DOI QR코드

DOI QR Code

Ultrasonographic findings of the normal diaphragm: thickness and contractility

  • Seok, Jung Im (Department of Neurology, Catholic University of Daegu School of Medicine) ;
  • Kim, Shin Yeop (Department of Neurology, Catholic University of Daegu School of Medicine) ;
  • Walker, Francis O. (Department of Neurology, Wake Forest University School of Medicine) ;
  • Kwak, Sang Gyu (Medical Statistics & Informatics, Catholic University of Daegu School of Medicine) ;
  • Kwon, Doo Hyuk (Department of Neurology, CHA Gumi Medical Center, CHA University)
  • 투고 : 2017.03.09
  • 심사 : 2017.05.12
  • 발행 : 2017.07.31

초록

Background: Neuromuscular ultrasound can be used to assess the diaphragm. Before it can be used clinically, the reference ranges of diaphragm thickness and contractility must be determined. Methods: We measured the thickness of the diaphragm and the diaphragmatic thickening fraction (DTF) in 80 healthy volunteers with ultrasound and collected their demographic information to determine if age, sex, and body mass index (BMI) influence these measures. Results: The thickness of the diaphragm at resting end expiration was $0.193{\pm}0.044cm$ on the right side and $0.187{\pm}0.039cm$ on the left. The DTF was $104.8{\pm}50.6%$ on the right side and $114.9{\pm}49.2%$ on the left. Sex, weight, height, and BMI significantly affected the thickness of the diaphragm, but had little effect on the DTF. Conclusions: Normal reference values for the diaphragm should be helpful when evaluating the diaphragm. The DTF appears more useful than resting diaphragm thickness because it is affected less by individual variation.

키워드

참고문헌

  1. McCool FD, Tzelepis GE. Dysfunction of the diaphragm. N Engl J Med 2012;366:932-942. https://doi.org/10.1056/NEJMra1007236
  2. Podgaetz E, Garza-Castillon R Jr, Andrade RS. Best approach and benefit of plication for paralyzed diaphragm. Thorac Surg Clin 2016;26:333-346. https://doi.org/10.1016/j.thorsurg.2016.04.009
  3. Ko MA, Darling GE. Acquired paralysis of the diaphragm. Thorac Surg Clin 2009;19:501-510. https://doi.org/10.1016/j.thorsurg.2009.08.011
  4. Sarwal A, Walker FO, Cartwright MS. Neuromuscular ultrasound for evaluation of the diaphragm. Muscle Nerve 2013;47:319-329. https://doi.org/10.1002/mus.23671
  5. Qureshi A. Diaphragm paralysis. Semin Respir Crit Care Med 2009;30:315-320. https://doi.org/10.1055/s-0029-1222445
  6. Chetta A, Rehman AK, Moxham J, Carr DH, Polkey MI. Chest radiography cannot predict diaphragm function. Respir Med 2005;99:39-44. https://doi.org/10.1016/j.rmed.2004.04.016
  7. Boon AJ, Alsharif KI, Harper CM, Smith J. Ultrasound-guided needle EMG of the diaphragm: technique description and case report. Muscle Nerve 2008;38:1623-1626. https://doi.org/10.1002/mus.21187
  8. Boon AJ, Harper CJ, Ghahfarokhi LS, Strommen JA, Watson JC, Sorenson EJ. Two-dimensional ultrasound imaging of the diaphragm: quantitative values in normal subjects. Muscle Nerve 2013;47:884-889. https://doi.org/10.1002/mus.23702
  9. Harper CJ, Shahgholi L, Cieslak K, Hellyer NJ, Strommen JA, Boon AJ. Variability in diaphragm motion during normal breathing, assessed with B-mode ultrasound. J Orthop Sports Phys Ther 2013;43:927-931. https://doi.org/10.2519/jospt.2013.4931
  10. Ueki J, De Bruin PF, Pride NB. In vivo assessment of diaphragm contraction by ultrasound in normal subjects. Thorax 1995;50:1157-1161. https://doi.org/10.1136/thx.50.11.1157
  11. Gottesman E, McCool FD. Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Crit Care Med 1997;155:1570-1574. https://doi.org/10.1164/ajrccm.155.5.9154859
  12. Baldwin CE, Paratz JD, Bersten AD. Diaphragm and peripheral muscle thickness on ultrasound: intra-rater reliability and variability of a methodology using non-standard recumbent positions. Respirology 2011;16:1136-1143. https://doi.org/10.1111/j.1440-1843.2011.02005.x
  13. De Bruin PF, Ueki J, Bush A, Khan Y, Watson A, Pride NB. Diaphragm thickness and inspiratory strength in patients with Duchenne muscular dystrophy. Thorax 1997;52:472-475. https://doi.org/10.1136/thx.52.5.472
  14. Summerhill EM, El-Sameed YA, Glidden TJ, McCool FD. Monitoring recovery from diaphragm paralysis with ultrasound. Chest 2008;133:737-743. https://doi.org/10.1378/chest.07-2200
  15. Hellyer NJ, Andreas NM, Bernstetter AS, Cieslak KR, Donahue GF, Steiner EA, et al. Comparison of diaphragm thickness measurements among postures via ultrasound imaging. PM R 2017;9:21-25. https://doi.org/10.1016/j.pmrj.2016.06.001

피인용 문헌

  1. Is ultrasonography a main armament or just a supplement for evaluating patients with neuromuscular disorder? vol.19, pp.2, 2017, https://doi.org/10.14253/acn.2017.19.2.77
  2. Sonographic evaluation of the diaphragm in patients with unilateral diaphragmatic paralysis vol.20, pp.2, 2017, https://doi.org/10.14253/acn.2018.20.2.93
  3. Ultrasound Imaging of the Diaphragm vol.39, pp.4, 2017, https://doi.org/10.17340/jkna.2021.4.2