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2D shear wave elastography for the assessment of quadriceps entheses—a methodological study

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Skeletal Radiology Aims and scope Submit manuscript

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.

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Data availability

The datasets generated or analyzed during the study are available from the corresponding author on reasonable request.

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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

  1. Centre for Medical Imaging Studies, Faculty of Health Sciences, Universiti Teknologi MARA, 42300, Selangor, Malaysia

    Sook Sam Leong & Lyana Shahirah Mohamad Yamin

  2. Department of Biomedical Imaging, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia

    Jeannie Hsiu Ding Wong & Faizatul Izza Rozalli

  3. Department of Medicine, Faculty of Medicine, Rheumatology Unit, Universiti Malaya, 50603, Kuala Lumpur, Malaysia

    Fariz Yahya & Ying Chew Tee

  4. Department of Radiology, Faculty of Medicine, Universiti Teknologi MARA, 47000, Sungai Buloh, Malaysia

    Mazuin Mohd Razalli

  5. Department of Internal Medicine, Faculty of Medicine, Rheumatology Unit, UniversitiTeknologi MARA, 47000, Sungai Buloh, Malaysia

    Hazlyna Baharuddin

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  1. Sook Sam Leong
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  2. Jeannie Hsiu Ding Wong
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  3. Faizatul Izza Rozalli
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Correspondence to Sook Sam Leong.

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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

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  • DOI: https://doi.org/10.1007/s00256-023-04425-1

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