Skip to main content
SpringerLink
Log in

Quantification of sonographic echogenicity by the gray-level histogram in patients with supraspinatus tendinopathy

  • Original Article
  • Published:
Journal of Medical Ultrasonics Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to compare the gray-level value of the supraspinatus tendon of a painful shoulder with that of a normal shoulder measured by ultrasonography, and to investigate whether a low mean gray-level value of the supraspinatus tendon could indicate a partial-thickness or incomplete full-thickness tear.

Methods

Two hundred and ten patients had significant unilateral shoulder pain with the clinical suspicion of rotator cuff tendinopathy. They underwent bilateral shoulder ultrasonography, and the mean echogenicity of the histogram was calculated on the screen. The mean gray-level value of each patient’s contralateral asymptomatic shoulder was compared with that of the painful shoulder.

Results

Based on the scan of transverse and longitudinal planes, a significant difference existed between the symptomatic shoulder and contralateral asymptomatic shoulder (p < 0.0001). The mean gray-level values of symptomatic shoulders showed no statistically significant difference between the patients who underwent surgery and the patients who underwent conservative treatment.

Conclusions

We demonstrated that the ultrasound gray-level histogram is a promising tool for detecting the hypoechogenic appearance of supraspinatus tendinopathy. A decrease in the mean gray-level value on the symptomatic shoulder may be used as an alternative sonographic indicator of rotator cuff partial-thickness tear or tendinopathy.

Level of evidence

Diagnostic level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Sipola P, Niemitukia L, Kroger H, et al. Detection and quantification of rotator cuff tears with untrasonography and magnetic resonance imaging - a prospective study in 77 consecutive patients with a surgical reference. Ultrasound Med Biol. 2010;36:1981–9.

    Article  PubMed  Google Scholar 

  2. Finnoff JT, Smith J, Peck ER. Ultrasonography of the shoulder. Phys Med Rehabil Clin N Am. 2010;21:481–507.

    Article  PubMed  Google Scholar 

  3. Smith TO, Back T, Toms AP, et al. Diagnostic accuracy of ultrasound for rotator cuff tear in adult: a systematic review and meta-analysis. Clin Radiol. 2011;66:1036–48.

    Article  CAS  PubMed  Google Scholar 

  4. Ziegler DW. Orthopedic perspectives of musculoskeletal ultrasound. Phys Med Rehabil Clin N Am. 2010;21:631–44.

    Article  PubMed  Google Scholar 

  5. Ottenheijm RP, Jansen MJ, Staal JB, et al. Accuracy of diagnostic ultrasound in patients with suspected subacromial disorders: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2010;91:1616–25.

    Article  PubMed  Google Scholar 

  6. Kelly AM, Fessell D. Ultrasound compared with magnetic resonance imaging for the diagnosis of rotator cuff tears: a critically appraised topic. Semin Roentgenol. 2009;3:196–200.

    Article  Google Scholar 

  7. Tsai YH, Huang TJ, Hsu WH, et al. Detection of subacromial bursa thickening by sonography in shoulder impingement syndrome. Chang Gung Med J. 2007;30:135–41.

    PubMed  Google Scholar 

  8. Fotiadou AN, Vlychou M, Papadopoulos P, et al. Ultrasonography of symptomatic rotator cuff tears compared with MRI imaging and surgery. Eur J Radiol. 2008;68:174–9.

    Article  PubMed  Google Scholar 

  9. Neer CS II. Impingements syndrome. Clin Orthop. 1983;173:70–7.

    PubMed  Google Scholar 

  10. Maeda K, Utsu M, Kihaile PE. Quantificaion of sonographic echogenicity with grey-level hostogram width: a clinical tissue characterization. Ultrasound Med Biol. 1998;24:225–34.

    Article  CAS  PubMed  Google Scholar 

  11. Ito T, Ishihara K, Deura I, et al. Tissue characterization of uterine myometrium using the ultrasound gray-level histogram width. J Med Ultrasonics. 2007;34:189–92.

    Article  Google Scholar 

  12. Maeda K, Ulsu M, Yamamoto N, et al. Echogenicity of fetal lung and liver quantified by the grey-level histogram width. Ultrasound Med Biol. 1999;25:201–8.

    Article  CAS  PubMed  Google Scholar 

  13. Serizawa M, Maeda K. Noninvasive fetal lung maturity prediction based on ultrasonic gray-level histogram width. Ultrasound Med Biol. 2010;36:1998–2003.

    Article  PubMed  Google Scholar 

  14. Collinger JL, Gagnon D, Jacobson J, et al. Reliability of quantitative ultrasound measures of the biceps and supraspinatus tendon. Acad Radiol. 2009;16:1424–32.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Yu TY, Tsai WC, Cheng JW, et al. The effects of aging on quantitative sonographic features of rotator cuff tendons. J Clin Ultrasound. 2012;40:471–8.

    Article  PubMed  Google Scholar 

  16. Van Schie JTM, Bakker EM, van Weeren PR. Ultrasonographic evaluation of equine tendons: a quantitative in vitro study of the effects of amplifier gain level, transducer-tilt, and transducer-displacement. Vet Radiol Ultrasound. 1999;40:151–60.

    Article  PubMed  Google Scholar 

  17. Van Schie JTM, Bakker EM, Jonker AM, et al. Ultrasonographic tissue characterization of equine superificial digital flexor tendons by means of graylevel statistics. Am J Vet Res. 2000;61:202–9.

    Article  PubMed  Google Scholar 

  18. Van Schie JTM, Bakker EM, Jonker AM, et al. Computerized ultrasonographic tissue characterization of equine superifical digital flexor tendons by means of stability quantification of echo patterns in contiguous transverse ultrasonographic images. Am J Vet Res. 2003;64:366–75.

    Article  PubMed  Google Scholar 

  19. Yang X, Tridandapani S, Beitler JJ, et al. Ultrasound histogram assessment of parotid gland injury following head-and neck radiotherapy: a feasibility study. Ultrasound Med Biol. 2012;38:1514–21.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Lee CH, Choi JW, Kim KA, et al. Usefulness of standard deviation on the histogram of ultrasound as a quantitative value for hepatic parenchymal echo texture; preliminary study. Ultrasound Med Biol. 2006;32:1817–26.

    Article  PubMed  Google Scholar 

  21. Al-Took S, Watkin K, Tulandi T, et al. Ovarian stromal echogenicity in women with clomiphene citrate-sensitive and clomiphene citrate-resistant polycystic ovary syndrome. Fertil Steril. 1999;71:952–4.

    Article  CAS  PubMed  Google Scholar 

  22. Pillan S, Verrips A, van Alfen N, et al. Quantitative skeletal muscle ultrasound: diagnostic value in childhood neuromuscular disease. Neuromuscul Disord. 2007;17:509–16.

    Article  Google Scholar 

  23. Pillen S, Tak RO, Zwart MJ, et al. Skeletal muscle ultrasound: correlation between fibrous tissue and echo intensity. Ultrasound Med Biol. 2009;35:443–6.

    Article  PubMed  Google Scholar 

  24. Verhulst FV, Leeuwesteijn AEEPM, Louwerens JWK, et al. Quantitative ultrasound of low leg and foot muscles: feasibility and reference values. Foot Ankle Surg. 2011;17:145–9.

    Article  CAS  PubMed  Google Scholar 

  25. Nielsen PK, Jensen BR, Darvann T, et al. Quantitative ultrasound tissue characterization in shoulder and thigh muscles—a new approach. BMC Musculoskel Disord. 2006;7:2.

    Article  Google Scholar 

  26. Horng MH, Chen SM. Multi-class classification of ultrasonic supraspinatus images based on radial basis function neural network. J Med Biol Eng. 2009;29:242–50.

    Google Scholar 

  27. Lewis JS, Raza SA, Pilcher J, et al. The prevalence of neovascularity in patients clinically diagnosed with rotator cuff tendinopathy. BMC Musculoskel Disord. 2009;10:163.

    Article  Google Scholar 

  28. Bianchi S, Martinoli C. Ultrasound of the musculoskeletal system. New York: Springer; 2007.

    Google Scholar 

  29. Wolff AB, Sethi P, Sutton KM, et al. Partial-thickness rotator cuff tears. J Am Acad Orthop Surg. 2006;14:715–25.

    PubMed  Google Scholar 

  30. Iagnocco A, Filippucci E, Sakellariou G, et al. Ultrasound imaging for the rheumatologist XLIV. Ultrasound of the shoulder in healthy individuals. Clin Exp Rheumatol. 2013;31:165–71.

    PubMed  Google Scholar 

Download references

Conflict of interest

There are no financial or other relations that could lead to a conflict of interest.

Ethical standards

This retrospective study was approved by the Ethics Committee and institutional review board of Chang Gung Memorial Hospital (97-1302B).

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chia-Yi, No. 6, West Sec, Chia-Pu Road, Putz, Cha-I, 613, Taiwan, ROC

    Yao-Hung Tsai, Kuo-Chin Huang, Shih-Hsun Shen, Tien-Yu Yang & Robert Wen-Wei Hsu

  2. College of Medicine, Chang Gung University at Taoyuan, Taoyuan, Taiwan, ROC

    Yao-Hung Tsai, Kuo-Chin Huang, Shih-Hsun Shen, Tien-Yu Yang, Tsung-Jen Huang & Robert Wen-Wei Hsu

  3. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan, ROC

    Tsung-Jen Huang

Authors
  1. Yao-Hung Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kuo-Chin Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shih-Hsun Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tien-Yu Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tsung-Jen Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert Wen-Wei Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yao-Hung Tsai.

About this article

Cite this article

Tsai, YH., Huang, KC., Shen, SH. et al. Quantification of sonographic echogenicity by the gray-level histogram in patients with supraspinatus tendinopathy. J Med Ultrasonics 41, 343–349 (2014). https://doi.org/10.1007/s10396-013-0516-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10396-013-0516-6

Keywords

Search

Navigation