Is Sonoelastography of Value in Assessing Tendons?

 

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ABSTRACT

Sonoelastography is a newly introduced ultrasound technique that evaluates tissue elasticity and thus provides additional information to that offered by conventional ultrasound images. In the musculoskeletal field, sonoelastography can help improve estimation of tendon stiffness.

In this article, the principles and future developments of sonoelastography are discussed using the strongest and thickest tendon of the human body, the Achilles tendon, for illustrative purposes. Preliminary findings of sonoelastography in healthy and pathological Achilles tendons, technical considerations, examination technique and several limitations are addressed.

The usefulness of elastography can be expected to increase rapidly in the musculoskeletal field, as soon as we learn to interpret elastographic artifacts as well as to take advantage of the new information provided by sonoelastography.

REFERENCES

• 1 Ophir J, Céspedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: a quantitative method for imaging the elasticity of biological tissues.  Ultrason Imaging. 1991;  13(2) 111-134
  CrossrefPubMedGoogle Scholar
• 2 Pesavento A, Perrey C, Krueger M, Ermert H. A time-efficient and accurate strain estimation concept for ultrasonic elastography using iterative phase zero estimation.  IEEE Trans Ultrason Ferroelectr Freq Control. 1999;  46(5) 1057-1067
  CrossrefPubMedGoogle Scholar
• 3 Varghese T, Ophir J, Konofagou E, Kallel F, Righetti R. Tradeoffs in elastographic imaging.  Ultrason Imaging. 2001;  23(4) 216-248
  CrossrefPubMedGoogle Scholar
• 4 Hall T J, Zhu Y, Spalding C S. In vivo real-time freehand palpation imaging.  Ultrasound Med Biol. 2003;  29(3) 427-435
  CrossrefPubMedGoogle Scholar
• 5 Frey H. Realtime elastography. A new ultrasound procedure for the reconstruction of tissue elasticity [in German].  Radiologe. 2003;  43(10) 850-855
  CrossrefPubMedGoogle Scholar
• 6 Konofagou E E, Ophir J, Kallel F, Varghese T. Elastographic dynamic range expansion using variable applied strains.  Ultrason Imaging. 1997;  19(2) 145-166
  PubMedGoogle Scholar
• 7 Hoyt K, Parker K J, Rubens D J. Real-time shear velocity imaging using sonoelastographic techniques.  Ultrasound Med Biol. 2007;  33(7) 1086-1097
  CrossrefPubMedGoogle Scholar
• 8 Friedrich-Rust M, Ong M F, Herrmann E et al.. Real-time elastography for noninvasive assessment of liver fibrosis in chronic viral hepatitis.  AJR Am J Roentgenol. 2007;  188(3) 758-764
  CrossrefPubMedGoogle Scholar
• 9 Montaldo G, Tanter M, Bercoff J, Benech N, Fink M. Coherent plane-wave compounding for very high frame rate ultrasonography and transient elastography.  IEEE Trans Ultrason Ferroelectr Freq Control. 2009;  56(3) 489-506
  CrossrefPubMedGoogle Scholar
• 10 Tanter M, Bercoff J, Athanasiou A et al.. Quantitative assessment of breast lesion viscoelasticity: initial clinical results using supersonic shear imaging.  Ultrasound Med Biol. 2008;  34(9) 1373-1386
  CrossrefPubMedGoogle Scholar
• 11 Hoyt K, Kneezel T, Castaneda B, Parker K J. Quantitative sonoelastography for the in vivo assessment of skeletal muscle viscoelasticity.  Phys Med Biol. 2008;  53(15) 4063-4080
  CrossrefPubMedGoogle Scholar
• 12 Tardivon A, El Khoury C, Thibault F, Wyler A, Barreau B, Neuenschwander S. Elastography of the breast: a prospective study of 122 lesions [in French].  J Radiol. 2007;  88(5 Pt 1) 657-662
  CrossrefPubMedGoogle Scholar
• 13 Itoh A, Ueno E, Tohno E et al.. Breast disease: clinical application of US elastography for diagnosis.  Radiology. 2006;  239(2) 341-350
  CrossrefPubMedGoogle Scholar
• 14 Bercoff J, Chaffai S, Tanter M et al.. In vivo breast tumor detection using transient elastography.  Ultrasound Med Biol. 2003;  29(10) 1387-1396
  CrossrefPubMedGoogle Scholar
• 15 Itoh A, Ueno E, Tohno E et al.. Breast disease: clinical application of US elastography for diagnosis.  Radiology. 2006;  239(2) 341-350
  CrossrefPubMedGoogle Scholar
• 16 Rubaltelli L, Corradin S, Dorigo A et al.. Differential diagnosis of benign and malignant thyroid nodules at elastosonography.  Ultraschall Med. 2009;  30(2) 175-179
  Article in Thieme ConnectPubMedGoogle Scholar
• 17 Rago T, Santini F, Scutari M, Pinchera A, Vitti P. Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules.  J Clin Endocrinol Metab. 2007;  92(8) 2917-2922
  CrossrefPubMedGoogle Scholar
• 18 Alam F, Naito K, Horiguchi J, Fukuda H, Tachikake T, Ito K. Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: comparison with conventional B-mode sonography.  AJR Am J Roentgenol. 2008;  191(2) 604-610
  CrossrefPubMedGoogle Scholar
• 19 Lyshchik A, Higashi T, Asato R et al.. Cervical lymph node metastases: diagnosis at sonoelastography—initial experience.  Radiology. 2007;  243(1) 258-267
  CrossrefPubMedGoogle Scholar
• 20 Kannus P. Etiology and pathophysiology of chronic tendon disorders in sports.  Scand J Med Sci Sports. 1997;  7(2) 78-85
  CrossrefPubMedGoogle Scholar
• 21 Józsa L, Bálint B J, Réffy A, Demel Z. Hypoxic alterations of tenocytes in degenerative tendinopathy.  Arch Orthop Trauma Surg. 1982;  99(4) 243-246
  CrossrefPubMedGoogle Scholar
• 22 Kannus P, Józsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients.  J Bone Joint Surg Am. 1991;  73(10) 1507-1525
  PubMedGoogle Scholar
• 23 Järvinen T A, Kannus P, Paavola M, Järvinen T L, Józsa L, Järvinen M. Achilles tendon injuries.  Curr Opin Rheumatol. 2001;  13(2) 150-155
  CrossrefPubMedGoogle Scholar
• 24 Schweitzer M E, Karasick D. MR imaging of disorders of the Achilles tendon.  AJR Am J Roentgenol. 2000;  175(3) 613-625
  PubMedGoogle Scholar
• 25 Nallamshetty L, Nazarian L N, Schweitzer M E et al.. Evaluation of posterior tibial pathology: comparison of sonography and MR imaging.  Skeletal Radiol. 2005;  34(7) 375-380
  CrossrefPubMedGoogle Scholar
• 26 Kainberger F, Nehrer S, Breitenseher M et al.. Ultrasound morphology of the Achilles tendon and differential diagnosis [in German].  Ultraschall Med. 1996;  17(5) 212-217
  Article in Thieme ConnectPubMedGoogle Scholar
• 27 Karjalainen P T, Soila K, Aronen H J et al.. MR imaging of overuse injuries of the Achilles tendon.  AJR Am J Roentgenol. 2000;  175(1) 251-260
  CrossrefPubMedGoogle Scholar
• 28 Shalabi A. Magnetic resonance imaging in chronic Achilles tendinopathy.  Acta Radiol Suppl (Stockholm). 2004;  (432) 1-45
  PubMedGoogle Scholar
• 29 Sharma P, Maffulli N. Biology of tendon injury: healing, modeling and remodeling.  J Musculoskelet Neuronal Interact. 2006;  6(2) 181-190
  PubMedGoogle Scholar
• 30 O'Brien M. The anatomy of the Achilles tendon.  Foot Ankle Clin. 2005;  10(2) 225-238
  CrossrefPubMedGoogle Scholar
• 31 Kannus P. Structure of the tendon connective tissue.  Scand J Med Sci Sports. 2000;  10(6) 312-320
  CrossrefPubMedGoogle Scholar
• 32 Khan K M, Cook J L, Bonar F, Harcourt P, Astrom M. Histopathology of common tendinopathies. Update and implications for clinical management.  Sports Med. 1999;  27(6) 393-408
  CrossrefPubMedGoogle Scholar
• 33 Fornage B D. Achilles tendon: US examination.  Radiology. 1986;  159(3) 759-764
  PubMedGoogle Scholar
• 34 Fornage B D, Rifkin M D. Ultrasound examination of tendons.  Radiol Clin North Am. 1988;  26(1) 87-107
  PubMedGoogle Scholar
• 35 Martinoli C, Derchi L E, Pastorino C, Bertolotto M, Silvestri E. Analysis of echotexture of tendons with US.  Radiology. 1993;  186(3) 839-843
  PubMedGoogle Scholar
• 36 Aström M, Gentz C F, Nilsson P, Rausing A, Sjöberg S, Westlin N. Imaging in chronic Achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases.  Skeletal Radiol. 1996;  25(7) 615-620
  CrossrefPubMedGoogle Scholar
• 37 Ohberg L, Lorentzon R, Alfredson H. Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up.  Br J Sports Med. 2004;  38(1) 8-11 discussion 11
  CrossrefPubMedGoogle Scholar
• 38 Richards P J, McCall I W, Day C, Belcher J, Maffulli N. Longitudinal microvascularity in Achilles tendinopathy: a pilot study.  Skeletal Radiol. 2009;  , August 27 (Epub ahead of print)
  CrossrefPubMedGoogle Scholar
• 39 Zanetti M, Metzdorf A, Kundert H P et al.. Achilles tendons: clinical relevance of neovascularization diagnosed with power Doppler US.  Radiology. 2003;  227(2) 556-560
  CrossrefPubMedGoogle Scholar
• 40 Jacobson J A, Andresen R, Jaovisidha S et al.. Detection of ankle effusions: comparison study in cadavers using radiography, sonography, and MR imaging.  AJR Am J Roentgenol. 1998;  170(5) 1231-1238
  PubMedGoogle Scholar
• 41 Khan K M, Forster B B, Robinson J et al.. Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders? A two year prospective study.  Br J Sports Med. 2003;  37(2) 149-153
  CrossrefPubMedGoogle Scholar
• 42 Archambault J M, Wiley J P, Bray R C, Verhoef M, Wiseman D A, Elliott P D. Can sonography predict the outcome in patients with achillodynia?.  J Clin Ultrasound. 1998;  26(7) 335-339
  CrossrefPubMedGoogle Scholar
• 43 Kälebo P, Allenmark C, Peterson L, Swärd L. Diagnostic value of ultrasonography in partial ruptures of the Achilles tendon.  Am J Sports Med. 1992;  20(4) 378-381
  CrossrefPubMedGoogle Scholar
• 44 Paavola M, Paakkala T, Kannus P, Järvinen M. Ultrasonography in the differential diagnosis of Achilles tendon injuries and related disorders. A comparison between pre-operative ultrasonography and surgical findings.  Acta Radiol. 1998;  39(6) 612-619
  CrossrefPubMedGoogle Scholar
• 45 Kayser R, Mahlfeld K, Heyde C E. Partial rupture of the proximal Achilles tendon: a differential diagnostic problem in ultrasound imaging.  Br J Sports Med. 2005;  39(11) 838-842 discussion 838-842
  CrossrefPubMedGoogle Scholar
• 46 Haims A H, Schweitzer M E, Patel R S, Hecht P, Wapner K L. MR imaging of the Achilles tendon: overlap of findings in symptomatic and asymptomatic individuals.  Skeletal Radiol. 2000;  29(11) 640-645
  CrossrefPubMedGoogle Scholar
• 47 Gibbon W W, Cooper J R, Radcliffe G S. Distribution of sonographically detected tendon abnormalities in patients with a clinical diagnosis of chronic Achilles tendinosis.  J Clin Ultrasound. 2000;  28(2) 61-66
  CrossrefPubMedGoogle Scholar
• 48 Fredberg U, Bolvig L. Significance of ultrasonographically detected asymptomatic tendinosis in the patellar and Achilles tendons of elite soccer players: a longitudinal study.  Am J Sports Med. 2002;  30(4) 488-491
  CrossrefPubMedGoogle Scholar
• 49 De Zordo T, Fink C, Feuchtner G M, Smekal V, Reindl M, Klauser A S. Real-time sonoelastography findings in healthy Achilles tendons.  AJR Am J Roentgenol. 2009;  193(2) W134-8
  CrossrefPubMedGoogle Scholar
• 50 De Zordo T, Chhem R, Smekal V et al.. Real-time sonoelastography: findings in patients with symptomatic Achilles tendons and comparison to healthy volunteers.  Ultraschall Med. November 27, 2009;  , [Epub ahead of print]
  PubMedGoogle Scholar
• 51 De Zordo T, Lill S R, Fink C et al.. Real-time sonoelastography of lateral epicondylitis: comparison of findings between patients and healthy volunteers.  AJR Am J Roentgenol. 2009;  193(1) 180-185
  CrossrefPubMedGoogle Scholar
• 52 Klauser A S, Peetrons P. Developments in musculoskeletal ultrasound and clinical applications.  Skeletal Radiol. September 3, 2009;  , [Epub ahead of print]
  PubMedGoogle Scholar
• 53 Skovoroda A, Emelianov S Y, O'Donnell M. Tissue elasticity reconstruction based on ultrasonic displacement and strain images.  IEEE Trans Ultrason Ferroelectr Freq Control. 1995;  42 747-765
  CrossrefPubMedGoogle Scholar

Andrea S KlauserM.D. 

Department of Diagnostic Radiology, Anichstrasse 35

Medical University Innsbruck, 6020 Innsbruck, Austria

Email: andrea.klauser@i-med.ac.at