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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

References

  1. Connell D, Burke F, Coombes P et al (2001) Sonographic examination of lateral epicondylitis. AJR 176:777–82

    Article  CAS  PubMed  Google Scholar 

  2. Miller TT, Shapiro MA, Schultz E, Kalish PE (2002) Comparison of sonography and MRI for diagnosing epicondylitis.JClin. Ultrasound 30:193–202

    Google Scholar 

  3. Levin D, Nazarian LN, Miller TT et al (2005) Lateral epicondylitis of the elbow: US findings. Radiology 237:230–4

    Article  PubMed  Google Scholar 

  4. Jaen-Diaz JI, Cerezo-Lopez E, Lopez-de CF et al (2010) Sonographic findings for the common extensor tendon of the elbow in the general population. J Ultrasound Med 29:1717–24

    Article  PubMed  Google Scholar 

  5. Shiri R, Viikari-Juntura E, Varonen H, Heliovaara M (2006) Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol 164:1065–74

    Article  PubMed  Google Scholar 

  6. Walz DM, Newman JS, Konin GP, Ross G (2010) Epicondylitis: pathogenesis, imaging, and treatment. Radiographics 30:167–84

    Article  PubMed  Google Scholar 

  7. Latham SK, Smith TO (2014) The diagnostic test accuracy of ultrasound for the detection of lateral epicondylitis: a systematic review and meta-analysis. Orthop Traumatol Surg Res 100:281–6

    Article  CAS  PubMed  Google Scholar 

  8. De Zordo T, Lill SR, Fink C et al (2009) Real-time sonoelastography of lateral epicondylitis: comparison of findings between patients and healthy volunteers. AJR 193:180–5

    Article  PubMed  Google Scholar 

  9. Dones VC III, Grimmer K, Thoirs K, Suarez CG, Luker J (2014) The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review. BMC Med Imaging 14:10

    Article  PubMed  PubMed Central  Google Scholar 

  10. Havre RF, Elde E, Gilja OH et al (2008) Freehand real-time elastography: impact of scanning parameters on image quality and in vitro intra- and interobserver validations. Ultrasound Med Biol 34:1638–50

    Article  PubMed  Google Scholar 

  11. Klauser AS, Miyamoto H, Bellmann-Weiler R, Feuchtner GM, Wick MC, Jaschke WR (2014) Sonoelastography: musculoskeletal applications. Radiology 272:622–33

    Article  PubMed  Google Scholar 

  12. Klauser AS, Faschingbauer R, Jaschke WR (2010) Is sonoelastography of value in assessing tendons? Semin Musculoskelet Radiol 14:323–33

    Article  PubMed  Google Scholar 

  13. Ahn KS, Kang CH, Hong SJ, Jeong WK (2014) Ultrasound elastography of lateral epicondylosis: clinical feasibility of quantitative elastographic measurements. AJR 202:1094–9

    Article  PubMed  Google Scholar 

  14. Ooi CC, Malliaras P, Schneider ME, Connell DA (2014) “Soft, hard, or just right” applications and limitations of axial-strain sonoelastography and shear-wave elastography in the assessment of tendon injuries. Skelet Radiol 43:1–12

    Article  CAS  Google Scholar 

  15. Kocyigit F, Kuyucu E, Kocyigit A et al (2016) Association of real-time sonoelastography findings with clinical parameters in lateral epicondylitis. Rheumatol Int 36:91–100

    Article  PubMed  Google Scholar 

  16. Klauser AS, Miyamoto H, Tamegger M et al (2013) Achilles tendon assessed with sonoelastography: histologic agreement. Radiology 267:837–42

    Article  PubMed  Google Scholar 

  17. Miyamoto H, Halpern EJ, Kastlunger M et al (2014) Carpal tunnel syndrome: diagnosis by means of median nerve elasticity--improved diagnostic accuracy of US with sonoelastography. Radiology 270:481–6

    Article  PubMed  Google Scholar 

  18. Giyoung P, Dongrak K, Junghyun P (2014) Diagnostic confidence of sonoelastography as adjunct to greyscale ultrasonography in lateral elbow tendinopathy. Chin Med J 127:3110–5

    Google Scholar 

  19. Khoury V, Cardinal É (2009) “Tenomalacia”: a new sonographic sign of tendinopathy? Eur Radiol 19:144–6

    Article  PubMed  Google Scholar 

  20. 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 278:465–74

    Article  PubMed  Google Scholar 

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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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  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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