Meta-Analysis Of Shear Wave Elastography In The Assessment Of Post-Stroke Spastic Muscles

Objective:A meta-analysis of observational studies on the application of Shear Wave Elastography(SWE)in the evaluation of limb spasticity after stroke was conducted to explore the value of SWE in the evaluation of limb spasticity.This included examination of the statistical differences between the spastic muscles of the affected limbs after stroke and the non-spasmodic muscles of the control group in terms of the key indicators of Shear Wave Elastography(Young’s modulus and shear wave velocity).Additionally,the correlation between of Young’s modulus and shear wave velocity and the Modified Ashworth Scale(MAS)was estimated by Fisher transformation of meta-analysis and correlation coefficient.This study aimed to provide a scientific basis for the clinical application of SWE to evaluate the status and degree of limb spasm after stroke and to establish contact with the corresponding spasm assessment scale.Methods:A computer-aided search of the China Knowledge Network,Wanfang,VIP,Pub Med,Cochrane Library,and Embase databases was conducted to collect observational studies on the application of SWE in the evaluation of limb spasticity after stroke,with the search time limit set to December 2022.The Newcastle-Ottawa Quality Assessment Scale(NOS)was used to assess the risk of bias in the included studies,and the GRADE pro GDT(Guideline Development Tool)online evaluation tool was used to grade the evidence quality and create an evidence summary table.STATA17.0 and Rev Man5.4 software were used to perform meta-analysis of the extracted data.The effect size of the meta-analysis was the weighted mean difference(MD)or the standardized mean difference(SMD).Excel software was used to edit formulas for the mutual conversion of Spearman correlation coefficients and Pearson correlation coefficients,as well as the Fisher transformation of correlation coefficients.Results:A total of 19 studies that met the inclusion criteria were identified,with a total sample size of 2422 for Young’s modulus,including 1181 in the spastic side and1241 in the healthy side or control group;and a total sample size of 1416 for shear wave velocity,including 743 in the spastic side and 673 in the healthy side or control group.The meta-analysis results showed that compared with the non-spastic muscles,the spastic muscles of the affected limbs after stroke had a significant difference in Young’s modulus(SMD=1.88,(95%CI:1.37,2.38),P<0.05)and shear wave velocity(SMD=1.38,(95%CI:0.86,1.89),P<0.05).Ten studies were used for correlation coefficient meta-analysis.Among the studies on Young’s modulus,there were 310stroke spastic patients.According to the meta-analysis results of the correlation between Young’s modulus and MAS scale,the summary Fisher’Z was 0.66,with good homogeneity(P<0.01,I~2=18%),and the summary r was 0.57 after conversion.Among the studies on shear wave velocity,there were 353 stroke spastic patients.According to the meta-analysis results of the correlation between shear wave velocity and MAS scale,the summary Fisher’Z was 0.66,with good homogeneity(P<0.01,I~2=0%),and the summary r was 0.57 after conversion.Conclusion:SWE can effectively evaluate the status and severity of limb spasticity after stroke and is positively correlated with the degree in the MAS scale,but further verification is still needed through multi-center,large-sample,and high-quality studies and diagnostic experiments.