Ultrasound Imaging of Spinal Vertebrae to Study Scoliosis

Wei Chen, Lawrence H. Le, Edmond H.M. Lou

Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada.
Department of Surgery, University of Alberta, Edmonton, Canada.
Departmentof Biomedical Engineering, University of Alberta, Edmonton, Canada.

DOI: 10.4236/oja.2012.23011                

Abstract

Scoliosis is a musculoskeletal disorder manifested as a three-dimensional spinal deformity. It affects 2% - 3% of the adolescent population. The conventional method to diagnose scoliosis is to measure the Cobb angle from posteroante-rior radiograph. Since radiation exposure is not desirable for patients, other non-ionizing methods have been explored. Among all the non-ionization methods, ultrasound (US) is a potential cost-effective method. However, our understand-ing of US interaction with the vertebrae or the spine is limited. The purpose of this study was to demonstrate the ability of US to identify bony landmarks for measuring spinal deformity. This study used a phased array US system with a 5 MHz transducer and a position encoder. In-vitro experiment on a cadaver vertebra and a pilot clinical study were carried out. The in-vitro experimental results showed that the lamina and spinous process were strong reflectors from the single vertebra. Less than 4% of error occurred on the dimension measurements. The pilot study was performed on a healthy subject and a scoliotic patient. The results indicated the lamina and spinous process could be identified and the curvature of the spine could be estimated using the reflectors. The difference of the curvature angle of the spine measured from the radiograph and the US images was 2?. These results have illustrated that US is a promising tool to measure curvature of spinal deformity and study scoliosis.

Keywords

Ultrasound; Cobb Angle; Phased Array; Scoliosis; Spinal Deformity; Ultrasonic Imaging

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	P. Deacon, B. M. Flood and R. A. Dickson, “Idiopathic Scoliosis in Three Dimensions. A Radiographic and Morphometric Analysis,” Journal of Bone & Joint Surgery, Vol. 66, No. 4, 1984, pp. 509-512.
[2]	R. T. Morrissy and S. L. Weinstein, “Idiopathic Scoliosis in Lovell & Winter’s Pediatric Orthopedics,” Lippincott Williams & Wilkins, Philadelphia, 2006, pp. 694-762.
[3]	W. P. Bunnell, “The Natural History of Idiopathic Scoliosis,” Clinical Orthopaedics and Related Research, Vol. 229, 1988, pp. 20-25.
[4]	A. Nachemson, “A Long Term Follow-Up Study of NonTreated Scoliosis,” Acta Orthopaedica Scandinavica, Vol. 39, No. 4, 1968, pp. 466-476. doi:10.3109/17453676808989664
[5]	K. Pehrsson, S. Larsson, A. Oden, et al., “Long-Term Follow-Up of Patients with Untreated Scoliosis—A Study of Mortality, Causes of Death, and Symptoms,” Spine, Vol. 17, No. 9, 1992, pp. 1091-1096. doi:10.1097/00007632-199209000-00014
[6]	S. L. Weinstein, L. A. Dolan, K. F. Spratt, et al., “Health and Function of Patients with Untreated Idiopathic Scoliosis—A 50-Year Natural History Study,” Journal of the American Medical Association, Vol. 289, No. 5, 2003, pp. 559-567. doi:10.1001/jama.289.5.559
[7]	S. L. Weinstein, D. C. Zavala and I. V. Ponseti, “Idiopathic Scoliosis—Long-Term Follow-Up and Prognosis in Untreated Patients,” The Journal of Bone & Joint Surgery, Vol. 63, No. 5, 1981, pp. 702-712.
[8]	J. Cobb, “Outline for the Study of Scoliosis,” Instructional Course Lectures, Vol. 5, 1948, pp. 261-275.
[9]	T. R. Kuklo, B. K. Potter and L. G. Lenke, “Vertebral Rotation and Thoracic Torsion in Adolescent Idiopathic Scoliosis: What Is the Best Radiographic Correlate?” Journal of Spinal Disorders & Techniques, Vol. 18, No. 2, 2005, pp. 139-147. doi:10.1097/01.bsd.0000159033.89623.bc
[10]	C. L. Nash Jr. and J. H. Moe, “A Study of Vertebral Rotation,” The Journal of Bone & Joint Surgery, Vol. 51, No. 2, 1969, pp. 223-229.
[11]	R. Perdriolle and J. Vidal, “Thoracic Idiopathic Scoliosis Curve Evaluation and Prognosis,” Spine, Vol. 10, No. 9, 1985, pp. 785-791. doi:10.1097/00007632-198511000-00001
[12]	I. A. Stokes, L. C. Bigalow and M. S. Moreland, “Measurement of Axial Rotation of Vertebrae in Scoliosis,” Spine, Vol. 11, No. 3, 1986, pp. 213-218. doi:10.1097/00007632-198604000-00006
[13]	S. Aaro and M. Dahlborn, “Estimation of Vertebral Rotation and the Spinal and Rib Cage Deformity in Scoliosis by Computer Tomography,” Spine, Vol. 6, No. 5, 1981, pp. 460-467.doi:10.1097/00007632-198109000-00007
[14]	E. K. Ho, S. S. Upadhyay, F. L. Chan, et al., “New Methods of Measuring Vertebral Rotation from Computed Tomographic Scans. An Intraobserver and Interobserver Study on Girls with Scoliosis,” Spine, Vol. 18, No. 9, 1993, pp. 1173-1177. doi:10.1097/00007632-199307000-00008
[15]	D. A. Hoffman, J. E. Lonstein, M. M. Morin, et al., “Breast Cancer in Women with Scoliosis Exposed to Multiple Diagnostic X Rays,” Journal of the National Cancer Institute, Vol. 81, No. 17, 1989, pp. 1307-1312. doi:10.1093/jnci/81.17.1307
[16]	M. M. Doody, J. E. Lonstein, M. Stovall, et al., “Breast Cancer Mortality after Diagnostic Radiography: Findings from the US Scoliosis Cohort Study,” Spine, Vol. 25, No. 16, 2000, pp. 2052-2063. doi:10.1097/00007632-200008150-00009
[17]	A. Schmitz, U. E. Jaeger, R. Koenig, et al., “A New MRI Technique for Imaging Scoliosis in the Sagittal Plane,” European Spine Journal, Vol. 10, No. 2, 2001, pp. 114117. doi:10.1007/s005860100250
[18]	D. Birchall, D. Hughes, B. Gregson, et al., “Demonstration of Vertebral and Disc Mechanical Torsion in Adolescent Idiopathic Scoliosis Using Three-Dimensional MR Imaging,” European Spine Journal, Vol. 14, No. 2, 2005, pp. 123-129. doi:10.1007/s00586-004-0705-5
[19]	N. J. Oxborrow, “Assessing the Child with Scoliosis: The Role of Surface Topography,” Archives of Disease in Childhood, Vol. 83, No. 5, 2000, pp. 453-455. doi:10.1136/adc.83.5.453
[20]	I. Weisz, R. J. Jefferson, A. R. Turner-Smith, et al., “ISIS Scanning: A Useful Assessment Technique in the Management of Scoliosis,” Spine, Vol. 13, No. 4, 1988, pp. 405-408. doi:10.1097/00007632-198804000-00006
[21]	J. S. Daruwalla and P. Balasubramaniam, “Moire Topography in Scoliosis. Its Accuracy in Detecting the Site and Size of the Curve,” The Journal of Bone & Joint Surgery, Vol. 67, No. 2, 1985, pp. 211-213.
[22]	A. R. Turnersmith, J. D. Harris, G. R. Houghton, et al., “A Method for Analysis of Back Shape in Scoliosis,” Journal of Biomechanics, Vol. 21, No. 6, 1988, pp. 497509. doi:10.1016/0021-9290(88)90242-4
[23]	C. J. Goldberg, M. Kaliszer, D. P. Moore, et al., “Surface Topography, Cobb Angles, and Cosmetic Change in Scoliosis,” Spine, Vol. 26, No. 4, 2001, pp. E55-63. doi:10.1097/00007632-200102150-00005
[24]	L. Song, Y. Bourassa, D. Beauchamp, et al., “Optical 3D Digitizer, System and Method for Digitizing an Object,” US Patent No. 6493095, 2002.
[25]	V. Pazos, F. Cheriet, L. Song, et al., “Accuracy Assessment of Human Trunk Surface 3D Reconstructions from an Optical Digitising System,” Medical & Biological Engineering & Computing, Vol. 43, No. 1, 2005, pp. 11-15. doi:10.1007/BF02345117
[26]	E. Parent, E. Watkins, M. Emrani, et al., “Differences in Measures of Full-Torso Surface Topography among Healthy Teenagersare Independent of Growth Indicators,” Scoliosis, Vol. 5, No. 1 Suppl, 2010, p. 9.
[27]	P. Parisini, F. Lolli, T. Greggi, et al., “An Innovative Diagnostic Procedure of Vertebral Deformities without Exposure to X-Rays,” Studies in Health Technology and Informatics, Vol. 123, 2006, pp. 527-532.
[28]	P. Knott, S. Mardjetko, D. Nance, et al., “Electromagnetic Topographical Technique of Curve Evaluation for Adolescent Idiopathic Scoliosis,” Spine, Vol. 31, No. 24, 2006, pp. E911-915. doi:10.1097/01.brs.0000245924.82359.ab
[29]	J. Bushberg, J. Seibert, E. Leidholdt, et al., “The Essential Physics of Medical Imaging,” 2nd Edition, Lippincott Williams & Wilkins, Philadelphia, 2002.
[30]	S. Suzuki, T. Yamamuro, J. Shikata, et al., “Ultrasound Measurement of Vertebral Rotation in Idiopathic Scoliosis,” Journal of Bone & Joint Surgery, Vol. 71, No. 2, 1989, pp. 252-255.
[31]	G. Furness, M. P. Reilly and S. Kuchi, “An Evaluation of Ultrasound Imaging for Identification of Lumbar Intervertebral Level,” Anaesthesia, Vol. 57, No. 3, 2002, pp. 277-280. doi:10.1046/j.1365-2044.2002.2403_4.x
[32]	M. Li, J. Cheng, M. Ying, et al., “Application of 3-D Ultrasound in Assisting the Fitting Procedure of Spinal Orthosis to Patients with Adolescent Idiopathic Scoliosis,” Studies in Health Technology and Informatics, Vol. 158, 2010, pp. 34-37.
[33]	J. E. Herzenberg, N. A. Waanders, R. F. Closkey, et al., “Cobb Angle versus Spinous Process Angle in Adolescent Idiopathic Scoliosis. The Relationship of the Anterior and Posterior Deformities,” Spine, Vol. 15, No. 9, 1990, pp. 874-879. doi:10.1097/00007632-199009000-00007
[34]	C. Zhang, L. H. Le, R. Zheng, et al., “Measurements of Ultrasonic Phase Velocities and Attenuation of Slow Waves in Cellular Aluminum Foams as Cancellous BoneMimicking Phantoms,” Journal of the Acoustical Society of America, Vol. 129, No. 5, 2011, pp. 3317-3326. doi:10.1121/1.3562560
[35]	A. Laurent, F. Mistretta, D. Bottigioli, et al., “Echographic Measurement of Skin Thickness in Adults by High Frequency Ultrasound to Assess the Appropriate Microneedle Length for Intradermal Delivery of Vaccines,” Vaccine, Vol. 25, No. 34, 2007, pp. 6423-6430. doi:10.1016/j.vaccine.2007.05.046
[36]	C. M. Moran, N. L. Bush and J. C. Bamber, “Ultrasonic Propagation Properties of Excised Human Skin,” Ultrasound in Medicine & Biology, Vol. 21, No. 9, 1995, pp. 1177-1190. doi:10.1016/0301-5629(95)00049-6
[37]	J. W. Wallis, T. R. Miller, C. A. Lerner and E. C. Kleerup, “Three-Dimensional Display in Nuclear Medicine,” IEEE Transactions on Medical Imaging, Vol. 8, No. 4, 1989, pp. 297-303. doi:10.1109/42.41482.
[38]	L. H. Le, Y. J. Gu, Y. P. Li, et al., “Probing Long Bones with Ultrasonic Body Waves,” Applied Physics Letters, Vol. 96, No. 11, 2010, pp. 114102-114104. doi:10.1063/1.3300474
[39]	R. Zheng, L. H. Le, M. D. Sacchi, et al., “Spectral Ratio Method to Estimate Broadband Ultrasound Attenuation of Cortical Bones in Vitro Using Multiple Reflections,” Physics in Medicine and Biology, Vol. 52, No. 19, 2007, pp. 5855-5869. doi:10.1088/0031-9155/52/19/008
[40]	R. Zheng, L. H. Le, M. D. Sacchi and E. Lou, “Broadband Ultrasound Attenuation Measurement of Long Bone Using Peak Frequency of the Echoes,” IEEE Transactions on Ultrasonics Ferroelectrics and Frequency Control, Vol. 56, No. 2, 2009, pp. 396-399. doi: 10.1109/Tuffc.2009.1049.