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 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Skeletal Radiology
Published in: Skeletal Radiology 12/2017

01-12-2017 | Review Article

Ultrasound elastography in tendon pathology: state of the art

Authors: Romain Domenichini, Jean-Baptiste Pialat, Andrea Podda, Sébastien Aubry

Published in: Skeletal Radiology | Issue 12/2017

Login to get access

Abstract

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.
Literature
1.
Pallwein L, Mitterberger M, Struve P, Pinggera G, Horninger W, Bartsch G, et al. Real-time elastography for detecting prostate cancer: preliminary experience. BJU International Blackwell Publishing Ltd. 2007;100:42–6.CrossRef
2.
Zhu Q-L, Jiang Y-X, Liu J-B, Liu H, Sun Q, Dai Q, et al. Real-time ultrasound elastography: its potential role in assessment of breast lesions. Ultrasound Med Biol. 2008;34:1232–8.CrossRefPubMed
3.
Rubaltelli L, Corradin S, Dorigo A, Stabilito M, Tregnaghi A, Borsato S, et al. Differential diagnosis of benign and malignant thyroid nodules at elastosonography. Ultraschall Med. © Georg Thieme Verlag KG Stuttgart ·New York; 2009;30:175–9.
4.
Gennisson J-L, Deffieux T, Fink M, Tanter M. Ultrasound elastography: principles and techniques. Diagn Interv Imaging. 2013;94:487–95.CrossRefPubMed
5.
Ophir J, Céspedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason imaging. SAGE PublicationsSage CA: Los Angeles. CA. 1991;13:111–34.
6.
Klauser AS, Miyamoto H, Bellmann-Weiler R, Feuchtner GM, Wick MC, Jaschke WR. Sonoelastography: musculoskeletal applications. Radiology. Radiological Society of North America. 2014;272:622–33.
7.
Ponnekanti H, Ophir J, Huang Y, Céspedes I. Fundamental mechanical limitations on the visualization of elasticity contrast in elastography. Ultrasound Med Biol. 1995;21:533–43.CrossRefPubMed
8.
Franchi-Abella S, Elie C, Corréas JM. Ultrasound elastography: advantages, limitations and artefacts of the different techniques from a study on a phantom. Diagn Interv Imaging. 2013;94:497–501.CrossRefPubMed
9.
Klauser AS, Faschingbauer R, Jaschke WR. Is sonoelastography of value in assessing tendons? Semin Musculoskelet Radiol. 2010;14:323–33.CrossRefPubMed
10.
Schneebeli A, Del Grande F, Vincenzo G, Cescon C, Clijsen R, Biordi F, et al. Real-time sonoelastography using an external reference material: test-retest reliability of healthy Achilles tendons. Skeletal Radiol. 5 ed. Springer Berlin Heidelberg; 2016;45:1045–52.
11.
Li Y, Snedeker JG. Elastography: modality-specific approaches, clinical applications, and research horizons. Skeletal Radiol Springer-Verlag. 2011;40:389–97.CrossRef
12.
Goertz RS, Zopf Y, Jugl V, Heide R, Janson C, Strobel D, et al. Measurement of liver elasticity with acoustic radiation force impulse (ARFI) technology: an alternative noninvasive method for staging liver fibrosis in viral hepatitis. Ultraschall Med. 2010;31:151–5.CrossRefPubMed
13.
Tozaki M, Isobe S, Fukuma E. Preliminary study of ultrasonographic tissue quantification of the breast using the acoustic radiation force impulse (ARFI) technology. Eur J Radiol. 2011;80:e182–7.CrossRefPubMed
14.
Bercoff J, Tanter M, Fink M. Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control. 2004;51:396–409.CrossRefPubMed
15.
Parker KJ, Fu D, Graceswki SM, Yeung F, Levinson SF. Vibration sonoelastography and the detectability of lesions. Ultrasound Med Biol. 1998;24:1437–47.CrossRefPubMed
16.
Brum J, Bernal M, Gennisson J-L, Tanter M. In vivo evaluation of the elastic anisotropy of the human Achilles tendon using shear wave dispersion analysis. Phys Med Biol IOP Publishing. 2014;59:505–23.CrossRef
17.
18.
Cortez CD, Hermitte L, Ramain A, Mesmann C, Lefort T, Pialat JB. Ultrasound shear wave velocity in skeletal muscle: a reproducibility study. Diagn Interv Imaging. 2016;97:71–9.CrossRefPubMed
19.
Dubois G, Kheireddine W, Vergari C, Bonneau D, Thoreux P, Rouch P, et al. Reliable protocol for shear wave elastography of lower limb muscles at rest and during passive stretching. Ultrasound Med Biol. 2015;41:2284–91.CrossRefPubMed
20.
Drakonaki EE, Allen GM, Wilson DJ. Real-time ultrasound elastography of the normal Achilles tendon: reproducibility and pattern description. Clin Radiol Elsevier. 2009;64:1196–202.CrossRef
21.
De Zordo T, Chhem R, Smekal V, Feuchtner G, Reindl M, Fink C, et al. Real-time sonoelastography: findings in patients with symptomatic Achilles tendons and comparison to healthy volunteers. Ultraschall Med. 2010;31:394–400.CrossRefPubMed
22.
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:W134–8.CrossRefPubMed
23.
Capalbo E, Peli M, Stradiotti P. Sonoelastography of the distal third of the Achilles tendon in asymptomatic volunteers: correlation with anthropometric data, ultrasound findings and reproducibility of the method. La Radiologia Medica Springer Milan. 2016;121:667–74.CrossRef
24.
Chen X-M, Cui L-G, He P, Shen W-W, Qian Y-J, Wang J-R. Shear wave elastographic characterization of normal and torn Achilles tendons: a pilot study. J Ultrasound Med. 2013;32:449–55.CrossRefPubMed
25.
Aubry S, Risson J-R, Barbier-Brion B, Tatu L, Vidal C, Kastler B. Transient elastography of calcaneal tendon: preliminary results and future prospects. J Radiol. 2011;92:421–7.CrossRefPubMed
26.
Dirrichs T, Quack V, Gatz M, Tingart M, Kuhl CK, Schrading S. Shear wave elastography (SWE) for the evaluation of patients with tendinopathies. Acad Radiol. 2016;23:1204–13.CrossRefPubMed
27.
Arda K, Ciledag N, Aktas E, Aribas BK, Köse K. Quantitative assessment of normal soft-tissue elasticity using shear-wave ultrasound elastography. AJR Am J Roentgenol. 2011;197:532–6.CrossRefPubMed
28.
Slane LC, Martin J, DeWall R, Thelen D, Lee K. Quantitative ultrasound mapping of regional variations in shear wave speeds of the aging Achilles tendon. Eur Radiol. Springer Berlin Heidelberg; 2017;27:474–82.
29.
Aubry S, Risson J-R, Kastler A, Barbier-Brion B, Siliman G, Runge M, et al. Biomechanical properties of the calcaneal tendon in vivo assessed by transient shear wave elastography. Skeletal Radiol. Springer-Verlag; 2013;42:1143–50.
30.
Rosskopf AB, Bachmann E, Snedeker JG, Pfirrmann CWA, Buck FM. Comparison of shear wave velocity measurements assessed with two different ultrasound systems in an ex-vivo tendon strain phantom. Skeletal Radiol. Springer Berlin Heidelberg; 2016;45:1541–51.
31.
Peltz CD, Haladik JA, Divine G, Siegal D, van Holsbeeck M, Bey MJ. ShearWave elastography: repeatability for measurement of tendon stiffness. Skeletal Radiol. Springer-Verlag; 2013;42:1151–6.
32.
Porta F, Damjanov N, Galluccio F, Iagnocco A, Matucci-Cerinic M. Ultrasound elastography is a reproducible and feasible tool for the evaluation of the patellar tendon in healthy subjects. Int J Rheum Dis. 2014;17:762–6.CrossRefPubMed
33.
Kot BCW, Zhang ZJ, Lee AWC, Leung VYF, Fu SN. Elastic modulus of muscle and tendon with shear wave ultrasound elastography: variations with different technical settings. Kellermayer MS, editor. PLoS ONE Public Library of Science. 2012;7:e44348.CrossRef
34.
Berko NS, Mehta AK, Levin TL, Schulz JF. Effect of knee position on the ultrasound elastography appearance of the patellar tendon. Clin Radiol. 2015:1083–6.
35.
Hsiao M-Y, Chen Y-C, Lin C-Y, Chen W-S, Wang T-G. Reduced patellar tendon elasticity with aging: in vivo assessment by shear wave elastography. Ultrasound Med Biol. 2015;41:2899–905.CrossRefPubMed
36.
Tudisco C, Bisicchia S, Stefanini M, Antonicoli M, Masala S, Simonetti G. Tendon quality in small unilateral supraspinatus tendon tears. Real-time sonoelastography correlates with clinical findings. Knee Surg Sports Traumatol Arthrosc. Springer Berlin Heidelberg; 2015;23:393–8.
37.
Järvinen TAH, Kannus P, Maffulli N, Khan KM. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin. 2005;10:255–66.CrossRefPubMed
38.
39.
Astrӧm M, Rausing A. Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings. Clin Orthop Relat Res. 1995:151–64.
40.
Kannus P, Józsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am. 1991;73:1507–25.CrossRefPubMed
41.
Ooi CC, Schneider ME, Malliaras P, Chadwick M, Connell DA. Diagnostic performance of axial-strain sonoelastography in confirming clinically diagnosed Achilles tendinopathy: comparison with B-mode ultrasound and color Doppler imaging. Ultrasound Med Biol. 2015;41:15–25.CrossRefPubMed
42.
Klauser AS, Miyamoto H, Tamegger M, Faschingbauer R, Moriggl B, Klima G, et al. Achilles tendon assessed with sonoelastography: histologic agreement. Radiology. 2013;267:837–42.CrossRefPubMed
43.
Ooi CC, Richards PJ, Maffulli N, Ede D, Schneider ME, Connell D, et al. A soft patellar tendon on ultrasound elastography is associated with pain and functional deficit in volleyball players. J Sci Med Sport. 2016;19:373–8.CrossRefPubMed
44.
Ooi CC, Schneider ME, Malliaras P, Counsel P, Connell DA. Prevalence of morphological and mechanical stiffness alterations of mid Achilles tendons in asymptomatic marathon runners before and after a competition. Skeletal Radiol. Springer Berlin Heidelberg; 2015;44:1119–27.
45.
Balaban M, Idilman IS, Ipek A, Ikiz SS, Bektaser B, Gumus M. Elastographic findings of Achilles tendons in asymptomatic professional male volleyball players. J Ultrasound Med. 2016;35:2623–8.CrossRefPubMed
46.
Siu W-L, Chan C-H, Lam C-H, Lee C-M, Ying M. Sonographic evaluation of the effect of long-term exercise on Achilles tendon stiffness using shear wave elastography. J Sci Med Sport. 2016;19:883–7.CrossRefPubMed
47.
Busilacchi A, Olivieri M, Ulisse S, Gesuita R, Skrami E, Lording T, et al. Real-time sonoelastography as novel follow-up method in Achilles tendon surgery. Knee Surg Sports Traumatol Arthrosc. 2016;24:2124–32.CrossRefPubMed
48.
Sconfienza LM, Silvestri E, Cimmino MA. Sonoelastography in the evaluation of painful Achilles tendon in amateur athletes. Clin Exp Rheumatol. 2010;28:373–8.PubMed
49.
Aubry S, Nueffer J-P, Tanter M, Becce F, Vidal C, Michel F. Viscoelasticity in Achilles tendonopathy: quantitative assessment by using real-time shear-wave elastography. Radiology. 2015;274:821–9.CrossRefPubMed
50.
Martin JA, Biedrzycki AH, Lee KS, DeWall RJ, Brounts SH, Murphy WL, et al. In vivo measures of shear wave speed as a predictor of tendon elasticity and strength. Ultrasound Med Biol. 2015;41:2722–30.CrossRefPubMedPubMedCentral
51.
Zhang L-N, Wan W-B, Wang Y-X, Jiao Z-Y, Zhang L-H, Luo Y-K, et al. Evaluation of elastic stiffness in healing Achilles tendon after surgical repair of a tendon rupture using in vivo ultrasound shear wave elastography. Med Sci Monit. 2016;22:1186–91.CrossRefPubMedPubMedCentral
52.
Lee S-U, Joo SY, Kim SK, Lee S-H, Park S-R, Jeong C. Real-time sonoelastography in the diagnosis of rotator cuff tendinopathy. J Shoulder Elb Surg. 2016;25:723–9.CrossRef
53.
Lalitha P, Reddy MCB, Reddy KJ. Musculoskeletal applications of elastography: a pictorial essay of our initial experience. Korean J Radiol. 2011;12:365–75.CrossRefPubMedPubMedCentral
54.
Seo J-B, Yoo J-S, Ryu J-W. Sonoelastography findings of biceps tendinitis and tendinosis. J Ultrasound. Springer International Publishing; 2014;17:271–7.
55.
Lin Y-H, Chiou H-J, Wang H-K, Lai Y-C, Chou Y-H, Chang C-Y. Management of rotator cuff calcific tendinosis guided by ultrasound elastography. J Chin Med Assoc. 2015;78:603–9.CrossRefPubMed
56.
Leong HT, Hug F, Fu SN. Increased upper trapezius muscle stiffness in overhead athletes with rotator cuff tendinopathy. Lucia A, editor. PLoS ONE. 2016;11:e0155187.
57.
Hou SW, Merkle AN, Babb JS, McCabe R, Gyftopoulos S, Adler RS. Shear wave ultrasound elastographic evaluation of the rotator cuff tendon. J Ultrasound Med. 2017;36:95–106.CrossRefPubMed
58.
Krepkin K, Bruno M, Raya JG, Adler RS, Gyftopoulos S. Quantitative assessment of the supraspinatus tendon on MRI using T2/T2* mapping and shear-wave ultrasound elastography: a pilot study. Skeletal Radiol. Springer Berlin Heidelberg; 2017;46:191–9.
59.
Hatta T, Giambini H, Uehara K, Okamoto S, Chen S, Sperling JW, et al. Quantitative assessment of rotator cuff muscle elasticity: reliability and feasibility of shear wave elastography. J Biomech. 2015;48:3853–8.CrossRefPubMedPubMedCentral
60.
Rosskopf AB, Ehrmann C, Buck FM, Gerber C, Flück M, Pfirrmann CWA. Quantitative shear-wave US elastography of the supraspinatus muscle: reliability of the method and relation to tendon integrity and muscle quality. Radiology Radiological Society of North America. 2015;278:465–74.
61.
Pochini A de C, Ferretti M, Kawakami EFKI, Fernandes ADRC, Yamada AF, Oliveira GC de, et al. Analisys of pectoralis major tendon in weightlifting athletes using ultrasonography and elastography. Einstein (Sao Paulo). Instituto Israelita de Ensino e Pesquisa Albert Einstein; 2015;13:541–6.
62.
Zhang ZJ, Ng GY-F, Lee WC, Fu SN. Changes in morphological and elastic properties of patellar tendon in athletes with unilateral patellar tendinopathy and their relationships with pain and functional disability. Hug FO, editor. PLoS ONE. 2014;9:e108337.
63.
De Zordo T, Lill SR, Fink C, Feuchtner GM, Jaschke W, Bellmann-Weiler R, et al. Real-time sonoelastography of lateral epicondylitis: comparison of findings between patients and healthy volunteers. AJR Am J Roentgenol. 2009;193:180–5.CrossRefPubMed
64.
Park G, Kwon D, Park J. Diagnostic confidence of sonoelastography as adjunct to greyscale ultrasonography in lateral elbow tendinopathy. Chin Med J. 2014;127:3110–5.PubMed
65.
Klauser AS, Pamminger M, Halpern EJ, Abd Ellah MMH, Moriggl B, Taljanovic MS, et al. Extensor tendinopathy of the elbow assessed with sonoelastography: histologic correlation. Eur Radiol. Springer Berlin Heidelberg; 2017;176:777–7.
66.
Klauser AS, Pamminger MJ, Halpern EJ, Abd Ellah MMH, Moriggl B, Taljanovic MS, et al. Sonoelastography of the common flexor tendon of the elbow with Histologic agreement: a cadaveric study. Radiology. 2017;283:486–91.CrossRefPubMed
67.
Turan A, Tufan A, Mercan R, Teber MA, Tezcan ME, Bitik B, et al. Real-time sonoelastography of Achilles tendon in patients with ankylosing spondylitis. Skelet Radiol. 2013;42:1113–8.CrossRef
68.
Evranos B, Idilman I, Ipek A, Polat SB, Cakir B, Ersoy R. Real-time sonoelastography and ultrasound evaluation of the Achilles tendon in patients with diabetes with or without foot ulcers: a cross sectional study. J Diabetes Complicat. 2015;29:1124–9.CrossRefPubMed
69.
Onal ED, Ipek A, Evranos B, Idilman IS, Cakir B, Ersoy R. Structural tendon changes in patients with acromegaly: assessment of Achilles tendon with sonoelastography. Med Ultrason. 2016;18:30–5.CrossRefPubMed
70.
Teber MA, Oğur T, Bozkurt A, Er B, Turan A, Gülbay M, et al. Real-time sonoelastography of the quadriceps tendon in patients undergoing chronic hemodialysis. J Ultrasound Med. 2015;34:671–7.CrossRefPubMed
71.
Guney A, Vatansever F, Karaman I, Kafadar IH, Oner M, Turk CY. Biomechanical properties of Achilles tendon in diabetic vs. non-diabetic patients. Exp. Clin. Endocrinol. Diabetes. © Georg Thieme Verlag KG, 2015 ;123:428–32.
Metadata
Title
Ultrasound elastography in tendon pathology: state of the art
Authors
Romain Domenichini
Jean-Baptiste Pialat
Andrea Podda
Sébastien Aubry
Publication date
01-12-2017
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 12/2017
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-017-2726-2

Other articles of this Issue 12/2017

Skeletal Radiology 12/2017 Go to the issue

Scientific Article

The influence of epidural catheter on the incidence of intravascular injection during caudal block

Case Report

Chordoma arising from benign multifocal notochordal tumors

Case Report

Cystic degeneration of the tibial nerve: magnetic resonance neurography and sonography appearances of an intraneural ganglion cyst

Case Report

Intermetatarsal bursa primary synovial chondromatosis: case report and review of the literature

Scientific Article

Magnetic resonance imaging at primary diagnosis cannot predict subsequent contralateral slip in slipped capital femoral epiphysis

Scientific Article

Femoral head retroposition as a potential compensatory mechanism in patients with a severe mismatch between pelvic incidence and lumbar lordosis