Median nerve evaluation by shear wave elastosonography: impact of “bone-proximity” hardening artifacts and inter-observer agreement

Bortolotto, Chandra; Turpini, Elena; Felisaz, Paolo Florent; Fresilli, Daniele; Fiorina, Ilaria; Raciti, Maria Vittoria; Belloni, Elena; Bottinelli, Olivia; Cantisani, Vito; Calliada, Fabrizio

doi:10.1007/s40477-017-0267-0

Cited by 37 publications

(34 citation statements)

References 19 publications

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“…This is an artifact that occurs when the region of interest is adjacent to a bone that affects even propagation of shear wave resulting in unreliable readings. An increasing median nerve stiffness was demonstrated as measurements were taken from the mid‐forearm, carpal tunnel inlet, and carpal tunnel outlet . This finding has implications for the reliability of nerve ultrasound elastography results of nerve running in close proximity to bones such as the median nerve in the carpal tunnel and ulnar nerve at the cubital tunnel.…”

Section: Discussionmentioning

confidence: 85%

“…Caution is also required regarding "bone-proximity" hardening artifacts. 67 This is an artifact that occurs when the region of interest is adjacent to a bone that affects even propagation of shear wave resulting in unreliable readings. An increasing median nerve stiffness was demonstrated as measurements were taken from the mid-forearm, carpal tunnel inlet, and carpal tunnel outlet.…”

Section: Other Technical Considerations and Artifactsmentioning

confidence: 99%

“…An increasing median nerve stiffness was demonstrated as measurements were taken from the mid-forearm, carpal tunnel inlet, and carpal tunnel outlet. 67 Furthermore, the size of the region of interest may influence the resulting values. While this has not been specifically studied in peripheral nerves, studies of breast lesions indicate that a smaller region of interest may result in the best diagnostic performance.…”

Section: Other Technical Considerations and Artifactsmentioning

confidence: 99%

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Ultrasound elastography for the evaluation of peripheral nerves: A systematic review

Wee

Simon

2019

Muscle and Nerve

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Peripheral nerve disorders are commonly encountered in clinical practice. Electrodiagnostic studies remain the cornerstone of the evaluation of nerve disorders. More recently, ultrasound has played an increasing complementary role in the neuromuscular clinic. Ultrasound elastography is a technique that measures the elastic properties of tissues. Given the histological changes that occur in diseased peripheral nerves, nerve ultrasound elastography has been explored as a noninvasive way to evaluate changes in nerve tissue composition. Studies to date suggest that nerve stiffness tends to increase in the setting of peripheral neuropathy, regardless of etiology, consistent with loss of more compliant myelin, and replacement with connective tissue. The aim of this systematic review is to summarize the current literature on the use of ultrasound elastography in the evaluation of peripheral neuropathy. Limitations of ultrasound elastography and gaps in current literature are discussed, and prospects for future clinical and research applications are raised.

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Section: Discussionmentioning

confidence: 85%

Section: Other Technical Considerations and Artifactsmentioning

confidence: 99%

Section: Other Technical Considerations and Artifactsmentioning

confidence: 99%

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Ultrasound elastography for the evaluation of peripheral nerves: A systematic review

Wee

Simon

2019

Muscle and Nerve

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“…[ 28 , 29 ] Second, when the nerve of interest is in close proximity to bone causing unreliable elasticity measurements. [ 30 ] Third factor was probe orientation, where some authors assessed nerve elasticity in long axis, and others in short axis. In our study, slightly higher values were obtained in the long axis.…”

Section: Discussionmentioning

confidence: 99%

Shear wave elastography of the saphenous nerve

et al. 2020

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The purpose of this study is to study sonoelastographic features of the saphenous nerve. The study included 72 saphenous nerves in 36 healthy subjects. High resolution ultrasound and Shearwave elastography were used to evaluate the saphenous nerve. Cross sectional area (CSA) and stiffness were measured. The mean CSA of the saphenous nerve was 5.7 mm 2 . The mean shear elastic modulus of the saphenous nerve in the short axis was 29.5 kPa. The mean shear elastic modulus of the saphenous nerve in long axis was 29.9 kPa. The saphenous nerve elastic modulus also showed no correlation with CSA in neither the long axis nor short axis. Positive correlation between elasticity measurements in the long and short axes. Age, height, weight, and BMI showed no correlation with saphenous nerve elastic modulus in short or long axes. The elastic modulus of the saphenous nerve has been determined in healthy subjects and can serve as a reference for future assessment of the saphenous nerve before different procedures.

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“…However, musculoskeletal tissues, tendons and nerves included, are often smaller than the wavelength, heterogeneous, anisotropic, and display a combination of elastic and viscous properties 45 and thus, could decrease the validity of elasticity measurements. Specific to the application in nerves, probe orientation might affect elasticity values, 46 exhibit boundary artefacts to their limited dimensions 47 (due to wave reflections at the nerve boundaries and acoustic impedance mismatching) and close proximity to highly reflecting structures such as tendons, bones, and ligaments 43,48 . Despite these confounding factors, it has been shown in tendons that the elastic modulus can still be used as an objective indicator of relative tissue elasticity as long as comparisons are done between similar tissue types, under similar conditions 49,50 ; for nerves, this is currently less known 4 …”

Section: Introductionmentioning

confidence: 99%

Shear wave elastography of the median nerve: A mechanical study

et al. 2020

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Background: Shear wave elastography (SWE) shows promise in peripheral neuropathy evaluation but has potential limitations due to tissue size and heterogeneity. We tested SWE sensitivity to elasticity change and the effect of probe position in a median nerve cadaver model. Methods: Ten specimens were used to measure median nerve elasticity under increasing loads using SWE and indentation. Measurements were compared using repeated-measures analysis of variance. Results: Indentation and SWE-based longitudinal nerve elasticity increased with tensile loading (P < .01), showing a similar relationship. Acquisition in a transverse plane showed lower values compared with longitudinal measurements, mostly under higher loads (P = .03), as did postdissection elasticity (P = .02). Elasticity did not change when measured proximal to the carpal tunnel. Conclusions: Longitudinal SWE is sensitive to changes in median nerve elasticity. Measuring elasticity of peripheral nerves noninvasively could elucidate intra-neural pathology related to compression neuropathies, and proof to be of added value as a diagnostic or prognostic tool. K E Y W O R D S carpal tunnel syndrome, elastography, nerve elasticity, neurodynamics, peripheral neuropathy

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Median nerve evaluation by shear wave elastosonography: impact of “bone-proximity” hardening artifacts and inter-observer agreement

Abstract: The stiffness of the median nerve progressively increases in its distal portions, where the nerve approaches the bone surface. Inter-observer agreement was generally good (from fair to moderate).

Cited by 37 publications

References 19 publications

Ultrasound elastography for the evaluation of peripheral nerves: A systematic review

Ultrasound elastography for the evaluation of peripheral nerves: A systematic review

Shear wave elastography of the saphenous nerve

Shear wave elastography of the median nerve: A mechanical study

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