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European Radiology

, Volume 27, Issue 8, pp 3460–3466 | Cite as

Extensor tendinopathy of the elbow assessed with sonoelastography: histologic correlation

  • Andrea S. Klauser
  • Mathias Pamminger
  • Ethan J. Halpern
  • Mohamed M. H. Abd EllahEmail author
  • Bernhard Moriggl
  • Mihra S. Taljanovic
  • Christian Deml
  • Judit Sztankay
  • Guenther Klima
  • Werner R. Jaschke
Musculoskeletal

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.

Keywords

Sonoelastography Epicondylitis Ultrasound Tendinosis Histology 

Abbreviations

LE

Lateral epicondylitis

SEL

Sonoelastography

US

Ultrasound

MSK

Musculoskeletal

B-mode US

B-mode ultrasound

ROI

Region of interest

Notes

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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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Andrea S. Klauser
    • 1
  • Mathias Pamminger
    • 1
  • Ethan J. Halpern
    • 2
  • Mohamed M. H. Abd Ellah
    • 1
    • 3
    Email author
  • Bernhard Moriggl
    • 4
  • Mihra S. Taljanovic
    • 5
  • Christian Deml
    • 6
  • Judit Sztankay
    • 7
  • Guenther Klima
    • 8
  • Werner R. Jaschke
    • 1
  1. 1.Department of RadiologyMedical University of InnsbruckInnsbruckAustria
  2. 2.Department of Radiology and Urology, Jefferson Prostate Diagnostic and Kimmel Cancer CenterThomas Jefferson UniversityPhiladelphiaUSA
  3. 3.Department of Diagnostic Radiology, South Egypt Cancer InstituteAssiut UniversityAssiutEgypt
  4. 4.Department of AnatomyMedical University of InnsbruckInnsbruckAustria
  5. 5.Department of Medical ImagingBanner- University Medical CenterTucsonUSA
  6. 6.Department of Trauma SurgeryMedical University of InnsbruckInnsbruckAustria
  7. 7.Department of RadiotherapyMedical University of InnsbruckInnsbruckAustria
  8. 8.Department of Histology & EmbryologyMedical University of InnsbruckInnsbruckAustria

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