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Anthropometry of Human Muscle Using Segmentation Techniques and 3D Modelling: Applications to Lower Motor Neuron Denervated Muscle in Spinal Cord Injury

  • Paolo Gargiulo
  • Ugo Carraro
  • Thomas Mandl
  • Helmut Kern
  • Sandra Zampieri
  • Winfried Mayr
  • Thordur Helgason
Chapter

Abstract

This chapter describes a novel approach to determining muscle anthropometry using medical imaging and processing techniques to evaluate and quantify: (1) progression of atrophy in permanent muscle lower motor neuron (LMN) denervation in humans and (2) muscle recovery as induced by functional electrical stimulation (FES). Briefly, we used three-dimensional reconstruction of muscle belly and bone images to study the structural changes occurring in these tissues in paralyzed subjects after complete lumbar-ischiatic spinal cord injury (SCI). These subjects were recruited through the European project RISE, an endeavour designed to establish a novel clinical rehabilitation method for patients who have permanent and non-recoverable muscle LMN denervation in the lower extremities. This chapter describes the use of anthropometric techniques to study muscles in several states: healthy, LMN denervated-degenerated not stimulated, and LMN denervated-stimulated. Here, we have used medical images to develop three-dimensional models, including computational models of activation patterns induced by FES. Shape, volume and density changes were measured on each part of the muscles studied. Changes in tissue composition within both normal and atrophic muscle were visualized by associating the Hounsfield unit values of fat and connective tissue with different colours. The minimal volumetric element (voxel) is approximately ten times smaller than the volume analyzed by needle muscle biopsy. The results of this microstructural analysis are presented as the percentage of different tissues (muscle, loose and fibrous connective tissue, fat) in the total volume of the rectus femoris muscle; the results display the first cortical layer of voxels that describe the muscle epimisium directly on the three-dimensional reconstruction of the muscle. These analyses show restoration of the muscular structure after FES. The three-dimensional approach used in this work also allows measurement of geometric changes in LMN denervated muscle. The computational methods developed allow us to calculate curvature indices along the muscle’s central line in order to quantify changes in muscle shape during the treatment. The results show a correlation between degeneration status and changes in shape; the differences in curvature between control and LMN denervated muscle diminish with the growth of the latter. Bone mineral density of the femur is also measured in order to study the structural changes induced by muscle contraction and current flow. Importantly, we show how segmented data can be used to build numerical models of the stimulated LMN denervated muscle. These models are used to study the distribution of the electrical field during stimulation and the activation patterns.

Keywords

Spinal Cord Injury Hounsfield Unit Functional Electrical Stimulation Muscle Volume Lower Motor Neuron 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

3D

Three dimensional

BMD

Bone mineral density

CT

X-ray Computer Tomography

DTI

Diffusion Tensor Imaging

FD

Finite difference

FE

Finite element

FES

Functional electrical stimulation

h-b FES

Home based functional electrical stimulation

HU

Hounsfield units

LMN

Lower motor neuron

MBMD

Mean bone mineral density

MRI

Magnetic resonance imaging

RF

Rectus femoris

SCI

Spinal Cord Injury

UMN

Upper motor neuron

Notes

Acknowledgements

The authors wish to express their sincerest gratitude to the following institutions and funds:

RANNÍS the Icelandic Centre for Research, Science Fund of Landspítali University Hospital of Iceland, the Icelandic Students Innovation Fund (NSN), the European Union Commission Shared Cost Project RISE (Contract n.QLG5-CT-2001-02191), the Austrian Ministry of Transport Innovation and Technology “Impulsprogramm”, Research Funds from the Ludwig Boltzmann Institute for Electrostimulation and Physical Rehabilitation (Wilhelminenspital, Vienna, Austria), the Italian C.N.R. funds, the Italian MIUR funds and the PRIN 2004–2006 Program.

The authors also wish to express their sincerest gratitude to Dr. Amber Pond of Purdue University, West Lafayette, Indiana for in-depth discussions and critical reading of the manuscript.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Paolo Gargiulo
    • 1
    • 2
  • Ugo Carraro
  • Thomas Mandl
  • Helmut Kern
  • Sandra Zampieri
  • Winfried Mayr
  • Thordur Helgason
  1. 1.Department of Research and DevelopmentUniversity Hospital LandspitaliReykjavikIceland
  2. 2.Department of Biomedical EngineeringUniversity of ReykjavikReykjavikIceland

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