UTC a novel approach for imaging of Achilles and patellar tendinopathy

35 Pages·2012·13.56 MB·English

UTC
a novel approach for imaging of
Achilles and patellar tendinopathy
Hans T. M. Van Schie PhD
UTC Imaging, Netherlands
1
Ladies and Gentlemen,
it is a great honor for me having the opportunity to tell you something
about UTC imaging, an innovative technique for diagnosis, therapy and
monitoring of Achilles and patellar tendinopathy.
What is UTC ?
= Ultrasound Tissue Characterization
~ visualizes & quantifies 3-D Tendon Integrity
~ discriminates various pathological stages
~ highly reproducible
2
UTC is our abbreviation for Ultrasound Tissue Characterisation.
This technique visualizes and quantifies 3-D tendon integrity.
UTC discriminates a variety of pathological tissue types
Tendinopathy
≈ chronic pain, swelling & loss of function
•
intra-tendinous disintegration due to
•
tendinosis
•
partial ruptures
•
surrounding paratenonitis
3
As you know, tendinopathy stands for chronic pain, swelling and loss of
function.
These clinical symptoms may be caused by
# tendinosis
# and/or partial ruptures,
# and/or paratenonitis.
“Tendinosis”, No Uniform Pathology !
fibrosis, a-cellularity
partial rupture fibro-proliferation
haematoma hyper-cellularity vascular sprouts
necrosis amorphous paratenonitis
cell-death degeneration mineraloid
4
Microscopy of tendinotic tendons shows multiple appearances.
# You may find partial ruptures and haematoma,
# or fibro-proliferation with hyper-cellularity and increased cell-
metabolism.
# or, on the other hand, extensive disintegration with a-cellularity and
vascular sprouts
# or focal degeneration with cell-death and necrosis.
# or, amorphous mucoid, fibro-myxoid and fatty degeneration
# at endstage, degeneration may lead even to calcification.
So, no uniform pathology at all !
Tendinopathy,
No Uniform Pathology !
inconsistent results of regenerative therapies !
regenerative therapy regenerate all stages ?
prognosis varies with type of pathology !
=> therapy based on tissue type !
=> exercise adapted to stage of integrity !
5
Even our smartest therapy suffers inconsistent results, raising
questions like
# do regenerative therapies really regenerate all tissue types, and
# does prognosis vary with type of pathology
In my opinion
# treatment protocols have to be based on tissue type, and
# during rehabilitation, exercise levels should be adapted to stage of
integrity
Therefore UTC !
✓
standardized scanning & analysis
✓
visualizes & quantifies 3-D tendon integrity
✓
UTC aims at:
• monitoring exercise effects
• early detection of matrix degradation
• staging of lesion
• targeted therapy
• guided rehabilitation
6
UTC is based on standardized scanning and analysis.
In contrast to conventional ultrasonography, UTC is highly reproducible
which allows
# monitoring of exercise effects
# early detection of matrix degradation
# staging of the lesion
# targeted therapy
# and guided rehabilitation
UTC configuration
✓
standardized scanning & foot-position
✓
motor-drive moves 7-12 MHz transducer
✓
transverse scans collected every 0.2 mm
✓
real-time storage in laptop
✓
scan over 12 cm takes < 60 sec.
7
This is the complete UTC configuration, a portable modality completely
different from conventional ultrasonography
Foot position and scanning are standardized.
The ultrasound transducer is fixed in a tracking device that moves
automatically along the tendon by means of a motor drive.
Transverse images are collected at regular distances of 0.2 mm and
stored real-time in a laptop computer.
Scanning over 12 cm takes less than 60 seconds.
Tomographic & 3-D Visualization
proximal
proximal
ü
transversal
ü
sagittal
ü
coronal
ü
3-D coronal
“surgeon´s view” into lesion
mineraloid (arrow)
8
By piling-up (and compounding) all successive transverse images, a 3
dimensional block is created, representing a tendon section with a
length of 12 cm.
Tendons can be visualized tomographically in 3 planes of view and in 3-D
Please notice that the 3-dimensional coronal image provides an inward
view into the lesion and visualizes perfectly the integrity and continuity of
fibres and fasciculi.
Tomographic & 3-D Visualization
proximal
proximal
ü
transversal
ü
sagittal
ü
coronal
ü
3-D coronal
“surgeon´s view” into lesion
mineraloid (arrow)
8
By piling-up (and compounding) all successive transverse images, a 3
dimensional block is created, representing a tendon section with a
length of 12 cm.
Tendons can be visualized tomographically in 3 planes of view and in 3-D
Please notice that the 3-dimensional coronal image provides an inward
view into the lesion and visualizes perfectly the integrity and continuity of
fibres and fasciculi.
Tissue Characterization
Echo-Types
I. intact, aligned bundle, Ø ≥ 0.38 mm
II. discontinuous, wavy bundle, Ø ≥ 0.38 mm
III. mainly fibrillar, Ø << 0.38 mm
IV. mainly cellular and fluid, Ø <<< 0.38 mm
9
Even more important than visualization is tissue characterization and
quantification of integrity.
Based on dynamics of echopatterns, UTC algorithms can discriminate 4
different echo-types, namely
+ type I, generated by intact and aligned fibres and fasciculi, colored
green
+ type II, generated by discontinuous or wavy fibres and fasciculi ,
colored blue
+ type III, related mainly to smaller fibrils, colored red, and
+ type IV, related mainly to amorphous tissue with cells and fluid, colored
black.
Please notice that echotypes I and II are generated by reflections from
larger structures, while III and IV are interfering echoes from smaller
entities with a size below the limits of resolution.