J Korean Soc Radiol.  2020 Jan;81(1):176-189. 10.3348/jksr.2020.81.1.176.

Clinical Efficacy of Real-Time Sonoelastography for the Follow-Up of Congenital Sternocleidomastoid Muscle Torticollis

• Jeong MR
• Lee IS
• Shin YB
• Song YS
• Park S
• Song JW
• Moon JI

• KMID: 2469191
• DOI: http://doi.org/10.3348/jksr.2020.81.1.176

Abstract

PURPOSE
To evaluate the clinical efficacy of real-time sonoelastography (RTS) for the follow-up of congenital muscular torticollis, based on measurements of muscle elasticity.
MATERIALS AND METHODS
Thirty-four infants (23 male, 11 female) with congenital sternocleidomastoid (SCM) muscle torticollis underwent ultrasonography and elastography between November 2012 and December 2014. We evaluated the thickness, morphology (mass-like, fusiform, or overall thickened shape), and echogenicity of the SCM muscle on grayscale images and color patterns (homogeneous blue, mixed green < 50% and ≥ 50%, and green to red) on elastography. Strain ratios were measured using Q-lab software. A clinician classified the degree of neck rotation and side flexion deficits using a 5-point grade system based on angles of neck rotation and side flexion. Correlations between the ultrasonography and clinical findings were evaluated by statistical analysis.
RESULTS
Twenty-two infants had right and 12 had left SCM torticollis, respectively. Linear regression analysis showed that involved/contralateral SCM thickness differences, morphology, elasticity color scores, and strain ratios of the affected SCM muscles were significantly correlated with neck rotation and side flexion deficit scores (p < 0.05). The elasticity color score of the affected SCM muscle was the most significant factor.
CONCLUSION
RTS might provide a reliable means for evaluating and monitoring congenital muscular torticollis.

MeSH Terms

Elasticity
Elasticity Imaging Techniques*
Follow-Up Studies*
Humans
Infant
Linear Models
Male
Muscles
Neck
Torticollis*
Treatment Outcome*
Ultrasonography

Figure

• 

  Fig. 1 Scoring of the echogenicity, morphology, and elasticity color pattern. A. Homogeneous hyperechoic (score 0). B. Heterogeneous hyperechoic ≥ 50% (score 1). C. Heterogeneous hyperechoic < 50% (score 2). D. Focally mass-like. E. Fusiform. F. Overall thickened shape. G. Nearly homogeneous blue: inelastic (score 0). H. Mainly blue, with small areas of green < 50% in the region of interest, slightly elastic (score 1). I. Blue and green areas with nearly the same distribution of blue and green or green areas accounting ≥ 50% of the region of interest, moderate elastic (score 2). J. Nearly homogeneous green or green to red: highly elastic (score 3).

• 

  Fig. 2 A 2-year-old male with left-sided congenital muscular torticollis. A. Initial examination performed at 1 month after birth. Axial grayscale sonogram shows focal mass-like thickening of the left SCM muscle with diffuse increased echogenicity. B. Simultaneous sonoelastography shows a predominantly blue color (score 0, strain ratio 2.5) within the involved SCM muscle, representing a hard consistency (neck rotation & side flexion deficit, each grade 4). C. The left SCM muscle thickness shows slight reduction (1.6 cm → 1.5 cm) and its morphology has changed, although it still appears as a focal mass, at the first follow-up sonography after 4 months of physiotherapy. The SCM muscle echogenicity increases to ≥ 50%. D. Simultaneous sonoelastography showing small areas of green < 50% (score 1, strain ratio 2.38) within the affected SCM muscle, representing a slightly less hard consistency (neck rotation and side flexion deficit grades were 4 and 2, respectively). E. The affected involved SCM muscle thickness is slightly reduced (1.5 cm → 1.1 cm) with a fusiform morphology, 3 months after the first follow-up. However, its echogenicity is diffusely increased. F. Simultaneous sonoelastography shows an increase in green to ≥ 50% (score 2, strain ratio 1.74) within the affected SCM muscle, representing a softer consistency (neck rotation and side flexion deficit grades were 2 and 2, respectively). SCM = sternocleidomastoid

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