Abstract
Ultrasonographic elastography is a relatively new imaging modality for the qualitative and quantitative assessments of tissue elasticity. While it has steadily gained use in adult clinical practice, including for liver diseases, breast cancer, thyroid pathologies, and muscle and tendon diseases, data on its paediatric application is still limited. Moreover, diagnosis of muscular diseases in children remains challenging. The gold standard methods, namely biopsy, electroneurography, and electromyography, are often limited owing to their invasive characteristics, possible contraindications, complications, and need for good cooperation, that is, a patient’s ability to perform certain tasks during the examination while withstanding discomfort, which is a significant problem especially in younger or uncooperative children. Genetic testing, which has broad diagnostic possibilities, often entails a high cost, which limits its application. Thus, a non-invasive, objective, repeatable, and accessible tool is needed to aid in both the diagnosis and monitoring of muscle pathologies. We believe that elastography may prove to be such a method. The aim of this review was to present the current knowledge on the use of muscle elastography in the paediatric population and information on the limitations of elastography in relation to examination protocols and factors for consideration in everyday practice and future studies.
Highlights
The diagnosis and monitoring of neuromuscular diseases remain a challenge despite the emerging role of genetic testing in this field
In a study in patients with Duchenne muscular dystrophy (DMD) aged 5 to 24 years, results were incoherent in that while a statistical correlation was found between age and gastrocnemius muscle (GCM) stiffness in the DMD group, no correlation was found in the healthy group or for other muscles in the DMD group [21]
Even though the study population was small and limited to one sex, apart from the practical conclusions for sport medicine and physiotherapy, this study showed that the elastography examination protocol should carefully consider passive muscle stretching [25]
Summary
The diagnosis and monitoring of neuromuscular diseases remain a challenge despite the emerging role of genetic testing in this field. Vital limitations in diagnosis and monitoring are relevant in the paediatric group owing to the high costs of genetic tests and invasiveness of gold standard tests (electromyography (EMG), electroneurography (ENG), and biopsy). Both ENG and EMG require good patient compliance (ability to simultaneously withstand discomfort and relax or contract muscles on demand), may lead to complications like most invasive procedures, and are often limited by the need to ensure patient safety and health-related contraindications. From a practical point of view, all these methods measure shear wave speed and offer quantitative results expressed in meters per second, which are subsequently converted to kilopascals by SWE is a group of methods that can be roughly divided into point and two-dimensional (2-D) SWEs, with further subdivision according to the method of force application. SAWsEinanthdeApRaeFdI imatariycaplsoopubleaatifofenc,tteidghbtymthuescdlepththicokfnexssamwianserdeptiossruteeds t[o7,9b–e1u1p]. tAos4i5nmthme . pTaheduisa,tSriWc pEompuiglahttiohna,vteigahtbmrouasdcelre athpipcklincaetsisown ains rtehpisoratgeedgtorobuepu[p12to]. 4In5 mgemne. rTahl uths,eSmWoEst mcoigmhmt hoanvlye ausberdoaddeevriacepsplairceatAioinxpinlotrheirs(aSguepgersoounpic[1I2m].aIgningee,nAerixa-letnh-ePmroovsetnccoem, Fmraonncley), uwsehdicdhevsuicpeps oarretsA2i-xDplSoWrerE(,SaunpderAsocnuiscoInma(Sg2in00e,0A/Si3x0-e0n0;-PSrioevmeenncse,, FWraanschei)n,gwtohnic,hDsCu,ppUoSrAts), 2w-DhiScWh gEe,naenrdatAescuAsRoFnI([S1230].00/S3000; Siemens, Washington, DC, USA), which generates ARFI [13]
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