteilung der AS-Steifigkeitseigenschaften. Ziel dieser Studie war es, die Inter-Examiner-Reliabilität der SWE zur Berechnung des Elastizitätsmoduls und der Scherwellengeschwindigkeit des AS-Muskels bei asymptomatischen Probanden zu analysieren.

Material und Methoden Mit einem linearen Schallkopf wurden bei 35 gesunden Probanden von einem erfahrenen Untersucher und einem unerfahrenen Untersucher Ultraschallbilder der anterolateralen Halsregion auf C7-Ebene aufgenommen. Nach der Kodierung der Bilder, die dazu diente, die Identität der Teilnehmer, die Studie und die Seite zu verblinden, wurden das Elastizitätsmodul und die Scherwellengeschwindigkeit von einem unabhängigen erfahrenen Bewerter in randomisierter Reihenfolge ermittelt. Es wurden Intra-Klassen-Korrelationskoeffizienten (ICC), Standardmessfehler (SEM), minimal nachweisbare Veränderungen (MDC) und der Variationskoeffizient (CV%) berechnet.

Ergebnisse Die bewerteten AS-Metriken zeigten keine Unterschiede zwischen den Seiten (p>0,05). Geschlechtsspezifische Unterschiede wurden bei der Muskelgröße festgestellt (p=0,002), aber die Muskelhelligkeit und -steifigkeit waren ähnlich (p>0,05). Die Inter-Examiner-Reliabilität war gut für die Bestimmung der AS-Muskelsteifigkeit (ICC = 0,881 für das Elastizitätsmodul und 0,850 für die Scherwellengeschwindigkeit).

Schlussfolgerung Die erzielten Ergebnisse deuten darauf hin, dass die Bewertung der AS-Steifigkeitseigenschaften bei asymptomatischen Personen ein zuverlässiges Verfahren ist. Weitere Studien sollten die Fähigkeit der SWE zur Differenzierung zwischen gesunden und klinischen Populationen überprüfen und potenzielle Faktoren identifizieren, die zur Varianz von Messfehlern beitragen.

Keywords

Anterior scalene - Diagnostic accuracy studies - Reliability - Shear wave elastography - Ultrasound imaging

Publication History

Received: 27 March 2023

Accepted after revision: 24 November 2023

Accepted Manuscript online:
24 November 2023

Article published online:
18 January 2024

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