Download PDF
Semin Musculoskelet Radiol 2020; 24(02): 125-134
DOI: 10.1055/s-0039-3401042
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

High-Frequency and Ultra-High Frequency Ultrasound: Musculoskeletal Imaging up to 70 MHz

Domenico Albano
1   IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, Milan, Italy
2   Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
,
Giacomo Aringhieri
3   Radiologia Diagnostica ed Interventistica, Dipartimento di Ricerca Traslazionale e Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, Pisa, Italy
,
Carmelo Messina
1   IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, Milan, Italy
4   Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
,
Luca De Flaviis
5   Studio di Radiologia “E. De Flaviis,” Milan, Italy
,
Luca Maria Sconfienza
1   IRCCS Istituto Ortopedico Galeazzi, Unità Operativa di Radiologia Diagnostica ed Interventistica, Milan, Italy
4   Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
21 May 2020 (online)

Also available at
    Permissions and Reprints

Abstract

Musculoskeletal (MSK) ultrasound has well-established advantages, able to investigate very small structures with high resolution and a quick and real-time dynamic evaluation with the possibility of contralateral comparison. Thus ultrasound has kept its own almost exclusive fields of application in daily clinical practice, and it is considered the first-level imaging technique to assess tendons, bursae, and capsuloligamentous structures of small peripheral joints as well as peripheral nerves. Up to now, however, clinical MSK ultrasound imaging could not go beyond the first 1 to 2 cm under the skin, using high-frequency probes up to 18 to 20 MHz with spatial resolution just below millimeters. We present the impressive technical advancements leading to image resolution as low as 30 µm using ultra-high frequency ultrasound (UHFUS) probes up to 70 MHz. High-frequency ultrasound and UHFUS, with frequencies ranging from 22 to 70 MHz, are promising tools to evaluate very superficial structures. In the MSK system, only two articles have assessed its value in limited case series. Future developments may be aimed to better assess ultrastructural changes of very superficial peripheral nerves and other thin structures such as pulleys, retinacula, and tendons.

Keywords

ultrasonography - ultra-high frequency ultrasonography - tendon - cartilage - peripheral nerve
 

  • References

  • 1 Bellelli A, Silvestri E, Barile A. , et al. Position paper on magnetic resonance imaging protocols in the musculoskeletal system (excluding the spine) by the Italian College of Musculoskeletal Radiology. Radiol Med (Torino) 2019; 124 (06) 522-538
    CrossrefPubMedSearch in Google Scholar
  • 2 Schmid AB, Campbell J, Hurley SA. , et al. Feasibility of diffusion tensor and morphologic imaging of peripheral nerves at ultra-high field strength. Invest Radiol 2018; 53 (12) 705-713
    CrossrefPubMedSearch in Google Scholar
  • 3 Vetrano IG, Sconfienza LM, Albano D, Chianca V, Nazzi V. Recurrence of carpal tunnel syndrome in isolated non-syndromic macrodactyly: DTI examination of a giant median nerve. Skeletal Radiol 2019; 48 (06) 989-993
    CrossrefPubMedSearch in Google Scholar
  • 4 Chianca V, Albano D, Messina C. , et al. Diffusion tensor imaging in the musculoskeletal and peripheral nerve systems: from experimental to clinical applications. Eur Radiol Exp 2017; 1 (01) 12
    CrossrefPubMedSearch in Google Scholar
  • 5 Rossi F, Zaottini F, Picasso R, Martinoli C, Tagliafico AS. Ankle and foot ultrasound: reliability of side-to-side comparison of small anatomic structures. J Ultrasound Med 2019; 38 (08) 2143-2153
    CrossrefPubMedSearch in Google Scholar
  • 6 Rossi F, Romano N, Muda A, Martinoli C, Tagliafico A. Wrist and hand ultrasound: reliability of side-to-side comparisons of very small (<2-mm) clinically relevant anatomic structures. J Ultrasound Med 2018; 37 (12) 2785-2795
    CrossrefPubMedSearch in Google Scholar
  • 7 Tagliafico A, Martinoli C. Reliability of side-to-side sonographic cross-sectional area measurements of upper extremity nerves in healthy volunteers. J Ultrasound Med 2013; 32 (03) 457-462
    CrossrefPubMedSearch in Google Scholar
  • 8 Tagliafico A, Cadoni A, Fisci E, Bignotti B, Padua L, Martinoli C. Reliability of side-to-side ultrasound cross-sectional area measurements of lower extremity nerves in healthy subjects. Muscle Nerve 2012; 46 (05) 717-722
    CrossrefPubMedSearch in Google Scholar
  • 9 Sconfienza LM, Albano D, Allen G. , et al. Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus. Eur Radiol 2018; 28 (12) 5338-5351
    CrossrefPubMedSearch in Google Scholar
  • 10 Aringhieri G, Vitali S, Rossi P, Caramella D. The new frontier of imaging: the micron. Clin Exp Rheumatol 2018; 36 (01) 169
    PubMedSearch in Google Scholar
  • 11 Brown JM, Yablon CM, Morag Y, Brandon CJ, Jacobson JA. US of the peripheral nerves of the upper extremity: a landmark approach. Radiographics 2016; 36 (02) 452-463
    CrossrefPubMedSearch in Google Scholar
  • 12 Albano D, Messina C, Usuelli FG. , et al. Magnetic resonance and ultrasound in Achilles tendinopathy: predictive role and response assessment to platelet-rich plasma and adipose-derived stromal vascular fraction injection. Eur J Radiol 2017; 95: 130-135
    CrossrefPubMedSearch in Google Scholar
  • 13 Sokolov SJ. Ultrasonic oscillations and their applications. Tech Phys USSR 1935; 2: 522-534
    PubMedSearch in Google Scholar
  • 14 Sherar MD, Noss MB, Foster FS. Ultrasound backscatter microscopy images the internal structure of living tumour spheroids. Nature 1987; 330 (6147): 493-495
    CrossrefPubMedSearch in Google Scholar
  • 15 Rong AJ, Fan KC, Golshani B. , et al. Multimodal imaging features of intraocular foreign bodies. Semin Ophthalmol 2019; 14: 1-15
    PubMedSearch in Google Scholar
  • 16 Bard RL. High-frequency ultrasound examination in the diagnosis of skin cancer. Dermatol Clin 2017; 35 (04) 505-511
    CrossrefPubMedSearch in Google Scholar
  • 17 Sundholm JKM, Paetau A, Albäck A, Pettersson T, Sarkola T. Non-invasive vascular very-high resolution ultrasound to quantify artery intima layer thickness: validation of the four-line pattern. Ultrasound Med Biol 2019; 45 (08) 2010-2018
    CrossrefPubMedSearch in Google Scholar
  • 18 Sarkola T, Redington A, Keeley F, Bradley T, Jaeggi E. Transcutaneous very-high-resolution ultrasound to quantify arterial wall layers of muscular and elastic arteries: validation of a method. Atherosclerosis 2010; 212 (02) 516-523
    CrossrefPubMedSearch in Google Scholar
  • 19 Foster FS, Pavlin CJ, Harasiewicz KA, Christopher DA, Turnbull DH. Advances in ultrasound biomicroscopy. Ultrasound Med Biol 2000; 26 (01) 1-27
    CrossrefPubMedSearch in Google Scholar
  • 20 Derchi L, Rizzatto G. Technical requirements. In: Bianchi S, Martinoli C. , eds. Ultrasound of the Musculoskeletal System. Berlin, Germany: Springer; 2007: 3-16
    CrossrefSearch in Google Scholar
  • 21 Ohashi S, Ohnishi I, Matsumoto T. , et al. Evaluation of the accuracy of articular cartilage thickness measurement by B-mode ultrasonography with conventional imaging and real-time spatial compound ultrasonography imaging. Ultrasound Med Biol 2012; 38 (02) 324-334
    CrossrefPubMedSearch in Google Scholar
  • 22 Peer S, Gruber H. , eds. Atlas of Peripheral Nerve Ultrasound. Berlin, Germany: Springer; 2013
    Search in Google Scholar
  • 23 Silvestri E, Barile A, Albano D. , et al. Interventional therapeutic procedures in the musculoskeletal system: an Italian survey by the Italian College of Musculoskeletal Radiology. Radiol Med (Torino) 2018; 123 (04) 314-321
    CrossrefPubMedSearch in Google Scholar
  • 24 Sconfienza LM, Albano D, Messina C, Silvestri E, Tagliafico AS. How, when, why in magnetic resonance arthrography: an international survey by the European Society of Musculoskeletal Radiology (ESSR). Eur Radiol 2018; 28 (06) 2356-2368
    CrossrefPubMedSearch in Google Scholar
  • 25 Sconfienza LM, Chianca V, Messina C, Albano D, Pozzi G, Bazzocchi A. Upper limb interventions. Radiol Clin North Am 2019; 57 (05) 1073-1082
    CrossrefPubMedSearch in Google Scholar
  • 26 Sconfienza LM, Adriaensen M, Albano D. , et al. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part I, shoulder. Eur Radiol 2019 ; September 16 (Epub ahead of print)
    PubMedSearch in Google Scholar
  • 27 Sconfienza LM, Adriaensen M, Albano D. , et al. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology-part III, nerves of the upper limb. Eur Radiol . In press
    PubMed
  • 28 Narouze SN. Atlas of Ultrasound-guided Procedures in Interventional Pain Management. New York, NY: Springer; 2010
    Search in Google Scholar
  • 29 Codari M, Melazzini L, Morozov SP, van Kujik CC, Sconfienza LM, Sardanelli F. ; European Society of Radiology (ESR). Impact of artificial intelligence on radiology: a EuroAIM survey among members of the European Society of Radiology. Insights Imaging 2019; 10 (01) 105
    CrossrefPubMedSearch in Google Scholar
  • 30 Viviano SL, Chandler LK, Keith JD. Ultrahigh frequency ultrasound imaging of the hand: a new diagnostic tool for hand surgery. Hand (N Y) 2018; 13 (06) 720-725
    CrossrefPubMedSearch in Google Scholar
  • 31 Krishnan P, Mishra R, Jena M, Das A. Transligamentous thenar branch of the median nerve: the million dollar nerve. Neurol India 2013; 61 (03) 311-312
    CrossrefPubMedSearch in Google Scholar
  • 32 Stokvis A, Van Neck JW, Van Dijke CF, Van Wamel A, Coert JH. High-resolution ultrasonography of the cutaneous nerve branches in the hand and wrist. J Hand Surg Eur Vol 2009; 34 (06) 766-771
    CrossrefPubMedSearch in Google Scholar
  • 33 Zappia M, Berritto D, Oliva F, Maffulli N. High resolution real time ultrasonography of the sural nerve after percutaneous repair of the Achilles tendon. Foot Ankle Surg 2018; 24 (04) 342-346
    CrossrefPubMedSearch in Google Scholar
  • 34 Zaidman CM, Seelig MJ, Baker JC, Mackinnon SE, Pestronk A. Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology 2013; 80 (18) 1634-1640
    CrossrefPubMedSearch in Google Scholar
  • 35 Albano D, Chianca V, Zappia M. , et al. Imaging of usual and unusual complication of rotator cuff repair. J Comput Assist Tomogr 2019; 43 (03) 359-366
    CrossrefPubMedSearch in Google Scholar
  • 36 Suk JI, Walker FO, Cartwright MS. Ultrasonography of peripheral nerves. Curr Neurol Neurosci Rep 2013; 13 (02) 328
    CrossrefPubMedSearch in Google Scholar
  • 37 Tagliafico AS. Peripheral nerve imaging: not only cross-sectional area. World J Radiol 2016; 8 (08) 726-728
    CrossrefPubMedSearch in Google Scholar
  • 38 Martinoli C, Schenone A, Bianchi S. , et al. Sonography of the median nerve in Charcot-Marie-Tooth disease. AJR Am J Roentgenol 2002; 178 (06) 1553-1556
    CrossrefPubMedSearch in Google Scholar
  • 39 Gruber H, Glodny B, Bendix N, Tzankov A, Peer S. High-resolution ultrasound of peripheral neurogenic tumors. Eur Radiol 2007; 17 (11) 2880-2888
    CrossrefPubMedSearch in Google Scholar
  • 40 Tagliafico A, Tagliafico G, Martinoli C. Nerve density: a new parameter to evaluate peripheral nerve pathology on ultrasound. Preliminary study. Ultrasound Med Biol 2010; 36 (10) 1588-1593
    CrossrefPubMedSearch in Google Scholar
  • 41 Taljanovic MS, Melville DM, Gimber LH. , et al. High-resolution US of rheumatologic diseases. Radiographics 2015; 35 (07) 2026-2048
    CrossrefPubMedSearch in Google Scholar
  • 42 Kim HK, Babyn PS, Harasiewicz KA, Gahunia HK, Pritzker KP, Foster FS. Imaging of immature articular cartilage using ultrasound backscatter microscopy at 50 MHz. J Orthop Res 1995; 13 (06) 963-970
    CrossrefPubMedSearch in Google Scholar
  • 43 Saïed A, Chérin E, Gaucher H. , et al. Assessment of articular cartilage and subchondral bone: subtle and progressive changes in experimental osteoarthritis using 50 MHz echography in vitro. J Bone Miner Res 1997; 12 (09) 1378-1386
    CrossrefPubMedSearch in Google Scholar
  • 44 Wang Y, Guo Y, Zhang L. , et al. Ultrasound biomicroscopy for the detection of early osteoarthritis in an animal model. Acad Radiol 2011; 18 (02) 167-173
    CrossrefPubMedSearch in Google Scholar
  • 45 Saarakkala S, Laasanen MS, Jurvelin JS. , et al. Ultrasound indentation of normal and spontaneously degenerated bovine articular cartilage. Osteoarthritis Cartilage 2003; 11 (09) 697-705
    CrossrefPubMedSearch in Google Scholar
  • 46 Saarakkala S, Laasanen MS, Jurvelin JS, Töyräs J. Quantitative ultrasound imaging detects degenerative changes in articular cartilage surface and subchondral bone. Phys Med Biol 2006; 51 (20) 5333-5346
    CrossrefPubMedSearch in Google Scholar
  • 47 Saarakkala S, Töyräs J, Hirvonen J, Laasanen MS, Lappalainen R, Jurvelin JS. Ultrasonic quantitation of superficial degradation of articular cartilage. Ultrasound Med Biol 2004; 30 (06) 783-792
    CrossrefPubMedSearch in Google Scholar
  • 48 Wang SZ, Huang YP, Saarakkala S, Zheng YP. Quantitative assessment of articular cartilage with morphologic, acoustic and mechanical properties obtained using high-frequency ultrasound. Ultrasound Med Biol 2010; 36 (03) 512-527
    CrossrefPubMedSearch in Google Scholar
  • 49 Gelse K, Olk A, Eichhorn S, Swoboda B, Schoene M, Raum K. Quantitative ultrasound biomicroscopy for the analysis of healthy and repair cartilage tissue. Eur Cell Mater 2010; 19: 58-71
    PubMedSearch in Google Scholar
  • 50 Kang T, Emery P, Wakefield RJ. A brief history of ultrasound in rheumatology: where we are now. Clin Exp Rheumatol 2014; 32 (01) (Suppl. 80) S7-S11
    PubMedSearch in Google Scholar
  • 51 Girish G, Melville DM, Kaeley GS. , et al. Imaging appearances in gout. Arthritis (Egypt) 2013; 2013: 673401
    PubMedSearch in Google Scholar
  • 52 Filippou G, Adinolfi A, Cimmino MA. , et al. Diagnostic accuracy of ultrasound, conventional radiography and synovial fluid analysis in the diagnosis of calcium pyrophosphate dihydrate crystal deposition disease. Clin Exp Rheumatol 2016; 34 (02) 254-260
    PubMedSearch in Google Scholar
  • 53 Filippou G, Adinolfi A, Iagnocco A. , et al. Ultrasound in the diagnosis of calcium pyrophosphate dihydrate deposition disease. A systematic literature review and a meta-analysis. Osteoarthritis Cartilage 2016; 24 (06) 973-981
    CrossrefPubMedSearch in Google Scholar
  • 54 Arend CF, da Silva TR. The role of US in the evaluation of clinically suspected ulnar collateral ligament injuries of the thumb: spectrum of findings and differential diagnosis. Acta Radiol 2014; 55 (07) 814-823
    CrossrefPubMedSearch in Google Scholar
  • 55 Melville D, Jacobson JA, Haase S, Brandon C, Brigido MK, Fessell D. Ultrasound of displaced ulnar collateral ligament tears of the thumb: the Stener lesion revisited. Skeletal Radiol 2013; 42 (05) 667-673
    CrossrefPubMedSearch in Google Scholar
  • 56 Sconfienza LM, Adriaensen M, Albano D. , et al. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology-part II, elbow and wrist. Eur Radiol . In press
    PubMed
  • 57 Dezfuli B, Taljanovic MS, Melville DM, Krupinski EA, Sheppard JE. Accuracy of high-resolution ultrasonography in the detection of extensor tendon lacerations. Ann Plast Surg 2016; 76 (02) 187-192
    CrossrefPubMedSearch in Google Scholar
  • 58 Miyamoto H, Miura T, Isayama H, Masuzaki R, Koike K, Ohe T. Stiffness of the first annular pulley in normal and trigger fingers. J Hand Surg Am 2011; 36 (09) 1486-1491
    CrossrefPubMedSearch in Google Scholar
  • 59 Bollen SR. Soft tissue injury in extreme rock climbers. Br J Sports Med 1988; 22 (04) 145-147
    CrossrefPubMedSearch in Google Scholar
  • 60 Schöffl I, Hugel A, Schöffl V, Rascher W, Jüngert J. Diagnosis of complex pulley ruptures using ultrasound in cadaver models. Ultrasound Med Biol 2017; 43 (03) 662-669
    CrossrefPubMedSearch in Google Scholar
  • 61 Numkarunarunrote N, Malik A, Aguiar RO, Trudell DJ, Resnick D. Retinacula of the foot and ankle: MRI with anatomic correlation in cadavers. AJR Am J Roentgenol 2007; 188 (04) W348-W354
    PubMedSearch in Google Scholar
  • 62 Kumar Y, Alian A, Ahlawat S, Wukich DK, Chhabra A. Peroneal tendon pathology: pre- and post-operative high resolution US and MR imaging. Eur J Radiol 2017; 92: 132-144
    CrossrefPubMedSearch in Google Scholar
  • 63 Spicer PJ, Romesberg A, Kamineni S, Beaman FD. Ultrasound of extensor carpi ulnaris tendon subluxation in a tennis player. Ultrasound Q 2016; 32 (02) 191-193
    CrossrefPubMedSearch in Google Scholar
  • 64 Aluja Jaramillo F, Quiasúa Mejía DC, Martínez Ordúz HM, González Ardila C. Nail unit ultrasound: a complete guide of the nail diseases. J Ultrasound 2017; 20 (03) 181-192
    CrossrefPubMedSearch in Google Scholar
  • 65 Berritto D, Iacobellis F, Rossi C, Reginelli A, Cappabianca S, Grassi R. Ultra high-frequency ultrasound: new capabilities for nail anatomy exploration. J Dermatol 2017; 44 (01) 43-46
    CrossrefPubMedSearch in Google Scholar
  • 66 Cecchini A, Montella A, Ena P, Meloni GB, Mazzarello V. Ultrasound anatomy of normal nails unit with 18 MHz linear transducer. Ital J Anat Embryol 2009; 114 (04) 137-144
    PubMedSearch in Google Scholar
  • 67 Wortsman X. Ultrasound in dermatology: why, how, and when?. Semin Ultrasound CT MR 2013; 34 (03) 177-195
    CrossrefPubMedSearch in Google Scholar
  • 68 Wortsman X, Gutierrez M, Saavedra T, Honeyman J. The role of ultrasound in rheumatic skin and nail lesions: a multi-specialist approach. Clin Rheumatol 2011; 30 (06) 739-748
    CrossrefPubMedSearch in Google Scholar
  • 69 Bobadilla F, Wortsman X, Muñoz C, Segovia L, Espinoza M, Jemec GB. Pre-surgical high resolution ultrasound of facial basal cell carcinoma: correlation with histology. Cancer Imaging 2008; 8: 163-172
    CrossrefPubMedSearch in Google Scholar
  • 70 Lassau N, Koscielny S, Avril MF. , et al. Prognostic value of angiogenesis evaluated with high-frequency and color Doppler sonography for preoperative assessment of melanomas. AJR Am J Roentgenol 2002; 178 (06) 1547-1551
    CrossrefPubMedSearch in Google Scholar
  • 71 Cannaò PM, Vinci V, Caviggioli F. , et al. Technical feasibility of real-time elastography to assess the peri-oral region in patients affected by systemic sclerosis. J Ultrasound 2014; 17 (04) 265-269
    CrossrefPubMedSearch in Google Scholar
  • 72 Ionescu R, Rednic S, Damjanov N. , et al. Repeated teaching courses of the modified Rodnan skin score in systemic sclerosis. Clin Exp Rheumatol 2010; 28 (02) (Suppl. 58) S37-S41
    PubMedSearch in Google Scholar
  • 73 Huttin C, Diaz JJH, Vernet P, Facca S, Igeta Y, Liverneaux P. Relevance of intraoperative ultrasound imaging for detecting foreign bodies in the hand: a series of 19 cases. Hand Surg Rehabil 2018; 37 (06) 363-367
    CrossrefPubMedSearch in Google Scholar
  • 74 Riegler G, Brugger PC, Gruber GM, Pivec C, Jengojan S, Bodner G. High-resolution ultrasound visualization of Pacinian corpuscles. Ultrasound Med Biol 2018; 44 (12) 2596-2601
    CrossrefPubMedSearch in Google Scholar