REAL-TIME strain elastography: Applications in musculoskeletal system

Abstract

Background: Strain or compression sonoelastography (CE) provides a colour-coded elastogram representing tissue elasticity by measuring tissue deformability after repeated probe compression. Elastographic ultrasound (EUS) is a valuable tool for screening diagnosis and follow-up of inflammatory, degenerative, benign and malignant neoplastic pathologies of skin, subcutaneous tissue, muscles, tendons, ligaments, fascia and nerves; help in targeted biopsy; monitor healing tendons after surgery or nerve stiffness changes during physiotherapy. Objectives: To assess stiffness of normal tendons, muscles and nerve. To diagnose cellulitis, fasciitis, abscess, tendinopathy, myositis, muscle/tendon rupture/contusion and differentiate between benign and malignant soft tissue tumours. To derive elastic score (ES) and strain ratio (SR) in cases and controls. To correlate B-mode findings with CE. Materials and methods: A prospective study on 50 healthy subjects between 25 and 30 years and 50 cases of diffuse and focal musculoskeletal pathologies was done using B-mode and CE over 2 years. Statistical analysis of distribution, mean, associations, sensitivity, specificity, area under Receiver Operating Characteristic curve (AUROC) for B-mode, ES, SR combined B-mode/CE and their comparison was done. Results: Significant association was noted between SR in muscles and tendons with sex. Significant correlation was noted between ES/SR with B-mode. CE and B-mode had 100% and 52.4% sensitivity respectively for diagnosing diffuse pathologies. For differentiating benign and malignant masses sensitivity, specificity, and diagnostic accuracy of B-mode was 71.43%, 86.36% and 82.76%; of SR was 71.43%, 90.91% and 86.21%; of Combined B-mode with CE was 100%, 90.91% and 93.1% respectively. Elastographic pattern had highest diagnostic accuracy and largest AUROC. Conclusion: CE as a screening test had higher diagnostic accuracy, supporting need for standardizing it for clinical use in MSK. EUS being a widely available, fast and affordable modality, can aid follow up of chronic MSK pathologies, response to medication, physiotherapy and surgery and mitigate the need for MRI.

Sonoelastography: A powerful technique in musculoskeletal imaging

“…Similar greater sensitivity of sonoelastography versus grayscale US for early stages of tendinopathy have been reported in the Achilles, quadriceps, biceps, supraspinatus, and other tendons 9,14–17 . Sonoelastography has also been applied to osteoarthritic cartilage, the transverse ligament in carpal tunnel syndrome, myopathies, ligaments, rheumatoid synovitis, methotrexate hepatotoxicity (important in rheumatology), meniscal disease, trigger finger, and musculoskeletal tumors with similar changes in elasticity of the relevant tissue with variable sensitivity and specificity for pathology versus alternative imaging methods 14–25 …”

“…The low cost, convenience, noninvasive nature, lack of ionizing radiation, direct relevance to palpable anatomy, point‐of‐care applicability, and increasing number of applications indicate that US will only increase in use in musculoskeletal medicine 1–4 . Sonoelastography is another powerful method available to observe the musculoskeletal system, and appears particularly valuable in detecting early tendinopathies, areas of myopathy suitable for biopsy, pursuing complaints of localized musculoskeletal pain, analyzing soft tissue masses, and research applications in musculoskeletal medicine 14–25 . Shear wave elastography in particular permits rapid quantitative assessments of musculoskeletal structures and will be particularly valuable at the beside, in research studies and clinical trials, and in monitoring disease presence, progression, and response to therapy, especially in muscle and tendon disease.…”

“…9,[14][15][16][17] Sonoelastography has also been applied to osteoarthritic cartilage, the transverse ligament in carpal tunnel syndrome, myopathies, ligaments, rheumatoid synovitis, methotrexate hepatotoxicity (important in rheumatology), meniscal disease, trigger finger, and musculoskeletal tumors with similar changes in elasticity of the relevant tissue with variable sensitivity and specificity for pathology versus alternative imaging methods. [14][15][16][17][18][19][20][21][22][23][24][25] US is increasingly becoming an extension of the physical examination in musculoskeletal medicine. 1 The low cost, convenience, noninvasive nature, lack of ionizing radiation, direct relevance to palpable anatomy, point-of-care applicability, and increasing number of applications indicate that US will only increase in use in musculoskeletal medicine.…”

“…[1][2][3][4] Sonoelastography is another powerful method available to observe the musculoskeletal system, and appears particularly valuable in detecting early tendinopathies, areas of myopathy suitable for biopsy, pursuing complaints of localized musculoskeletal pain, analyzing soft tissue masses, and research applications in musculoskeletal medicine. [14][15][16][17][18][19][20][21][22][23][24][25] Shear wave elastography in particular permits rapid quantitative assessments of musculoskeletal structures and will be particularly valuable at the beside, in research studies and clinical trials, and in monitoring disease presence, progression, and response to therapy, especially in muscle and tendon disease. It is anticipated that sonoelastography will increase in specificity, sensitivity, depth of imaging, and applications as the technology of this US method becomes increasingly sophisticated.…”

The ultrasound elastography findings in lateral epicondylitis in comparison with healthy individuals

“…Numerous clinical SEL applications and studies were found to evaluate diagnosis and assessment of changes in tissue stiffness and elasticity in pathological conditions. [9][10][11][12][13][14] However, clinical utility of elastography has been infrequently studied in LE and has not been evaluated with tendon thickness.…”