Abstract
Objective
To establish the scanning protocol for 2-dimensional shear wave elastography (SWE) on normal entheses by investigating the possible confounding factors that may increase the variability of measured elasticity.
Material and methods
30 normal quadriceps entheses were scanned using SWE to compare the stiffness and coefficient variation by changing the ultrasonic coupling gel thickness, knee position, region of interest size, and scanning plane.
Results
No significant difference in median shear wave velocity (SWV) was observed in different coupling gel thicknesses. The median SWV was higher in the knee flexion position than in the extended position (p < 0.001). Increased knee flexion led to stiffer quadriceps enthesis and higher SWV (ρ = 0.8, p < 0.001). The median SWV was higher when the diameter region of interest was 4.0 mm than 2.0 mm (p = 0.001). The median SWV was higher in the transverse plane than in the longitudinal plane (p < 0.001). Strong correlation was found between SWV and the degree of the shear wave to muscle fiber direction (ρ = 0.8, p < 0.001). The coefficient variation was lower in a gel thickness of 2.5 cm, with an extended knee, a region of interest of 2.0 mm, and a longitudinal plane (p > 0.05). For interobserver reliability for the proposed protocol, the intraclass correlation coefficients was 0.763.
Conclusion
In this study, we determined supine position with the knee extended; using 2.0 mm diameter region of interest and image acquisition at the longitudinal plane with thicker layer coupling gel seems most appropriate to reliably image healthy quadriceps entheses with SWE.
Similar content being viewed by others
Data availability
The datasets generated or analyzed during the study are available from the corresponding author on reasonable request.
References
Lu HH, Thomopoulos S. Functional attachment of soft tissues to bone: development, healing, and tissue engineering. Annu Rev Biomed. 2013;15:201.
Claudepierre P, Voisin M-C. The entheses: histology, pathology, and pathophysiology. Jt Bone Spine. 2005;72(1):32–7.
Zabotti A, Bandinelli F, Batticciotto A, Scire CA, Iagnocco A, Sakellariou G, et al. Musculoskeletal ultrasonography for psoriatic arthritis and psoriasis patients: a systematic literature review. Rheumatology. 2017;56(9):1518–32.
Elsherbiny DA, Habeeb RA, Rahman MAA, Mustafa HA, Hussein SA. Lower limb entheseal involvement in systemic lupus erythematosus patients: relation to disease activity. Egypt Rheumatologist. 2021;43(4):305–9.
Tang Y, Cheng S, Yang Y, Xiang X, Wang L, Zhang L, et al. Ultrasound assessment in psoriatic arthritis (PsA) and psoriasis vulgaris (non-PsA): which sites are most commonly involved and what features are more important in PsA? Quant Imaging Med Surg. 2020;10(1):86.
Eder L, Barzilai M, Peled N, Gladman DD, Zisman D. The use of ultrasound for the assessment of enthesitis in patients with spondyloarthritis. Clin Radiol. 2013;68(3):219–23.
Molina Collada J, Macía-Villa C, Plasencia C, Álvaro-Gracia JM, de Miguel E. Doppler enthesitis: a potential useful outcome in the assessment of axial spondyloarthritis and psoriatic arthritis. Clin Rheumatol. 2021;40:2013–20.
Wervers K, Vis M, Rasappu N, van der Ven M, Tchetverikov I, Kok MR, et al. Modification of a sonographic enthesitis score to differentiate between psoriatic arthritis and young healthy volunteers. Scand J Rheumatol. 2018;47(4):291–4.
Michelsen B, Diamantopoulos AP, Soldal DM, Hammer HB, Kavanaugh A, Haugeberg G. Achilles enthesitis defined by ultrasound is not associated with clinical enthesitis in patients with psoriatic arthritis. RMD Open. 2017;3(2):e000486.
Dattola A, Altobelli S, Marsico S, Plastina D, Nistico SP, Cavallo A, et al. Hypodermal adipose tissue sonoelastography for monitoring treatment response in patients with plaque psoriasis. Photomed Laser Surg. 2017;35(9):484–91.
Taljanovic MS, Gimber LH, Becker GW, Latt LD, Klauser AS, Melville DM, et al. Shear-wave elastography: basic physics and musculoskeletal applications. Radiographics : Rev Publ Radiol Soc North Am, Inc. 2017;37(3):855–70.
Heales LJ, Badya R, Ziegenfuss B, Hug F, Coombes JS, van den Hoorn W, et al. Shear-wave velocity of the patellar tendon and quadriceps muscle is increased immediately after maximal eccentric exercise. Eur J Appl Physiol. 2018;118(8):1715–24.
Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155–63.
Konar S, Bolam SM, Coleman B, Dalbeth N, McGlashan SR, Leung S, et al. Changes in physiological tendon substrate stiffness have moderate effects on tendon-derived cell growth and immune cell activation. Front Bioeng Biotechnol. 2022;10:800748.
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(4):394–400.
Moon JH, Hwang JY, Park JS, Koh SH, Park SY. Impact of region of interest (ROI) size on the diagnostic performance of shear wave elastography in differentiating solid breast lesions. Acta Radiol. 2018;59(6):657–63.
Prado-Costa R, Rebelo J, Monteiro-Barroso J, Preto AS. Ultrasound elastography: compression elastography and shear-wave elastography in the assessment of tendon injury. Insights Imaging. 2018;9(5):791–814.
Bianchi S, Martinoli C. Ultrasound of the musculoskeletal system. Springer Science & Business Media; 2007.
Xu J, Hug F, Fu SN. Stiffness of individual quadriceps muscle assessed using ultrasound shear wave elastography during passive stretching. J Sport Health Sci. 2018;7(2):245–9.
Innocenti B, Galbusera F, editors. Human Orthopaedic Biomechanics: Fundamentals, Devices and Applications. Academic Press; 2022.
Bulum A, Ivanac G, Divjak E, BiondićŠpoljar I, DžoićDominković M, Bojanić K, et al. Elastic modulus and elasticity ratio of malignant breast lesions with shear wave ultrasound elastography: variations with different region of interest and lesion size. Diagnostics. 2021;11(6):1015.
Gennisson J-L, Deffieux T, Macé E, Montaldo G, Fink M, Tanter M. Viscoelastic and anisotropic mechanical properties of in vivo muscle tissue assessed by supersonic shear imaging. Ultrasound Med Biol. 2010;36(5):789–801.
Wang X, Zhu J, Liu Y, Li W, Chen S, Zhang H. Assessment of ultrasound shear wave elastography: An animal ex-vivo study. J Appl Clin Med Phys. 2023;24(4).
Cortez CD, Hermitte L, Ramain A, Mesmann C, Lefort T, Pialat J. Ultrasound shear wave velocity in skeletal muscle: a reproducibility study. Diagn Interv Imaging. 2016;97(1):71–9.
Kot BC, Zhang ZJ, Lee AW, Leung VY, Fu SN. Elastic modulus of muscle and tendon with shear wave ultrasound elastography: variations with different technical settings. PLoS ONE. 2012;7(8).
Leong SS, Jalalonmuhali M, Md Shah MN, Ng KH, Vijayananthan A, Hisham R, et al. Ultrasound shear wave elastography for the evaluation of renal pathological changes in adult patients. Br J Radiol. 2023;96(1144):20220288.
Lee SM, Kim M-J, Yoon JH, Hong W, Ha HI, Lee K, et al. Comparison of point and 2-dimensional shear wave elastography for the evaluation of liver fibrosis. Ultrasonography. 2020;39(3):288.
Acknowledgements
The authors would like to thank the sonographer and radiographers Mohammad Khairi Jahidi Bin Mahazer, Suziela Mohamad, and Sarah Syafrina Komarul Arifin for helping in this study.
Funding
This study was supported by Research Grant MyRA Lepasan PhD 600-RMC/GPM LPHD 5/3 (067/2021) from Universiti Teknologi MARA Selangor.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Leong, S.S., Wong, J.H.D., Rozalli, F.I. et al. 2D shear wave elastography for the assessment of quadriceps entheses—a methodological study. Skeletal Radiol 53, 455–463 (2024). https://doi.org/10.1007/s00256-023-04425-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-023-04425-1