Is Sonoelastography of Value in Assessing Tendons?

ABSTRACT

Sonoelastography is a newly introduced ultrasound technique that evaluates tissue elasticity and thus provides additional information to that offered by conventional ultrasound images. In the musculoskeletal field, sonoelastography can help improve estimation of tendon stiffness.

In this article, the principles and future developments of sonoelastography are discussed using the strongest and thickest tendon of the human body, the Achilles tendon, for illustrative purposes. Preliminary findings of sonoelastography in healthy and pathological Achilles tendons, technical considerations, examination technique and several limitations are addressed.

The usefulness of elastography can be expected to increase rapidly in the musculoskeletal field, as soon as we learn to interpret elastographic artifacts as well as to take advantage of the new information provided by sonoelastography.

KEYWORDS

Achilles tendon - sonography - elastography - sonoelastography - tendinosis

REFERENCES

• 1 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) 111-134
• 2 Pesavento A, Perrey C, Krueger M, Ermert H. A time-efficient and accurate strain estimation concept for ultrasonic elastography using iterative phase zero estimation.  IEEE Trans Ultrason Ferroelectr Freq Control. 1999;  46(5) 1057-1067
• 3 Varghese T, Ophir J, Konofagou E, Kallel F, Righetti R. Tradeoffs in elastographic imaging.  Ultrason Imaging. 2001;  23(4) 216-248
• 4 Hall T J, Zhu Y, Spalding C S. In vivo real-time freehand palpation imaging.  Ultrasound Med Biol. 2003;  29(3) 427-435
• 5 Frey H. Realtime elastography. A new ultrasound procedure for the reconstruction of tissue elasticity [in German].  Radiologe. 2003;  43(10) 850-855
• 6 Konofagou E E, Ophir J, Kallel F, Varghese T. Elastographic dynamic range expansion using variable applied strains.  Ultrason Imaging. 1997;  19(2) 145-166
• 7 Hoyt K, Parker K J, Rubens D J. Real-time shear velocity imaging using sonoelastographic techniques.  Ultrasound Med Biol. 2007;  33(7) 1086-1097
• 8 Friedrich-Rust M, Ong M F, Herrmann E et al.. Real-time elastography for noninvasive assessment of liver fibrosis in chronic viral hepatitis.  AJR Am J Roentgenol. 2007;  188(3) 758-764
• 9 Montaldo G, Tanter M, Bercoff J, Benech N, Fink M. Coherent plane-wave compounding for very high frame rate ultrasonography and transient elastography.  IEEE Trans Ultrason Ferroelectr Freq Control. 2009;  56(3) 489-506
• 10 Tanter M, Bercoff J, Athanasiou A et al.. Quantitative assessment of breast lesion viscoelasticity: initial clinical results using supersonic shear imaging.  Ultrasound Med Biol. 2008;  34(9) 1373-1386
• 11 Hoyt K, Kneezel T, Castaneda B, Parker K J. Quantitative sonoelastography for the in vivo assessment of skeletal muscle viscoelasticity.  Phys Med Biol. 2008;  53(15) 4063-4080
• 12 Tardivon A, El Khoury C, Thibault F, Wyler A, Barreau B, Neuenschwander S. Elastography of the breast: a prospective study of 122 lesions [in French].  J Radiol. 2007;  88(5 Pt 1) 657-662
• 13 Itoh A, Ueno E, Tohno E et al.. Breast disease: clinical application of US elastography for diagnosis.  Radiology. 2006;  239(2) 341-350
• 14 Bercoff J, Chaffai S, Tanter M et al.. In vivo breast tumor detection using transient elastography.  Ultrasound Med Biol. 2003;  29(10) 1387-1396
• 15 Itoh A, Ueno E, Tohno E et al.. Breast disease: clinical application of US elastography for diagnosis.  Radiology. 2006;  239(2) 341-350
• 16 Rubaltelli L, Corradin S, Dorigo A et al.. Differential diagnosis of benign and malignant thyroid nodules at elastosonography.  Ultraschall Med. 2009;  30(2) 175-179
• 17 Rago T, Santini F, Scutari M, Pinchera A, Vitti P. Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules.  J Clin Endocrinol Metab. 2007;  92(8) 2917-2922
• 18 Alam F, Naito K, Horiguchi J, Fukuda H, Tachikake T, Ito K. Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: comparison with conventional B-mode sonography.  AJR Am J Roentgenol. 2008;  191(2) 604-610
• 19 Lyshchik A, Higashi T, Asato R et al.. Cervical lymph node metastases: diagnosis at sonoelastography—initial experience.  Radiology. 2007;  243(1) 258-267
• 20 Kannus P. Etiology and pathophysiology of chronic tendon disorders in sports.  Scand J Med Sci Sports. 1997;  7(2) 78-85
• 21 Józsa L, Bálint B J, Réffy A, Demel Z. Hypoxic alterations of tenocytes in degenerative tendinopathy.  Arch Orthop Trauma Surg. 1982;  99(4) 243-246
• 22 Kannus P, Józsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients.  J Bone Joint Surg Am. 1991;  73(10) 1507-1525
• 23 Järvinen T A, Kannus P, Paavola M, Järvinen T L, Józsa L, Järvinen M. Achilles tendon injuries.  Curr Opin Rheumatol. 2001;  13(2) 150-155
• 24 Schweitzer M E, Karasick D. MR imaging of disorders of the Achilles tendon.  AJR Am J Roentgenol. 2000;  175(3) 613-625
• 25 Nallamshetty L, Nazarian L N, Schweitzer M E et al.. Evaluation of posterior tibial pathology: comparison of sonography and MR imaging.  Skeletal Radiol. 2005;  34(7) 375-380
• 26 Kainberger F, Nehrer S, Breitenseher M et al.. Ultrasound morphology of the Achilles tendon and differential diagnosis [in German].  Ultraschall Med. 1996;  17(5) 212-217
• 27 Karjalainen P T, Soila K, Aronen H J et al.. MR imaging of overuse injuries of the Achilles tendon.  AJR Am J Roentgenol. 2000;  175(1) 251-260
• 28 Shalabi A. Magnetic resonance imaging in chronic Achilles tendinopathy.  Acta Radiol Suppl (Stockholm). 2004;  (432) 1-45
• 29 Sharma P, Maffulli N. Biology of tendon injury: healing, modeling and remodeling.  J Musculoskelet Neuronal Interact. 2006;  6(2) 181-190
• 30 O'Brien M. The anatomy of the Achilles tendon.  Foot Ankle Clin. 2005;  10(2) 225-238
• 31 Kannus P. Structure of the tendon connective tissue.  Scand J Med Sci Sports. 2000;  10(6) 312-320
• 32 Khan K M, Cook J L, Bonar F, Harcourt P, Astrom M. Histopathology of common tendinopathies. Update and implications for clinical management.  Sports Med. 1999;  27(6) 393-408
• 33 Fornage B D. Achilles tendon: US examination.  Radiology. 1986;  159(3) 759-764
• 34 Fornage B D, Rifkin M D. Ultrasound examination of tendons.  Radiol Clin North Am. 1988;  26(1) 87-107
• 35 Martinoli C, Derchi L E, Pastorino C, Bertolotto M, Silvestri E. Analysis of echotexture of tendons with US.  Radiology. 1993;  186(3) 839-843
• 36 Aström M, Gentz C F, Nilsson P, Rausing A, Sjöberg S, Westlin N. Imaging in chronic Achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases.  Skeletal Radiol. 1996;  25(7) 615-620
• 37 Ohberg L, Lorentzon R, Alfredson H. Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up.  Br J Sports Med. 2004;  38(1) 8-11 discussion 11
• 38 Richards P J, McCall I W, Day C, Belcher J, Maffulli N. Longitudinal microvascularity in Achilles tendinopathy: a pilot study.  Skeletal Radiol. 2009;  , August 27 (Epub ahead of print)
• 39 Zanetti M, Metzdorf A, Kundert H P et al.. Achilles tendons: clinical relevance of neovascularization diagnosed with power Doppler US.  Radiology. 2003;  227(2) 556-560
• 40 Jacobson J A, Andresen R, Jaovisidha S et al.. Detection of ankle effusions: comparison study in cadavers using radiography, sonography, and MR imaging.  AJR Am J Roentgenol. 1998;  170(5) 1231-1238
• 41 Khan K M, Forster B B, Robinson J et al.. Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders? A two year prospective study.  Br J Sports Med. 2003;  37(2) 149-153
• 42 Archambault J M, Wiley J P, Bray R C, Verhoef M, Wiseman D A, Elliott P D. Can sonography predict the outcome in patients with achillodynia?.  J Clin Ultrasound. 1998;  26(7) 335-339
• 43 Kälebo P, Allenmark C, Peterson L, Swärd L. Diagnostic value of ultrasonography in partial ruptures of the Achilles tendon.  Am J Sports Med. 1992;  20(4) 378-381
• 44 Paavola M, Paakkala T, Kannus P, Järvinen M. Ultrasonography in the differential diagnosis of Achilles tendon injuries and related disorders. A comparison between pre-operative ultrasonography and surgical findings.  Acta Radiol. 1998;  39(6) 612-619
• 45 Kayser R, Mahlfeld K, Heyde C E. Partial rupture of the proximal Achilles tendon: a differential diagnostic problem in ultrasound imaging.  Br J Sports Med. 2005;  39(11) 838-842 discussion 838-842
• 46 Haims A H, Schweitzer M E, Patel R S, Hecht P, Wapner K L. MR imaging of the Achilles tendon: overlap of findings in symptomatic and asymptomatic individuals.  Skeletal Radiol. 2000;  29(11) 640-645
• 47 Gibbon W W, Cooper J R, Radcliffe G S. Distribution of sonographically detected tendon abnormalities in patients with a clinical diagnosis of chronic Achilles tendinosis.  J Clin Ultrasound. 2000;  28(2) 61-66
• 48 Fredberg U, Bolvig L. Significance of ultrasonographically detected asymptomatic tendinosis in the patellar and Achilles tendons of elite soccer players: a longitudinal study.  Am J Sports Med. 2002;  30(4) 488-491
• 49 De Zordo T, Fink C, Feuchtner G M, Smekal V, Reindl M, Klauser A S. Real-time sonoelastography findings in healthy Achilles tendons.  AJR Am J Roentgenol. 2009;  193(2) W134-8
• 50 De Zordo T, Chhem R, Smekal V et al.. Real-time sonoelastography: findings in patients with symptomatic Achilles tendons and comparison to healthy volunteers.  Ultraschall Med. November 27, 2009;  , [Epub ahead of print]
• 51 De Zordo T, Lill S R, Fink C et al.. Real-time sonoelastography of lateral epicondylitis: comparison of findings between patients and healthy volunteers.  AJR Am J Roentgenol. 2009;  193(1) 180-185
• 52 Klauser A S, Peetrons P. Developments in musculoskeletal ultrasound and clinical applications.  Skeletal Radiol. September 3, 2009;  , [Epub ahead of print]
• 53 Skovoroda A, Emelianov S Y, O'Donnell M. Tissue elasticity reconstruction based on ultrasonic displacement and strain images.  IEEE Trans Ultrason Ferroelectr Freq Control. 1995;  42 747-765