Ultrasound elastography in tendon pathology: state of the art

Elastography assesses the biomechanical and structural properties of tissues by measuring their stiffness. Despite promising results, elastography has not yet earned its place in the daily practice of musculoskeletal radiologists. The purpose of this article is to present and examine the data available to date on ultrasound elastography of the tendons through a review of the literature to provide musculoskeletal radiologists with an overview that may help them better understand and use elastography routinely. The most common techniques in ultrasound elastography are described. Then, the aspects of the physiologic and pathologic tendon are presented and discussed. One must make this technique one’s own to better apprehend its contribution to the musculoskeletal imaging field, while bearing in mind that further research will be required before admitting elastography as a reliable and validated tool able to optimize our daily clinical practice.

[1]  K J Parker,et al.  Vibration sonoelastography and the detectability of lesions. , 1998, Ultrasound in medicine & biology.

[2]  S. Polat,et al.  Real-time sonoelastography and ultrasound evaluation of the Achilles tendon in patients with diabetes with or without foot ulcers: a cross sectional study. , 2015, Journal of diabetes and its complications.

[3]  Mickael Tanter,et al.  Reliable protocol for shear wave elastography of lower limb muscles at rest and during passive stretching. , 2015, Ultrasound in medicine & biology.

[4]  M Tanter,et al.  In vivo evaluation of the elastic anisotropy of the human Achilles tendon using shear wave dispersion analysis , 2014, Physics in medicine and biology.

[5]  Sachiko Isobe,et al.  Preliminary study of ultrasonographic tissue quantification of the breast using the acoustic radiation force impulse (ARFI) technology. , 2011, European journal of radiology.

[6]  Y. Chou,et al.  Management of rotator cuff calcific tendinosis guided by ultrasound elastography , 2015, Journal of the Chinese Medical Association : JCMA.

[7]  Jack A. Martin,et al.  In Vivo Measures of Shear Wave Speed as a Predictor of Tendon Elasticity and Strength. , 2015, Ultrasound in medicine & biology.

[8]  N. Maffulli,et al.  Achilles Tendinopathy , 2018, Sports medicine and arthroscopy review.

[9]  M. Ferretti,et al.  Analisys of pectoralis major tendon in weightlifting athletes using ultrasonography and elastography , 2015, Einstein.

[10]  A. Schneebeli,et al.  Real-time sonoelastography using an external reference material: test–retest reliability of healthy Achilles tendons , 2016, Skeletal Radiology.

[11]  Che-Yu Lin,et al.  Reduced Patellar Tendon Elasticity with Aging: In Vivo Assessment by Shear Wave Elastography. , 2015, Ultrasound in medicine & biology.

[12]  P. Lalitha,et al.  Musculoskeletal Applications of Elastography: a Pictorial Essay of Our Initial Experience , 2011, Korean journal of radiology.

[13]  G. Feuchtner,et al.  Sonoelastography: musculoskeletal applications. , 2014, Radiology.

[14]  Werner Jaschke,et al.  Real-time sonoelastography of lateral epicondylitis: comparison of findings between patients and healthy volunteers. , 2009, AJR. American journal of roentgenology.

[15]  M. Ying,et al.  Sonographic evaluation of the effect of long-term exercise on Achilles tendon stiffness using shear wave elastography. , 2016, Journal of science and medicine in sport.

[16]  M. Bey,et al.  ShearWave elastography: repeatability for measurement of tendon stiffness , 2013, Skeletal Radiology.

[17]  Sébastien Aubry,et al.  Élastographie transitoire du tendon calcanéen : résultats préliminaires et perspectives , 2011 .

[18]  R. Goertz,et al.  Measurement of Liver Elasticity with Acoustic Radiation Force Impulse (ARFI) Technology: An Alternative Noninvasive Method for Staging Liver Fibrosis in Viral Hepatitis , 2010, Ultraschall in der Medizin.

[19]  Sonoelastography of the Common Flexor Tendon of the Elbow with Histologic Agreement: A Cadaveric Study. , 2017, Radiology.

[20]  François Hug,et al.  Increased Upper Trapezius Muscle Stiffness in Overhead Athletes with Rotator Cuff Tendinopathy , 2016, PloS one.

[21]  C. Gerber,et al.  Quantitative Shear-Wave US Elastography of the Supraspinatus Muscle: Reliability of the Method and Relation to Tendon Integrity and Muscle Quality. , 2016, Radiology.

[22]  Qingli Zhu,et al.  Real-time ultrasound elastography: its potential role in assessment of breast lesions. , 2008, Ultrasound in medicine & biology.

[23]  Ping He,et al.  Shear Wave Elastographic Characterization of Normal and Torn Achilles Tendons , 2013, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[24]  R. Stramare,et al.  Differential Diagnosis of Benign and Malignant Thyroid Nodules at Elastosonography , 2008, Ultraschall in der Medizin.

[25]  Kemal Arda,et al.  Quantitative assessment of normal soft-tissue elasticity using shear-wave ultrasound elastography. , 2011, AJR. American journal of roentgenology.

[26]  D. Wilson,et al.  Real-time ultrasound elastography of the normal Achilles tendon: reproducibility and pattern description. , 2009, Clinical radiology.

[27]  J. Babb,et al.  Shear Wave Ultrasound Elastographic Evaluation of the Rotator Cuff Tendon , 2017, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[28]  A. Iagnocco,et al.  Ultrasound elastography is a reproducible and feasible tool for the evaluation of the patellar tendon in healthy subjects , 2014, International journal of rheumatic diseases.

[29]  J. Pialat,et al.  Ultrasound shear wave velocity in skeletal muscle: A reproducibility study. , 2016, Diagnostic and interventional imaging.

[30]  T. Ogur,et al.  Real‐time Sonoelastography of the Quadriceps Tendon in Patients Undergoing Chronic Hemodialysis , 2015, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[31]  C. Kuhl,et al.  Shear Wave Elastography (SWE) for the Evaluation of Patients with Tendinopathies. , 2016, Academic radiology.

[32]  K. An,et al.  Quantitative assessment of rotator cuff muscle elasticity: Reliability and feasibility of shear wave elastography. , 2015, Journal of biomechanics.

[33]  E. Halpern,et al.  Extensor tendinopathy of the elbow assessed with sonoelastography: histologic correlation , 2017, European Radiology.

[34]  P. Kannus,et al.  Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. , 1991, The Journal of bone and joint surgery. American volume.

[35]  R. Gesuita,et al.  Real-time sonoelastography as novel follow-up method in Achilles tendon surgery , 2016, Knee Surgery, Sports Traumatology, Arthroscopy.

[36]  Sang-Ho Lee,et al.  Real-time sonoelastography in the diagnosis of rotator cuff tendinopathy. , 2016, Journal of shoulder and elbow surgery.

[37]  B. Kastler,et al.  [Transient elastography of calcaneal tendon: preliminary results and future prospects]. , 2011, Journal de radiologie.

[38]  A. Rausing,et al.  Chronic Achilles Tendinopathy: A Survey of Surgical and Histopathologic Findings Mats , 1995, Clinical orthopaedics and related research.

[39]  P. Malliaras,et al.  Diagnostic performance of axial-strain sonoelastography in confirming clinically diagnosed Achilles tendinopathy: comparison with B-mode ultrasound and color Doppler imaging. , 2015, Ultrasound in medicine & biology.

[40]  M. Fink,et al.  Supersonic shear imaging: a new technique for soft tissue elasticity mapping , 2004, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

[41]  G. Simonetti,et al.  Tendon quality in small unilateral supraspinatus tendon tears. Real-time sonoelastography correlates with clinical findings , 2015, Knee Surgery, Sports Traumatology, Arthroscopy.

[42]  G. Feuchtner,et al.  Real-Time Sonoelastography: Findings in Patients with Symptomatic Achilles Tendons and Comparison to Healthy Volunteers , 2009, Ultraschall in der Medizin.

[43]  B. Goker,et al.  Real-time sonoelastography of Achilles tendon in patients with ankylosing spondylitis , 2013, Skeletal Radiology.

[44]  P. Stradiotti,et al.  Sonoelastography of the distal third of the Achilles tendon in asymptomatic volunteers: correlation with anthropometric data, ultrasound findings and reproducibility of the method , 2016, La radiologia medica.

[45]  D. Kwon,et al.  Diagnostic confidence of sonoelastography as adjunct to greyscale ultrasonography in lateral elbow tendinopathy. , 2014, Chinese medical journal.

[46]  G. Ng,et al.  Changes in Morphological and Elastic Properties of Patellar Tendon in Athletes with Unilateral Patellar Tendinopathy and Their Relationships with Pain and Functional Disability , 2014, PloS one.

[47]  Li-Hai Zhang,et al.  Evaluation of Elastic Stiffness in Healing Achilles Tendon After Surgical Repair of a Tendon Rupture Using In Vivo Ultrasound Shear Wave Elastography , 2016, Medical science monitor : international medical journal of experimental and clinical research.

[48]  R. Ersoy,et al.  Structural tendon changes in patients with acromegaly: assessment of Achilles tendon with sonoelastography. , 2016, Medical ultrasonography.

[49]  Jack A. Martin,et al.  Quantitative ultrasound mapping of regional variations in shear wave speeds of the aging Achilles tendon , 2017, European Radiology.

[50]  J. Ophir,et al.  Elastography: A Quantitative Method for Imaging the Elasticity of Biological Tissues , 1991, Ultrasonic imaging.

[51]  L. Sconfienza,et al.  Sonoelastography in the evaluation of painful Achilles tendon in amateur athletes. , 2010, Clinical and experimental rheumatology.

[52]  G. Bartsch,et al.  Real‐time elastography for detecting prostate cancer: preliminary experience , 2007, BJU international.

[53]  Jess G. Snedeker,et al.  Elastography: modality-specific approaches, clinical applications, and research horizons , 2011, Skeletal Radiology.

[54]  M. Fink,et al.  Ultrasound elastography: principles and techniques. , 2013, Diagnostic and interventional imaging.

[55]  M. Benjamin,et al.  The anatomy of the Achilles tendon , 2009 .

[56]  N S Berko,et al.  Effect of knee position on the ultrasound elastography appearance of the patellar tendon. , 2015, Clinical radiology.

[57]  G. Feuchtner,et al.  Achilles tendon assessed with sonoelastography: histologic agreement. , 2013, Radiology.

[58]  S. Fu,et al.  Elastic Modulus of Muscle and Tendon with Shear Wave Ultrasound Elastography: Variations with Different Technical Settings , 2012, PloS one.

[59]  P. Malliaras,et al.  Prevalence of morphological and mechanical stiffness alterations of mid Achilles tendons in asymptomatic marathon runners before and after a competition , 2015, Skeletal Radiology.

[60]  P. Kannus,et al.  Achilles tendon disorders: etiology and epidemiology. , 2005, Foot and ankle clinics.

[61]  I. Karaman,et al.  Biomechanical properties of Achilles tendon in diabetic vs. non-diabetic patients. , 2015, Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association.

[62]  I Céspedes,et al.  Fundamental mechanical limitations on the visualization of elasticity contrast in elastography. , 1995, Ultrasound in medicine & biology.

[63]  Fabio Becce,et al.  Viscoelasticity in Achilles tendonopathy: quantitative assessment by using real-time shear-wave elastography. , 2015, Radiology.

[64]  N. Maffulli,et al.  A soft patellar tendon on ultrasound elastography is associated with pain and functional deficit in volleyball players. , 2016, Journal of science and medicine in sport.

[65]  I. Idilman,et al.  Elastographic Findings of Achilles Tendons in Asymptomatic Professional Male Volleyball Players , 2016, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[66]  Mary Bruno,et al.  Quantitative assessment of the supraspinatus tendon on MRI using T2/T2* mapping and shear-wave ultrasound elastography: a pilot study , 2017, Skeletal Radiology.

[67]  Y. Endo Is Sonoelastography of Value in Assessing Tendons , 2011 .

[68]  G. Feuchtner,et al.  Real-time sonoelastography findings in healthy Achilles tendons. , 2009, AJR. American journal of roentgenology.

[69]  C. Pfirrmann,et al.  Comparison of shear wave velocity measurements assessed with two different ultrasound systems in an ex-vivo tendon strain phantom , 2016, Skeletal Radiology.

[70]  B. Kastler,et al.  Biomechanical properties of the calcaneal tendon in vivo assessed by transient shear wave elastography , 2013, Skeletal Radiology.

[71]  S Franchi-Abella,et al.  Ultrasound elastography: advantages, limitations and artefacts of the different techniques from a study on a phantom. , 2013, Diagnostic and interventional imaging.