Abstract
Diagnostic ultrasound techniques used in the evaluation of the musculoskeletal system are rapidly evolving. Conventional B-mode and Doppler ultrasound imaging methods are workhorses in the diagnosis and treatment decision making for traumatic and pathologic conditions of joints, tendons, muscles, ligaments, and peripheral nerves. Recently developed sonoelastography techniques enable the qualitative and quantitative evaluation of the material properties of musculoskeletal tissues . The recent availability of sonoelastography on clinical machines will facilitate its progressive utilization in routine clinical practice. Exciting new developments in ultrasound imaging enable real-time fusion with imported magnetic resonance or computed tomography images, facilitating ultrasound-guided interventional procedures and teaching of ultrasound anatomy to trainees. In this review article, the authors discuss new advances in sonoelastography of the lower extremity with emphasis on shear wave imaging and briefly the exciting features of ultrasound fusion imaging with computed tomography and magnetic resonance imaging.
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References
Recently published papers of particular interest have been highlighted as: • Of importance
Jacobson JA. Musculoskeletal ultrasound: focused impact on MRI. Am J Roentgenol. 2009;193(3):619–27.
Bracken J, Ditchfield M. Ultrasonography in developmental dysplasia of the hip: what have we learned? Pediatr Radiol. 2012;42(12):1418–31. doi:10.1007/s00247-012-2429-8.
Royall NA, Farrin E, Bahner DP, Stawicki SP. Ultrasound-assisted musculoskeletal procedures: a practical overview of current literature. World J Orthop. 2011;2(7):57–66. doi:10.5312/wjo.v2.i7.
Robotti G, Canepa MG, Bortolotto C, Draghi F. Interventional musculoskeletal US: an update on materials and methods. J Ultrasound. 2013;16(2):45–55. doi:10.1007/s40477-013-0018-9.
James SL, Ali K, Pocock C, Robertson C, Walter J, Bell J, et al. Ultrasound guided dry needling and autologous blood injection for patellar tendinosis. Br J Sports Med. 2007;41(8):518–21 (discussion 522).
de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010;303(2):144–9.
Lee KS, Rosas HG, Phancao JP. Snapping hip: imaging and treatment. Semin Musculoskelet Radiol. 2013;17(3):286–94. doi:10.1055/s-0033-1348095.
Lewis CL. Extra-articular snapping hip: a literature review. Sports Health. 2010;2(3):186–90.
Garbuz DS, Hargreaves BA, Duncan CP, Masri BA, Wilson DR, Forster BB. The John Charnley award: diagnostic accuracy of MRI versus ultrasound for detecting pseudotumors in asymptomatic metal-on-metal THA. Clin Orthop Relat Res. 2014;472(2):417–23. doi:10.1007/s11999-013-3181-6.
Nishii T, Sakai T, Takao M, Yoshikawa H, Sugano N. Ultrasound screening of periarticular soft tissue abnormality around metal-on-metal bearings. J Arthroplast. 2012;27(6):895–900. doi:10.1016/j.arth.2011.09.015.
Teh J. Applications of Doppler imaging in the musculoskeletal system. Curr Probl Diagn Radiol. 2006;35(1):22–34.
Klauser AS, Miyamoto H, Bellmann-Weiler R, Feuchtner GM, Wick MC, Jaschke WR. Sonoelastography: musculoskeletal applications. Radiology. 2014;272(3):622–33. doi:10.1148/radiol.14121765.
Drakonaki EE, Allen GM, Wilson DJ. Ultrasound elastography for musculoskeletal applications. Br J Radiol. 2012;85(1019):1435–45. doi:10.1259/bjr/93042867.
Ophir J, Céspedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991;13(2):111–34.
Ponnekanti H, Ophir J, Huang Y, Céspedes I. Fundamental mechanical limitations on the visualization of elasticity contrast in elastography. Ultrasound Med Biol. 1995;21(4):533–43.
Ophir J, Alam SK, Garra BS, et al. Elastography: imaging the elastic properties of soft tissues with ultrasound. J Med Ultrason. 2002;29(4):155–71.
Klauser AS, Tagliafico A, Allen GM, et al. Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology. Eur Radiol. 2012;22(5):1140–8.
Klauser AS, Faschingbauer R, Jaschke WR. Is sonoelastography of value in assessing tendons? Semin Musculoskelet Radiol. 2010;14(3):323–33.
• Gao L, Yuan JS, Heden GJ, Szivek JA, Taljanovic MS, Latt LD, Witte RS. Ultrasound elasticity imaging for determining the mechanical properties of human posterior tibial tendon: a cadaveric study. IEEE Trans Biomed Eng. 2014. doi:10.1109/TBME.2014.2381002. The authors measure Young’s modulus of 5 human cadaveric posterior tibial tendons using tension elastography. Although this technique is not yet commercially available, it holds great promise as a new functional imaging test of tendon, which may help guide treatment for degenerative disease of tendons.
Bercoff J, Tanter M, Fink M. Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control. 2004;51(4):396–409.
Li Y, Snedeker JG. Elastography: modality-specific approaches, clinical applications, and research horizons. Skelet Radiol. 2011;40(4):389–97. doi:10.1007/s00256-010-0918-0.
De Zordo T, Chhem R, Smekal V, Feuchtner G, Reindl M, Fink C, Faschingbauer R, Jaschke W, Klauser AS. Real-time sonoelastography: findings in patients with symptomatic achilles tendons and comparison to healthy volunteers. Ultraschall Med. 2010;31(4):394–400. doi:10.1055/s-0028-1109809.
De Zordo T, Fink C, Feuchtner GM, Smekal V, Reindl M, Klauser AS. Real-time sonoelastography findings in healthy Achilles tendons. Am J Roentgenol. 2009;193(2):W134–8. doi:10.2214/AJR.08.1843.
Drakonaki EE, Allen GM, Wilson DJ. Real-time ultrasound elastography of the normal Achilles tendon: reproducibility and pattern description. Clin Radiol. 2009;64(12):1196–202. doi:10.1016/j.crad.2009.08.006.
Tan S, Kudaş S, Özcan AS, İpek A, Karaoğlanoğlu M, Arslan H, Bozkurt M. Real-time sonoelastography of the Achilles tendon: pattern description in healthy subjects and patients with surgically repaired complete ruptures. Skelet Radiol. 2012;41(9):1067–72. doi:10.1007/s00256-011-1339-4.
Klauser AS, Miyamoto H, Tamegger M, et al. Achilles tendon assessed with sonoelastography: histologic agreement. Radiology. 2013;267(3):837–42.
Rist HJ, Mauch M. Quantified TDI elastography of the patellar tendon in athletes (in German). Sportverletz Sportschaden. 2012;26(1):27–32.
Wu CH, Chang KV, Mio S, Chen WS, Wang TG. Sonoelastography of the plantar fascia. Radiology. 2011;259(2):502–7.
Drakonaki EE, Allen GM. Magnetic resonance imaging, ultrasound and real-time ultrasound elastography of the thigh muscles in congenital muscle dystrophy. Skelet Radiol. 2010;39(4):391–6.
Vasilescu D, Vasilescu D, Dudea S, BotarJid C, Sfrângeu S, Cosma D. Sonoelastography contribution in cerebral palsy spasticity treatment assessment, preliminary report: a systematic review of the literature apropos of seven patients. Med Ultrasound. 2010;12(4):306–10.
Cantisani V, Orsogna N, Porfiri A, Fioravanti C, D’Ambrosio F. Elastographic and contrast-enhanced ultrasound features of a benign schwannoma of the common fibular nerve. J Ultrasound. 2013;16(3):135–8. doi:10.1007/s40477-013-0027-8.
Arda K, Ciledag N, Aktas E, Aribas BK, Köse K. Quantitative assessment of normal soft-tissue elasticity using shear-wave ultrasound elastography. Am J Roentgenol. 2011;197(3):532–6.
• DeWall RJ, Slane LC, Lee KS, Thelen DG. Spatial variations in Achilles tendon shear wave speed. J Biomech. 2014;47(11):2685–2692. doi: 10.1016/j.jbiomech.2014.05.008. The results of this study showed that shear wave speed is closely linked to the spatial position along the Achilles tendon, varies between the medial and lateral sides, and depends directly on ankle posture. These observations demonstrated the critical importance of considering both spatial location and posture when using SWE for biomechanical or clinical evaluations of the Achilles tendon.
Chen XM, Cui LG, He P, Shen WW, Qian YJ, Wang JR. Shear wave elastographic characterization of normal and torn achilles tendons: a pilot study. J Ultrasound Med. 2013;32(3):449–55.
Aubry S, Nueffer JP, Tanter M, Becce F, Vidal C, Michel F. Viscoelasticity in achilles tendonopathy: quantitative assessment by using real-time shear-wave elastography. Radiology. 2015;274(3):821–9. doi:10.1148/radiol.14140434.
Zhang ZJ, Ng GY, Lee WC, Fu SN. Changes in morphological and elastic properties of patellar tendon in athletes with unilateral patellar tendinopathy and their relationships with pain and functional disability. PLoS One. 2014;9(10):e108337. doi:10.1371/journal.pone.0108337.
Shinohara M, Sabra K, Gennisson JL, Fink M, Tanter M. Real-time visualization of muscle stiffness distribution with ultrasound shear wave imaging during muscle contraction. Muscle Nerve. 2010;42(3):438–41.
Wang CZ, Li TJ, Zheng YP. Shear modulus estimation on vastus intermedius of elderly and young females over the entire range of isometric contraction. PLoS One. 2014;9(7):e101769. doi:10.1371/journal.pone.0101769.
• Lacourpaille L, Hug F, Guével A, Péréon Y, Magot A, Hogrel JY, Nordez A. Non-invasive assessment of muscle stiffness in patients with duchenne muscular dystrophy. Muscle Nerve. 2014. doi: 10.1002/mus.24445. The study revealed significantly higher stiffness in DMD patients compared to controls for all the muscles suggesting that SWE is a sensitive non-invasive technique to assess the increase in muscle stiffness associated with DMD.
Kantarci F, Ustabasioglu FE, Delil S, Olgun DC, Korkmazer B, Dikici AS, Tutar O, Nalbantoglu M, Uzun N, Mihmanli I. Median nerve stiffness measurement by shear wave elastography: a potential sonographic method in the diagnosis of carpal tunnel syndrome. Eur Radiol. 2014;24(2):434–40. doi:10.1007/s00330-013-3023-7.
Palmeri ML, Dahl JJ, MacLeod DB, Grant SA, Nightingale KR. On the feasibility of imaging peripheral nerves using acoustic radiation force impulse imaging. Ultrason Imaging. 2009;31(3):172–82.
Aubry S, Risson JR, Barbier-Brion B, Tatu L, Vidal C, Kastler B. Transient elastography of calcaneal tendon: preliminary results and future prospects (in French). J Radiol. 2011;92(5):421–7.
Nordez A, Gennisson JL, Casari P, Catheline S, Cornu C. Characterization of muscle belly elastic properties during passive stretching using transient elastography. J Biomech. 2008;41(10):2305–11.
Klauser AS, De Zordo T, Feuchtner GM, Djedovic G, Weiler RB, Faschingbauer R, Schirmer M, Moriggl B. Fusion of real-time US with CT images to guide sacroiliac joint injection in vitro and in vivo. Radiology. 2010;256(2):547–53. doi:10.1148/radiol.10090968.
• Vollman A, Hulen R, Dulchavsky S, Pinchcofsky H, Amponsah D, Jacobsen G, Dulchavsky A, van Holsbeeck M. Educational benefits of fusing magnetic resonance imaging with sonograms. J Clin Ultrasound. 2014;42(5):257–263. doi: 10.1002/jcu.22136. The authors emphasized the value of fusion US and MR images in teaching radiology residents US anatomy.
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Taljanovic, M.S., Melville, D.M., Klauser, A.S. et al. Advances in Lower Extremity Ultrasound. Curr Radiol Rep 3, 19 (2015). https://doi.org/10.1007/s40134-015-0100-5
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DOI: https://doi.org/10.1007/s40134-015-0100-5