Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Skeletal Radiology
Published in: Skeletal Radiology 11/2010

01-11-2010 | Review Article

Developments in musculoskeletal ultrasound and clinical applications

Authors: Andrea S. Klauser, Philippe Peetrons

Published in: Skeletal Radiology | Issue 11/2010

Login to get access

Abstract

Objective

Ultrasound (US) technologies are rapidly advancing, offering several refined transducer technologies as well as soft and hardware facilities. The aim of this article is to outline US developments, from B-mode technologies over Doppler advances to more sophisticated technologies, and their potential clinical impact in the field of musculoskeletal (MSK) imaging.

New advances

When using B-mode ultrasound, compound imaging and beam-steering are of help to decrease anisotropy in tendons and ligaments, that are less well depicted due to their oblique course. Doppler imaging has become sensitive in the detection of flow in small vessels, which is of particular value in rheumatologic conditions, tumour and overuse assessment. The use of US microbubble contrast agents improves detection of low-volume blood flow in smaller vessels by increasing the signal-to-noise ratio and thereby facilitating detection of angiogenetic vessels in inflammatory conditions or tumours. The use of US blood pool contrast agents enables molecular imaging in real-time, and thus the diagnostic potential of US is expanded, opening up a new field of US applications. Objective quantification of altered tissue (e.g., synovial proliferation, tumours) is still demanding and might be improved by the use of three-dimensional imaging and software tools as parametric evaluation. Real-time sonoelastography (EUS) is a new development for visualization of tissue elasticity by measurement of tissue displacement in terms of tissue stiffness changes, promising new insights into tendon disorders. Image fusion is an exciting development that enables superimposition of CT/MRI data sets on real-time US scanning. This technique might be helpful in guiding injections under real-time conditions even in regions less easily accessible by US as, for instance, the axial skeleton, and can additionally provide an interesting tool for teaching MSK imaging and ways to guide interventions.

Conclusion

In summary, exciting developments are expanding the applications of US in the MSK field, offering the advantages of real-time performance, high tissue resolution and relative speed at a reasonable cost.
Literature
1.
Claudon M, Tranquart F, Evans DH, et al. Advances in ultrasound. Eur Radiol. 2002;9:331–3.
2.
Lin CD, Nazarian LN, O’Kane Pl, et al. Advantages of real-time compound sonography of the musculoskeletal system versus conventional sonography. AJR. 2002;171:1629–31.
3.
Strobel K, Zanetti M, Nagy L, Hodler J. Suspected rotator cuff lesions: tissue harmonic imaging versus conventional US of the shoulder. Radiology. 2004;230(1):243–49.CrossRefPubMed
4.
Ophir J, Cespedes I, Ponnekanti H, et al. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991;13:111–34.CrossRefPubMed
5.
Varghese T, Ophir J, Konofagou E, et al. Tradeoffs in elastographic imaging. Ultrason Imaging. 2001;23:216–48.PubMed
6.
Pesavento A, Perrey C, Krueger M, et al. A time efficient and accurate strain estimation concept for ultrasonic elastography using iterative phase zero estimation. IEEE Trans Ultrason Ferroelectr Freq Contr. 1999;46:1057–67.CrossRef
7.
Pallwein L, Mitterberger M, Struve P, et al. Comparison of sonoelastography guided biopsy with systematic biopsy: impact on prostate cancer detection. Eur Radiol. 2007;17:2278–85.CrossRefPubMed
8.
Frey H. Realtime elastography: a new ultrasound procedure for the reconstruction of tissue elasticity. Radiologe. 2003;43:850–5.CrossRefPubMed
9.
Garra BS, Cespedes EI, Ophir J, et al. Elastography of breast lesions: initial clinical results. Radiology. 1997;202:79–86.PubMed
10.
Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006;239:341–50.CrossRefPubMed
11.
Lyshchik A, Higashi T, Asato R, et al. Thyroid gland tumor diagnosis at US elastography. Radiology. 2005;237:202–11.CrossRefPubMed
12.
Lyshchik A, Higashi T, Asato R, et al. Cervical lymph node metastases: diagnosis at sonoelastography-initial experience. Radiology. 2007;243:258–67.CrossRefPubMed
13.
De Zordo T, Lill SR, Fink C, Feuchtner GM, Jaschke W, Bellmann-Weiler R, et al. Value of real-time sonoelastography in lateral epicondylitis: comparison of findings between patients and healthy volunteers. AJR Am J Roentgenol. 2009;193(1):180–5.CrossRefPubMed
14.
De Zordo T, Fink C, Feuchtner GM, Smekal V, Reindl M, Klauser AS. Real-time sonoelastography findings in healthy Achilles tendons. AJR Am J Roentgenol. 2009;193(2):W134–8.CrossRefPubMed
15.
Klauser A, De Zordo T,Pallwein L,et al. Value of real-time sonoelastography in Achilles tendon comparison of findings between healthy volunteers and patients with symptomatic Achilles tendons. Abstract, RSNA Chicago, IL;Dec 2007: SSG16–04.
16.
Hau M, Kneitz C, Tony HP, Keberle M, Jahns R, Jenett M. High resolution ultrasound detects a decrease in pannus vascularisation of small finger joints in patients with rheumatoid arthritis receiving treatment with soluble tumour necrosis factor alpha receptor (etanercept). Ann Rheum Dis. 2002;61(1):55–8.CrossRefPubMed
17.
Walther M, Harms H, Krenn V, Radke S, Kirschner S, Gohlke F. Synovial tissue of the hip at power Doppler US: correlation between vascularity and power Doppler US signal. Radiology. 2002;225(1):225–31.CrossRefPubMed
18.
Naredo E, Möller I, Cruz A, Carmona L, Garrido J. Power Doppler ultrasonographic monitoring of response to anti-tumor necrosis factor therapy in patients with rheumatoid arthritis. Arthritis Rheum. 2008;58:2248–56.CrossRefPubMed
19.
Zanetti M, Metzdorf A, Kundert HP, et al. Achilles tendons: clinical relevance of neovascularization diagnosed with power Doppler US. Radiology. 2003;227(2):556–60.CrossRefPubMed
20.
Reiter M, Ulreich N, Dirisamer A, Tscholakoff D, Bucek RA. Colour and power Doppler sonography in symptomatic Achilles tendon disease. Int J Sports Med. 2004;25(4):301–5.CrossRefPubMed
21.
Koch A. Review: angiogenesis: implications for rheumatoid arthritis. Arthritis Rheum. 1998;41(6):951–62.CrossRefPubMed
22.
Bodolay E, Koch A, Kim J, Szegedi G, Szekanecz Z. Angiogenesis and chemokines in rheumatoid arthritis and other systemic inflammatory rheumatic diseases. J Cell Mol Med. 2002;6(3):357–76CrossRefPubMed
23.
Taylor P. VEGF and imaging of vessels in rheumatoid arthritis. Arthritis Res. 2002;4(Suppl 3):S99–107.CrossRefPubMed
24.
Ostergaard M, Hansen M, Stoltenberg M, et al. Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Arthritis Rheum. 1999;42(5):918–29.CrossRefPubMed
25.
Conaghan P, O’Connor P, McGonagle D, et al. Elucidation of the relationship between synovitis and bone damage: a randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis. Arthritis Rheum. 2003;48(1):64–71.CrossRefPubMed
26.
McQueen F, Stewart N, Crabbe J, et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis. 1999;58(3):156–63.CrossRefPubMed
27.
Nell V, Machold K, Eberl G, Stamm T, Uffmann M, Smolen J. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford). 2004;43(7):906–14.CrossRef
28.
Bajaj S, Lopez-Ben R, Oster R, Alarcón GS. Ultrasound detects rapid progression of erosive disease in early rheumatoid arthritis: a prospective longitudinal study. Skeletal Radiol. 2007;36(2):123–8.CrossRefPubMed
29.
Gamradt SC, Gallo RA, Adler RS, Maderazo A, Altchek DW, Warren RF, Fealy S.Vascularity of the supraspinatus tendon three months after repair: characterization using contrast-enhanced ultrasound. J Shoulder Elbow Surg. 2009 Jun 12.
30.
Adler RS, Fealy S, Rudzki JR, Kadrmas W, Verma NN, Pearle A, et al. Rotator cuff in asymptomatic volunteers: contrast-enhanced US depiction of intratendinous and peritendinous vascularity. Radiology. 2008;248(3):954–61.CrossRefPubMed
31.
Rudzki JR, Adler RS, Warren RF, Kadrmas WR, Verma N, Pearle AD, et al. Contrast-enhanced ultrasound characterization of the vascularity of the rotator cuff tendon: age- and activity-related changes in the intact asymptomatic rotator cuff. J Shoulder Elbow Surg. 2008;17(Suppl 1):96S–100.CrossRefPubMed
32.
Delle Sedie A, Riente L, Bombardieri S. Limits and perspectives of ultrasound in the diagnosis and management of rheumatic diseases. Mod Rheumatol. 2008;18(2):125–31.CrossRefPubMed
33.
Le Corroller T, Cohen M, Aswad R, Pauly V, Champsaur P. Sonography of the painful shoulder: role of the operator’s experience. Skeletal Radiol. 2008;37(11):979–86.CrossRefPubMed
34.
Koski J, Saarakkala S, Helle M, et al. Assessing the intra- and inter-reader reliability of dynamic ultrasound images in power Doppler ultrasonography. Ann Rheum Dis. 2006;65(12):1658–60.CrossRefPubMed
35.
Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen H, Østergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum. 2003;48(4):955–62.CrossRefPubMed
36.
Klauser A, Frauscher F, Schirmer M, Halpern E, Pallwein L, Herold M, et al. The value of contrast-enhanced color Doppler ultrasound in the detection of vascularization of finger joints in patients with rheumatoid arthritis. Arthritis Rheum. 2002;46(3):647–53.CrossRefPubMed
37.
Klauser A, Demharter J, De Marchi A, et al. Contrast enhanced gray-scale sonography in assessment of joint vascularity in rheumatoid arthritis: results from the IACUS study group. Eur Radiol. 2005;15(12):2404–10.CrossRefPubMed
38.
Schueller-Weidekamm C, Krestan C, Schueller G, Kapral T, Aletaha D, Kainberger F. Power Doppler sonography and pulse-inversion harmonic imaging in evaluation of rheumatoid arthritis synovitis. AJR Am J Roentgenol. 2007;188(2):504–8.CrossRefPubMed
39.
Song I, Althoff C, Hermann K, et al. Contrast-enhanced ultrasound in monitoring the efficacy of a bradykinin receptor-2 antagonist in painful knee osteoarthritis compared to magnetic resonance imaging. Ann Rheum Dis. 2009;68(1):75–83.CrossRefPubMed
40.
Song I, Althoff C, Hermann K, et al. Knee Osteoarthritis Efficacy of a new method of contrast-enhanced musculoskeletal ultrasonography in detection of synovitis in patients with knee osteoarthritis in comparison with magnetic resonance imaging. Ann Rheum Dis 2007 May 14. (Epub ahead of print)
41.
Ricci P, Cantisani V, D’Onofrio M, et al. Behavior of hepatocellular adenoma on real-time low-mechanical index contrast-enhanced ultrasonography with a second-generation contrast agent. J Ultrasound Med. 2008;27(12):1719–26.PubMed
42.
Ricci P, Cantisani V, Ballesio L, et al. Benign and malignant breast lesions: efficacy of real time contrast-enhanced ultrasound vs. magnetic resonance imaging. Ultraschall Med 2007;28(1):57–62.
43.
Brandl H, Gritzky A, Haitzinger M. 3 D Ultrasound: a dedicated system. Eur Radiol. 1999;9:331–3.CrossRef
44.
Albrecht K, Grob K, Lange U, Müller-Ladner U, Strunk J. Reliability of different Doppler ultrasound quantification methods and devices in the assessment of therapeutic response in arthritis. Rheumatology (Oxford). 2008;47(10):1521–6.CrossRef
45.
Strunk J, Strube K, Rumbaur C, Lange U, Müller-Ladner U. Interobserver agreement in two- and three-dimensional power Doppler sonographic assessment of synovial vascularity during anti-inflammatory treatment in patients with rheumatoid arthritis. Ultraschall Med. 2007;28(4):409–15.CrossRefPubMed
46.
Serafin-Król M, Król R, Ziólkowski M, Jedrzejczyk M, Marianowska A, Mlosek R, et al. Potential value of three-dimensional ultrasonography in diagnosing muscle injuries in comparison to two-dimensional examination: preliminary results. Orthop Traumatol Rehabil. 2008;10(2):137–45.
47.
Ju JH, Kang KY, Kim IJ, Yoon JU, Kim HY, Park SH. Three-dimensional ultrasonographic application for analyzing synovial hypertrophy of the knee in patients with osteoarthritis. J Ultrasound Med. 2008;27(5):729–36.PubMed
48.
Albrecht H, Stroszczynski C, Felix R, Hünerbein M. Real time 3D (4D) ultrasound-guided percutaneous biopsy of solid tumours. Ultraschall Med. 2006;27(4):324–8.CrossRefPubMed
49.
Ma CM, Paskalev K. In-room CT techniques for image-guided radiation therapy. Med Dosim. 2006;31:30–9.CrossRefPubMed
50.
Grunert P, Darabi K, Espinosa J, Filippi R. Computer-aided navigation in neurosurgery. Neurosurg Rev. 2003;26:73–99.CrossRefPubMed
51.
Pereira PL, Günaydin I, Trübenbach J, et al. Interventional MR imaging for injection of sacroiliac joints in patients with sacroiliitis. AJR Am J Roentgenol. 2000;175:265–6.PubMed
52.
Pekkafahli MZ, Kiralp MZ, Başekim CC, et al. Sacroiliac joint injections performed with sonographic guidance. J Ultrasound Med. 2003;22:553–9.PubMed
53.
Klauser A, De Zordo T, Feuchtner G, Sögner P, Schirmer M, Gruber J, Sepp N, Moriggl B. Feasibility of ultrasound-guided sacroiliac joint injection considering sonoanatomic landmarks at two different levels in cadavers and patients. Arthritis Rheum 2008;15;59(11):1618–1624
54.
Sofka CM. Current applications of advanced cross-sectional imaging techniques in evaluating the painful arthroplasty. Skeletal Radiol. 2007;36(3):183–93.CrossRefPubMed
55.
Crocetti L, Lencioni R, De Beni S, et al. Targeting liver lesions for radiofrequency ablation: an experimental feasibility study using a CT-US fusion imaging system. Invest Radiol. 2008;43:33–9.CrossRefPubMed
56.
Lockhart ME. The role of radiology in the future of sonography. AJR. 2008;190:8141–2.
57.
Galiano K, Obwegeser AA, Bale R, et al. Ultrasound-guided and CT-navigation-assisted periradicular and facet joint injections in the lumbar and cervical spine: a new teaching tool to recognize the sonoanatomic pattern. Reg Anesth Pain Med. 2007;32:254–7.PubMed
Metadata
Title
Developments in musculoskeletal ultrasound and clinical applications
Authors
Andrea S. Klauser
Philippe Peetrons
Publication date
01-11-2010
Publisher
Springer-Verlag
Published in
Skeletal Radiology / Issue 11/2010
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-009-0782-y

Other articles of this Issue 11/2010

Skeletal Radiology 11/2010 Go to the issue

Scientific Article

Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view

Scientific Article

Finger fractures imaging: accuracy of cone-beam computed tomography and multislice computed tomography

Scientific Article

Pelvic crush fractures in survivors of the Sichuan earthquake evaluated by digital radiography and multidetector computed tomography

Scientific Article

Measurements of bone mineral density in the lumbar spine and proximal femur using lunar prodigy and the new pencil-beam dual-energy X-ray absorptiometry

Test Yourself: Question

A 65-year-old man presents with pelvic pain

Scientific Article

Lobular capillary hemangioma in the soft tissue of the finger: sonographic findings