European Radiology

, Volume 28, Issue 7, pp 2830–2837 | Cite as

Shear-wave elastography can evaluate annulus fibrosus alteration in adolescent scoliosis

  • Tristan LanglaisEmail author
  • Claudio Vergari
  • Raphael Pietton
  • Jean Dubousset
  • Wafa Skalli
  • Raphael Vialle



In vitro studies showed that annulus fibrosus lose its integrity in idiopathic scoliosis. Shear-wave ultrasound elastography can be used for non-invasive measurement of shear-wave speed (SWS) in vivo in the annulus fibrosus, a parameter related to its mechanical properties. The main aim was to assess SWS in lumbar annulus fibrosus of scoliotic adolescents and compare it to healthy subjects.


SWS was measured in 180 lumbar IVDs (L3L4, L4L5, L5S1) of 30 healthy adolescents (13 ± 1.9 years old) and 30 adolescent idiopathic scoliosis patients (13 ± 2 years old, Cobb angle: 28.8° ± 10.4°). SWS was compared between the scoliosis and healthy control groups.


In healthy subjects, average SWS (all disc levels pooled) was 3.0 ± 0.3 m/s, whereas in scoliotic patients it was significantly higher at 3.5 ± 0.3 m/s (p = 0.0004; Mann-Whitney test). Differences were also significant at all disc levels. No difference was observed between males and females. No correlation was found with age, weight and height.


Non-invasive shear-wave ultrasound is a novel method of assessment to quantitative alteration of annulus fibrosus. These preliminary results are promising for considering shear-wave elastography as a biomechanical marker for assessment of idiopathic scoliosis.

Key Points

Adolescent idiopathic scoliosis may have an altered lumbar annulus fibrosus.

Shear-wave elastography can quantify lumbar annulus fibrosus mechanical properties.

Shear-wave speed was higher in scoliotic annulus than in healthy subjects.

Elastography showed potential as a biomechanical marker for characterizing disc alteration.


Scoliosis Paediatrics Spine Elasticity imaging techniques Annulus fibrosus 



Annulus Fibrosus


Intervertebral Disc


Magnetic Resonance Imaging


Shear-Wave Speed



This study has received funding by the ParisTech BiomecAM chair program on subject-specific muskuloskeletal modelling for funding (with the support of ParisTech and Yves Cotrel Foundations, Société Générale, Proteor and Covea). The authors are also grateful to SOFCOT and DHU MAMUTH for funding and technical support. We would also like to thank Ms. Sonia Simoes, Ms. Marion Langlais and Trousseau’s hospital fellowship for their technical help.

Compliance with ethical standards


The scientific guarantor of this publication is Wafa Skalli.

Conflict of interest

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.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from parents of all minor subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in national congress.


• Prospective

• Diagnostic or prognostic study

• Performed at one institution


  1. 1.
    Coonrad RW, Murrell GA, Motley G et al (1998) A logical coronal pattern classification of 2,000 consecutive idiopathic scoliosis cases based on the scoliosis research society-defined apical vertebra. Spine 23:1380–1391CrossRefPubMedGoogle Scholar
  2. 2.
    Lonstein JE (1994) Adolescent idiopathic scoliosis. Lancet Lond Engl 344:1407–1412CrossRefGoogle Scholar
  3. 3.
    Kouwenhoven J-WM, Castelein RM (2008) The pathogenesis of adolescent idiopathic scoliosis: review of the literature. Spine 33:2898–2908CrossRefPubMedGoogle Scholar
  4. 4.
    Altaf F, Gibson A, Dannawi Z, Noordeen H (2013) Adolescent idiopathic scoliosis. BMJ 346:f2508CrossRefPubMedGoogle Scholar
  5. 5.
    Skalli W, Vergari C, Ebermeyer E et al (2016) Early detection of progressive adolescent idiopathic Scoliosis: a severity index. Spine.
  6. 6.
    Duval-Beaupère G (1992) Rib hump and supine angle as prognostic factors for mild scoliosis. Spine 17:103–107CrossRefPubMedGoogle Scholar
  7. 7.
    Duval-Beaupere G (1996) Threshold values for supine and standing Cobb angles and rib hump measurements: prognostic factors for scoliosis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 5:79–84CrossRefGoogle Scholar
  8. 8.
    Shi L, Wang D, Driscoll M et al (2011) Biomechanical analysis and modeling of different vertebral growth patterns in adolescent idiopathic scoliosis and healthy subjects. Scoliosis 6:11CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Nault M-L, Mac-Thiong J-M, Roy-Beaudry M et al (2014) Three-dimensional spinal morphology can differentiate between progressive and nonprogressive patients with adolescent idiopathic scoliosis at the initial presentation: a prospective study. Spine 39:E601–E606CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Nault M-L, Mac-Thiong J-M, Roy-Beaudry M et al (2014) Three-dimensional spinal morphology can differentiate between progressive and non-progressive patients with adolescent idiopathic scoliosis at the initial presentation. Spine.
  11. 11.
    Modi HN, Suh SW, Song H-R et al (2008) Differential wedging of vertebral body and intervertebral disc in thoracic and lumbar spine in adolescent idiopathic scoliosis - a cross sectional study in 150 patients. Scoliosis 3:11CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Stokes IA, Spence H, Aronsson DD, Kilmer N (1996) Mechanical modulation of vertebral body growth. Implications for scoliosis progression. Spine 21:1162–1167CrossRefPubMedGoogle Scholar
  13. 13.
    Drevelle X, Lafon Y, Ebermeyer E et al (2010) Analysis of idiopathic scoliosis progression by using numerical simulation. Spine 35:E407–E412CrossRefPubMedGoogle Scholar
  14. 14.
    Yu J, Fairbank JCT, Roberts S, Urban JPG (2005) The elastic fiber network of the anulus fibrosus of the normal and scoliotic human intervertebral disc. Spine 30:1815–1820CrossRefPubMedGoogle Scholar
  15. 15.
    Schlösser TPC, van Stralen M, Brink RC et al (2014) Three-dimensional characterization of torsion and asymmetry of the intervertebral discs versus vertebral bodies in adolescent idiopathic scoliosis. Spine 39:E1159–E1166CrossRefPubMedGoogle Scholar
  16. 16.
    Walter BA, Mageswaran P, Mo X et al (2017) MR elastography-derived stiffness: a biomarker for intervertebral disc degeneration. Radiology 162287.
  17. 17.
    Deviren V, Berven S, Kleinstueck F et al (2002) Predictors of flexibility and pain patterns in thoracolumbar and lumbar idiopathic scoliosis. Spine 27:2346–2349CrossRefPubMedGoogle Scholar
  18. 18.
    Gennisson J-L, Deffieux T, Fink M, Tanter M (2013) Ultrasound elastography: principles and techniques. Diagn Interv Imaging 94:487–495CrossRefPubMedGoogle Scholar
  19. 19.
    Cong R, Li J, Guo S (2017) A new qualitative pattern classification of shear wave elastograghy for solid breast mass evaluation. Eur J Radiol 87:111–119CrossRefPubMedGoogle Scholar
  20. 20.
    Yoon HM, Kim SY, Kim KM et al (2017) Liver stiffness measured by shear-wave elastography for evaluating intra-hepatic portal hypertension in children. J Pediatr Gastroenterol Nutr.
  21. 21.
    Rouvière O, Melodelima C, Hoang Dinh A et al (2016) Stiffness of benign and malignant prostate tissue measured by shear-wave elastography: a preliminary study. Eur Radiol.
  22. 22.
    Moreau B, Vergari C, Gad H et al (2016) Non-invasive assessment of human multifidus muscle stiffness using ultrasound shear wave elastography: a feasibility study. Proc Inst Mech Eng [H] 230:809–814CrossRefGoogle Scholar
  23. 23.
    Vergari C, Rouch P, Dubois G et al (2014) Intervertebral disc characterization by shear wave elastography: an in vitro preliminary study. Proc Inst Mech Eng [H] 228:607–615CrossRefGoogle Scholar
  24. 24.
    Vergari C, Rouch P, Dubois G et al (2014) Non-invasive biomechanical characterization of intervertebral discs by shear wave ultrasound elastography: a feasibility study. Eur Radiol 24:3210–3216CrossRefPubMedGoogle Scholar
  25. 25.
    Vergari C, Dubois G, Vialle R et al (2015) Lumbar annulus fibrosus biomechanical characterization in healthy children by ultrasound shear wave elastography. Eur Radiol.
  26. 26.
    Pruijs JE, Hageman MA, Keessen W et al (1994) Variation in Cobb angle measurements in scoliosis. Skeletal Radiol 23:517–520CrossRefPubMedGoogle Scholar
  27. 27.
    Deswal A, Tamang BK, Bala A (2014) Study of aortic- common iliac bifurcation and its clinical significance. J Clin Diagn Res JCDR 8:AC06–AC08PubMedGoogle Scholar
  28. 28.
    Dubousset J, Charpak G, Dorion I et al (2005) A new 2D and 3D imaging approach to musculoskeletal physiology and pathology with low-dose radiation and the standing position: the EOS system. Bull Acad Natl Med 189:287–297PubMedGoogle Scholar
  29. 29.
    Humbert L, De Guise JA, Aubert B et al (2009) 3D reconstruction of the spine from biplanar X- rays using parametric models based on transversal and longitudinal inferences. Med Eng Phys 31:681–687CrossRefPubMedGoogle Scholar
  30. 30.
    Risser JC (1958) The Iliac apophysis; an invaluable sign in the management of scoliosis. Clin Orthop 11:111–119PubMedGoogle Scholar
  31. 31.
    Huber M, Gilbert G, Roy J et al (2016) Sensitivity of MRI parameters within intervertebral discs to the severity of adolescent idiopathic scoliosis. J Magn Reson Imaging JMRI 44:1123–1131CrossRefPubMedGoogle Scholar
  32. 32.
    Cortes DH, Magland JF, Wright AC, Elliott DM (2014) The shear modulus of the nucleus pulposus measured using magnetic resonance elastography: a potential biomarker for intervertebral disc degeneration. Magn Reson Med 72:211–219CrossRefPubMedGoogle Scholar
  33. 33.
    Ben-Abraham EI, Chen J, Felmlee JP et al (2015) Feasibility of MR elastography of the intervertebral disc. Magn Reson Imaging.
  34. 34.
    Yu J, Winlove PC, Roberts S, Urban JPG (2002) Elastic fibre organization in the intervertebral discs of the bovine tail. J Anat 201:465–475CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Kobielarz M, Szotek S, Głowacki M et al (2016) Qualitative and quantitative assessment of collagen and elastin in annulus fibrosus of the physiologic and scoliotic intervertebral discs. J Mech Behav Biomed Mater 62:45–56CrossRefPubMedGoogle Scholar
  36. 36.
    Hirsch C, Ilharreborde B, Mazda K (2016) Flexibility analysis in adolescent idiopathic scoliosis on side-bending images using the EOS imaging system. Orthop Traumatol Surg Res 102:495–500CrossRefPubMedGoogle Scholar
  37. 37.
    Ilharreborde B, Ferrero E, Angelliaume A et al (2017) Selective versus hyperselective posterior fusions in Lenke 5 adolescent idiopathic scoliosis: comparison of radiological and clinical outcomes. Eur Spine J.
  38. 38.
    Perie D, De Gauzy JS, Sevely A, Hobatho MC (2002) CTM brace effect on scoliotic intervertebral discs using MRI method. Stud Health Technol Inform 88:230–234PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department for Innovative Therapies in Musculoskeletal Diseases, DHU MAMUTH - Department of Pediatric OrthopaedicArmand Trousseau HospitalParis Cedex 12France
  2. 2.Arts et Metiers ParisTechLBM/Institut de Biomécanique Humaine Georges CharpakParisFrance

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