Magnetic Resonance Imaging (MRI) can be regarded as the gold standard for muscle imaging; however there is little knowledge about in vivo morphometric features of neck extensor muscles in healthy subjects and how muscle size alters across vertebral segments. It is not known how body size and activity levels may influence neck muscle cross-sectional area (CSA) or if the muscles differ from left and right. The purpose of this study was to establish relative CSA (rCSA) data for the cervical extensor musculature with a reliable MRI measure in asymptomatic females within a defined age range and to determine if side-side and vertebral level differences exist. MRI of the cervical spine was performed on 42 asymptomatic female subjects within the age range of 18-45. The rCSA values for the cervical extensor muscles were measured from axial T1-weighted images. We found significant side-side rCSA differences for the rectus capitis posterior minor, major (P < 0.001), multifidus (P = 0.002), and the semispinalis cervicis/capitis (P = 0.001, P < 0.001). There were significant vertebral level differences in rCSA of the semispinalis cervicis/capitis, multifidus, splenius capitis, and upper trapezius (P < 0.001). Activity levels were shown to impact on the size of semispinalis cervicis (P = 0.027), semispinalis capitis (P = 0.003), and the splenius capitis (P = 0.004). In conclusion, measuring differences in neck extensor muscle rCSA with MRI in an asymptomatic population provides the basis for future study investigating relationships between muscular atrophy and symptoms in patients suffering from persistent neck pain. Clin.
"MR measurement of neck muscle cross sectional area (CSA) has been shown to be feasible in young healthy adults using scans dedicated to this purpose (ie MR Imaging of the neck), but older adults have not been studied –. These studies have demonstrated good inter-rater reliability , . "
[Show abstract][Hide abstract] ABSTRACT: Low muscle mass secondary to disease and ageing is an important cause of excess mortality and morbidity. Many studies include a MR brain scan but no peripheral measure of muscle mass. We developed a technique to measure posterior neck muscle cross-sectional area (CSA) on volumetric MR brain scans enabling brain and muscle size to be measured simultaneously.
We performed four studies to develop and test: feasibility, inter-rater reliability, repeatability and external validity. We used T1-weighted MR brain imaging from young and older subjects, obtained on different scanners, and collected mid-thigh MR data.
After developing the technique and demonstrating feasibility, we tested it for inter-rater reliability in 40 subjects. Intraclass correlation coefficients (ICC) between raters were 0.99 (95% confidence intervals (CI) 0.98-1.00) for the combined group (trapezius, splenius and semispinalis), 0.92 (CI 0.85-0.96) for obliquus and 0.92 (CI 0.85-0.96) for sternocleidomastoid. The first unrotated principal component explained 72.2% of total neck muscle CSA variance and correlated positively with both right (r = 0.52, p = .001) and left (r = 0.50, p = .002) grip strength. The 14 subjects in the repeatability study had had two MR brain scans on three different scanners. The ICC for between scanner variation for total neck muscle CSA was high at 0.94 (CI 0.86-0.98). The ICCs for within scanner variations were also high, with values of 0.95 (CI 0.86-0.98), 0.97 (CI 0.92-0.99) and 0.96 (CI 0.86-0.99) for the three scanners. The external validity study found a correlation coefficient for total thigh CSA and total neck CSA of 0.88.
We present a feasible, valid and reliable method for measuring neck muscle CSA on T1-weighted MR brain scans. Larger studies are needed to validate and apply our technique with subjects differing in age, ethnicity and geographical location.
PLoS ONE 04/2012; 7(4):e34444. DOI:10.1371/journal.pone.0034444 · 3.23 Impact Factor
"Elliot et al. (2007) found, in contrast to others (Kristjansson et al., 2004; Fernández-delas-peñas et al, 2008), that patients with whiplash-associated disorders have a larger CSA (C3- C7) on MRI than controls. This finding was interpreted as reflecting fatty infiltration in the muscles (Elliott et al., 2007). The disturbance in deep neck muscles after trauma and pain demonstrate the need for additional understanding of muscular patterning in healthy and diseased persons, and a better understanding of how to optimize rehabilitation. "
[Show abstract][Hide abstract] ABSTRACT: Persons with neck pain exhibit altered patterns of muscle patterning, but limited investigations have been carried out on these alterations or muscle patterning in healthy volunteers. This study investigated the tissue motion of the dorsal neck muscles at the C4 segmental level in 15 healthy subjects during manually resisted head extension. Doppler-based tissue velocity ultrasound imaging (TVI) was used to detect regional tissue deformation, providing indirect evidence of inter-muscular movement patterning. The deep muscles, multifidus and semispinalis, had different muscular movement patterning than the superficial muscles, especially the trapezius muscle. The semispinalis cervicis (SSCerv) was the first deformed upon exercise initiation, followed by multifidus and semispinalis capitis (SSCap). The semispinalis muscles, notably capitis, exhibited a high rate of deformation during the exercise. The trapezius muscle exhibited the least and lowest deformation rate. In conclusion, TVI provided detailed information on regional tissue activity and muscle movement patterning among the dorsal neck muscles. In future studies, data from patients with neck disorders will have to be matched to data from healthy volunteers in a variety of situations and activities.
"The rCSA measures for the bilateral segmental extensor muscles (C3–C7) were measured after identifying the individual muscle at the most cephalad portion of each particular vertebral level on the MR axial scan. This process ensured consistent representation of rCSA measures for each muscle at each level between the subjects and has been previously reported in detail (Elliott et al., 2005). The examiner (JE) was not blinded to the status of the subjects. "
[Show abstract][Hide abstract] ABSTRACT: Cervical muscle function is disturbed in patients with persistent pain related to a whiplash associated disorder (WAD) but little is known about neck extensor muscle morphometry in this group. This study used magnetic resonance imaging to measure relative cross-sectional area (rCSA) of the rectus capitis posterior minor and major, multifidus, semispinalis cervicis and capitis, splenius capitis and upper trapezius muscles bilaterally at each cervical segment. In total, 113 female subjects (79 WAD, 34 healthy control; 18-45 years, 3 months-3 years post-injury) were recruited for the study. Significant main effects for differences in muscle and segmental level were found between the two groups (P < 0.0001) as well as a significant group * muscle * level interaction (P < 0.0001). The cervical multifidus muscle in the WAD group had significantly larger rCSA at all spinal levels and in contrast, there were variable differences in rCSA measures across levels in the intermediate and superficial extensor muscles when compared to the healthy controls (P < 0.0001). There were occasional weak, although statistically significant relationships between age, body mass index (BMI), duration of symptoms and the size of some muscles in both healthy control and WAD subjects (P < 0.01). It is possible that the consistent pattern of larger rCSA in multifidus at all levels and the variable pattern of rCSA values in the intermediate and superficial muscles in patients with WAD may reflect morphometric change due to fatty infiltrate in the WAD muscles. Future clinical studies are required to investigate the relationships between muscular morphometry, symptoms and function in patients with persistent WAD.
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