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Extensor tendinopathy of the elbow assessed with sonoelastography: histologic correlation

  • Musculoskeletal
  • Published:
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Abstract

Purpose

To compare agreement between conventional B-mode ultrasound (US) and compression sonoelastography (SEL) of the common extensor tendons of the elbow with histological evaluation.

Materials and methods

Twenty-six common extensor tendons were evaluated in 17 cadavers (11 females, median age 85 years and 6 males, median age 80 years). B-mode US was graded into: Grade 1, homogeneous fibrillar pattern; grade 2, hypoechoic areas and/or calcifications <30%; and grade 3 > 30%. SEL was graded into: Grade 1 indicated blue (hardest) to green (hard); grade 2 yellow (soft); and grade 3 red (softest). B-mode US, SEL, and a combined grading score incorporating both were compared to histological findings in 76 biopsies.

Results

Histological alterations were detected in 55/76 biopsies. Both modalities showed similar results (sensitivity, specificity, and accuracy 84%, 81%, and 83% for B-mode US versus 85%, 86%, and 86% for SEL, respectively, P > 0.3). However, a combination of both resulted in significant improvement in sensitivity (96%, P < 0.02) without significant change in specificity (81%, P < 0.3), yielding an improved overall accuracy (92%).

Conclusion

Combined imaging of the extensor tendons with both modalities is superior to either modality alone for predicting the presence of pathologic findings on histology.

Key Points

• Combination of B-mode US and SEL proved efficiency in diagnosing lateral epicondylitis.

• Combination of B-mode US and SEL in lateral epicondylitis correlates to histology.

• Combination of both modalities provides improved sensitivity without loss of specificity.

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Abbreviations

LE:

Lateral epicondylitis

SEL:

Sonoelastography

US:

Ultrasound

MSK:

Musculoskeletal

B-mode US:

B-mode ultrasound

ROI:

Region of interest

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Acknowledgements

The scientific guarantor of this publication is Andrea S Klauser. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was not indicated as this work was conducted on cadavers, who dedicated their bodies for research after death according to their will and they signed this consent form before death. Written informed consent was obtained from all subjects in this study. Methodology: Prospective, Diagnostic or prognostic study, Performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Medical University of Innsbruck, Anich St. 35, 6020, Innsbruck, Austria

    Andrea S. Klauser, Mathias Pamminger, Mohamed M. H. Abd Ellah & Werner R. Jaschke

  2. Department of Radiology and Urology, Jefferson Prostate Diagnostic and Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA

    Ethan J. Halpern

  3. Department of Diagnostic Radiology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

    Mohamed M. H. Abd Ellah

  4. Department of Anatomy, Medical University of Innsbruck, Innsbruck, Austria

    Bernhard Moriggl

  5. Department of Medical Imaging, Banner- University Medical Center, Tucson, Arizona, USA

    Mihra S. Taljanovic

  6. Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria

    Christian Deml

  7. Department of Radiotherapy, Medical University of Innsbruck, Innsbruck, Austria

    Judit Sztankay

  8. Department of Histology & Embryology, Medical University of Innsbruck, Innsbruck, Austria

    Guenther Klima

Authors
  1. Andrea S. Klauser
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  2. Mathias Pamminger
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  3. Ethan J. Halpern
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  4. Mohamed M. H. Abd Ellah
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  5. Bernhard Moriggl
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  6. Mihra S. Taljanovic
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  7. Christian Deml
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  8. Judit Sztankay
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  9. Guenther Klima
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  10. Werner R. Jaschke
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Corresponding author

Correspondence to Mohamed M. H. Abd Ellah.

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Klauser, A.S., Pamminger, M., Halpern, E.J. et al. Extensor tendinopathy of the elbow assessed with sonoelastography: histologic correlation. Eur Radiol 27, 3460–3466 (2017). https://doi.org/10.1007/s00330-016-4711-x

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  • DOI: https://doi.org/10.1007/s00330-016-4711-x

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