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Published on: May 7, 2015
Ultrasound Shear-wave Elastography Reveals Biomechanical Heterogeneity Following Acute Spinal Cord Injury
Patrick Kramer1, Max J Kerensky2, Annie Pan3
1Department of Neurosurgery, Johns Hopkins University School of Medicine Baltimore, MD, USA.
Objective:
Traumatic spinal cord injury (SCI) triggers rapid biomechanical and biological changes that extend beyond the primary lesion and drive secondary tissue loss. Conventional imaging defines structural injury but provides limited information regarding evolving mechanical tissue properties. Shear-wave elastography (SWE) enables real-time quantification of tissue stiffness and may identify mechanically vulnerable peri-lesional regions after SCI.
Methods:
A porcine thoracic contusion model was used to evaluate SWE signatures following acute SCI. Severe (60 g, n = 8) injuries and an exploratory mild (20 g, n = 1) injury were induced after T4-T6 laminectomy. SWE was performed pre- and post-injury at early (<15 min), mid (15-45 min) and late (>45 min) time points. Shear-wave velocity (SWV) heat maps were processed using a custom image analysis pipeline to quantify stiffness relative to the injury epicenter within ±1 cm. The hematoma area was segmented from the co-registered B-mode images.
Results:
Severe injuries produced large increases in SWV relative to baseline. In severe SCI, Δ-SWV peaked during early and mid-intervals and attenuated at later time points, while hematoma size remained relatively stable over time. Spatial SWV profiles demonstrated dynamic heterogeneity: early post-injury patterns were unimodal and centered at the epicenter, whereas mid- and late-stage profiles frequently evolved into bimodal morphologies with elevated peri-lesional stiffness flanking a relatively softer core. These stiffness gradients extended several millimeters beyond the epicenter and were not explained by hematoma expansion alone.
Conclusion:
SWE reveals rapid, spatially heterogeneous biomechanical remodeling after acute SCI, distinct from gross morphologic injury. The emergence of peri-lesional stiffness gradients suggests an imaging-defined biomechanical zone of altered tissue mechanics that warrants further investigation as a potential marker of secondary injury processes.
