Correlation of B-mode sonography and compression elastography for diagnosis of tendon degeneration: a pictorial review

Abstract

A pictorial review of 76 examinations of the extensor carpi ulnaris tendon using compression sonoelastography in conjunction with B-mode ultrasound imaging is presented here. A comparison of these two technologies is presented and the corresponding images were evaluated to determine whether there is correlation between the two technologies. Furthermore, the possibility that tendon degeneration and softening can be diagnosed earlier than has previously been possible using both of these technologies rather than B-mode imaging alone was explored and the results presented. Patients with unilateral or bilateral extensor carpi ulnaris tenosynovitis were scanned as part of a larger rheumatoid arthritis research study, which included extensor carpi ulnaris evaluation as part of its protocol. B-mode images were acquired with corresponding compression sonoelastography colour map, the region of interest being that portion of the tendon between the ulnar styloid and the insertion at the fifth metacarpal base. Seven paired images from different patients, which represent the varying appearances of extensor carpi ulnaris tenosynovitis seen in the study cohort are shown. Healthy tendons have a uniform hyperechoic fibrillar pattern longitudinally on B-mode imaging with predominantly mid-blue overlay on elastography. Tenosynovitis is shown on grey scale to have the usual appearances of loss of fibrillar echotexture and hypoechoic mucoid degeneration with the elastographic colour map showing predominantly red, yellow and green areas of tendon softening. There appears to be good correlation between the B-mode images and the elastographic overlay. The additional tissue characteristics yielded by sonoelastography in relation to tendon and peritendinous soft tissue elasticity may provide clinicians with information that could alter patient management. This technique shows promise in the earlier detection of tendon degeneration.