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Clinical applicability of shear wave elastography for the evaluation of medial epicondylitis

  • Ultrasound
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Abstract

Objectives

To evaluate the ability of shear wave elastography (SWE) in diagnosing medial epicondylitis and to compare the diagnostic performance of SWE with that of grey-scale ultrasound (GSU) and strain elastography (SE).

Methods

GSU, SE, and SWE were performed on 61 elbows of 54 patients from March 2018 to April 2019. An experienced radiologist evaluated the GSU findings (swelling, cortical irregularity, hypoechogenicity, calcification, and tear), colour Doppler findings (hyperaemia), SE findings (strain ratio [SR]), and SWE findings (stiffness and shear wave velocity [SWV]). Participants were divided in two groups: patients with clinically diagnosed medial epicondylitis and patients without medial elbow pain. Findings from the two groups were compared, and the receiver operating characteristic (ROC) curves were calculated for significant features.

Results

Of the 54 patients, 25 patients with 28 imaged elbows were clinically diagnosed with medial epicondylitis and 29 patients with 33 imaged elbows had no medial elbow pain. Cortical irregularity, hypoechogenicity, calcification, hyperaemia, SR, stiffness, and SWV were significantly different between the two groups. The areas under the ROC curves were 0.838 for hypoechogenicity, 0.948 for SR, 0.999 for stiffness, and 0.999 for SWV. The diagnostic performances of SR, stiffness, and SWV were significantly superior compared to that of hypoechogenicity. However, there were no significant differences among SR, stiffness, and SWV.

Conclusions

SWE can obtain both stiffness and SWV, which are valuable diagnostic tools in the diagnosis of medial epicondylitis. The diagnostic performance of SWE and SE is similar in detecting medial epicondylitis.

Key Points

• Shear wave elastography providing stiffness and shear wave velocity showed excellent performance in the diagnosis of medial epicondylitis.

• There was no significant difference in the ability of SE and SWE for diagnosing medial epicondylitis.

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Abbreviations

ARF:

Acoustic radiation force

AUC:

Area under the curve

CET:

Common extensor tendon

CFT:

Common flexor tendon

GSU:

Grey-scale ultrasound

ME:

Medial epicondylitis

ROC:

Receiver operating characteristic

ROI:

Region of interest

SE:

Strain elastography

SR:

Strain ratio

SWE:

Shear wave elastography

SWS:

Shear wave speed

SWV:

Shear wave velocity

References

  1. Kijowski R, De Smet AA (2005) Magnetic resonance imaging findings in patients with medial epicondylitis. Skeletal Radiol 34:196–202

    Article  Google Scholar 

  2. Tarpada SP, Morris MT, Lian J, Rashidi S (2018) Current advances in the treatment of medial and lateral epicondylitis. J Orthop 15:107–110

    Article  Google Scholar 

  3. Walz DM, Newman JS, Konin GP, Ross G (2010) Epicondylitis: pathogenesis, imaging, and treatment. Radiographics 30:167–184

    Article  Google Scholar 

  4. O’Dwyer KJ, Howie CR (1995) Medial epicondylitis of the elbow. Int Orthop 19:69–71

    PubMed  Google Scholar 

  5. Konin GP, Nazarian LN, Walz DM (2013) US of the elbow: indications, technique, normal anatomy, and pathologic conditions. Radiographics 33:E125–E147

    Article  Google Scholar 

  6. Aubry S, Nueffer JP, Tanter M, Becce F, Vidal C, Michel F (2015) Viscoelasticity in Achilles tendonopathy: quantitative assessment by using real-time shear-wave elastography. Radiology 274:821–829

    Article  Google Scholar 

  7. Chen XM, Cui LG, He P, Shen WW, Qian YJ, Wang JR (2013) Shear wave elastographic characterization of normal and torn Achilles tendons: a pilot study. J Ultrasound Med 32:449–455

    Article  Google Scholar 

  8. Hou SW, Merkle AN, Babb JS, McCabe R, Gyftopoulos S, Adler RS (2017) Shear wave ultrasound elastographic evaluation of the rotator cuff tendon. J Ultrasound Med 36:95–106

    Article  Google Scholar 

  9. Hatta T, Giambini H, Uehara K et al (2015) Quantitative assessment of rotator cuff muscle elasticity: reliability and feasibility of shear wave elastography. J Biomech 48:3853–3858

    Article  Google Scholar 

  10. Rosskopf AB, Ehrmann C, Buck FM, Gerber C, Fluck M, Pfirrmann CW (2016) Quantitative shear-wave US elastography of the supraspinatus muscle: reliability of the method and relation to tendon integrity and muscle quality. Radiology 278:465–474

    Article  Google Scholar 

  11. Kantarci F, Ustabasioglu FE, Delil S et al (2014) Median nerve stiffness measurement by shear wave elastography: a potential sonographic method in the diagnosis of carpal tunnel syndrome. Eur Radiol 24:434–440

    Article  Google Scholar 

  12. Andrade RJ, Nordez A, Hug F et al (2016) Non-invasive assessment of sciatic nerve stiffness during human ankle motion using ultrasound shear wave elastography. J Biomech 49:326–331

    Article  Google Scholar 

  13. Wu CH, Chen WS, Wang TG (2016) Elasticity of the coracohumeral ligament in patients with adhesive capsulitis of the shoulder. Radiology 278:458–464

    Article  Google Scholar 

  14. Tavare AN, Alfuraih AM, Hensor EMA, Astrinakis E, Gupta H, Robinson P (2019) Shear-wave elastography of benign versus malignant musculoskeletal soft-tissue masses: comparison with conventional US and MRI. Radiology 290:410–417

    Article  Google Scholar 

  15. Taljanovic MS, Gimber LH, Becker GW et al (2017) Shear-wave elastography: basic physics and musculoskeletal applications. Radiographics 37:855–870

    Article  Google Scholar 

  16. Bamber J, Cosgrove D, Dietrich CF et al (2013) EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: basic principles and technology. Ultraschall Med 34:169–184

    Article  CAS  Google Scholar 

  17. Hodgson RJ, O’Connor PJ, Grainger AJ (2012) Tendon and ligament imaging. Br J Radiol 85:1157–1172

    Article  CAS  Google Scholar 

  18. Ollivierre CO, Nirschl RP, Pettrone FA (1995) Resection and repair for medial tennis elbow. A prospective analysis. Am J Sports Med 23:214–221

    Article  CAS  Google Scholar 

  19. Klauser AS, Pamminger MJ, Halpern EJ et al (2017) Sonoelastography of the common flexor tendon of the elbow with histologic agreement: a cadaveric study. Radiology 283:486–491

    Article  Google Scholar 

  20. Shin M, Hahn S, Yi J, Lim YJ, Bang JY (2019) Clinical application of real-time sonoelastography for evaluation of medial epicondylitis: a pilot study. Ultrasound Med Biol 45:246–254

    Article  Google Scholar 

  21. Vinod AV, Ross G (2015) An effective approach to diagnosis and surgical repair of refractory medial epicondylitis. J Shoulder Elbow Surg 24:1172–1177

    Article  Google Scholar 

  22. Park GY, Lee SM, Lee MY (2008) Diagnostic value of ultrasonography for clinical medial epicondylitis. Arch Phys Med Rehabil 89:738–742

    Article  Google Scholar 

  23. Connell D, Burke F, Coombes P et al (2001) Sonographic examination of lateral epicondylitis. AJR Am J Roentgenol 176:777–782

    Article  CAS  Google Scholar 

  24. Bodor M, Fullerton B (2010) Ultrasonography of the hand, wrist, and elbow. Phys Med Rehabil Clin N Am 21:509–531

    Article  Google Scholar 

  25. Tran N, Chow K (2007) Ultrasonography of the elbow. Semin Musculoskelet Radiol 11:105–116

    Article  Google Scholar 

  26. Krogh TP, Fredberg U, Christensen R, Stengaard-Pedersen K, Ellingsen T (2013) Ultrasonographic assessment of tendon thickness, Doppler activity and bony spurs of the elbow in patients with lateral epicondylitis and healthy subjects: a reliability and agreement study. Ultraschall Med 34:468–474

    Article  CAS  Google Scholar 

  27. Dirrichs T, Quack V, Gatz M, Tingart M, Kuhl CK, Schrading S (2016) Shear wave elastography (SWE) for the evaluation of patients with tendinopathies. Acad Radiol 23:1204–1213

    Article  Google Scholar 

  28. Zhu B, You Y, Xiang X, Wang L, Qiu L (2020) Assessment of common extensor tendon elasticity in patients with lateral epicondylitis using shear wave elastography. Quant Imaging Med Surg 10:211–219

    Article  Google Scholar 

  29. Şendur HN, Cindil E, Cerit M, Demir NB, Şendur AB, Oktar S (2019) Interobserver variability and stiffness measurements of normal common extensor tendon in healthy volunteers using shear wave elastography. Skeletal Radiol 48:137–141

    Article  Google Scholar 

  30. Yun SJ, Jin W, Cho NS et al (2019) Shear-wave and strain ultrasound elastography of the supraspinatus and infraspinatus tendons in patients with idiopathic adhesive capsulitis of the shoulder: a prospective case-control study. Korean J Radiol 20:1176–1185

    Article  Google Scholar 

  31. Drakonaki EE, Allen GM, Wilson DJ (2012) Ultrasound elastography for musculoskeletal applications. Br J Radiol 85:1435–1445

    Article  CAS  Google Scholar 

  32. Klauser AS, Miyamoto H, Bellmann-Weiler R, Feuchtner GM, Wick MC, Jaschke WR (2014) Sonoelastography: musculoskeletal applications. Radiology 272:622–633

    Article  Google Scholar 

  33. Lee MH, Cha JG, Jin W et al (2011) Utility of sonographic measurement of the common tensor tendon in patients with lateral epicondylitis. AJR Am J Roentgenol 196:1363–1367

    Article  Google Scholar 

  34. Mulabecirovic A, Vesterhus M, Gilja OH, Havre RF (2016) In vitro comparison of five different elastography systems for clinical applications, using strain and shear wave technology. Ultrasound Med Biol 42:2572–2588

    Article  Google Scholar 

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Acknowledgements

This work was supported by the 2019 Inje University research grant.

Funding

This work was supported by the 2019 Inje University research grant.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea

    Jin-Young Bang

  2. Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea

    Seok Hahn, Jisook Yi, Yun-jung Lim & Hyun Kyung Jung

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Correspondence to Seok Hahn.

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The scientific guarantor of this publication is Seok Hahn.

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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.

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Bang, JY., Hahn, S., Yi, J. et al. Clinical applicability of shear wave elastography for the evaluation of medial epicondylitis. Eur Radiol 31, 6726–6735 (2021). https://doi.org/10.1007/s00330-021-07791-3

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  • DOI: https://doi.org/10.1007/s00330-021-07791-3

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