Sonoelastography Research Articles

Sonoelastography findings of biceps tendinitis and tendinosis.

The purpose of this study was to evaluate sonoelastography (SE) in the assessment of the long head of biceps tendon (LHBT) in patients with symptoms of biceps tendinitis or tendinosis and in patients without biceps lesion. The findings were compared with those obtained at clinical examination, using ultrasonography (US). 36 shoulders of 34 consecutively registered patients with clinical symptoms and US findings of biceps tendinitis or tendinosis, and 114 shoulders of 98 patients without biceps lesions were assessed with SE. Transverse and longitudinal images of LHBT were obtained using SE. SE images were evaluated by reviewers using an experimentally proven color grading system. The transverse images of SE showed a mean sensitivity of 69.4%, a mean specificity of 95.6% and a mean accuracy of 89.3%. Good correlation of conventional ultrasound findings was found (p<0.001, r=0.763). The longitudinal images of SE showed a mean sensitivity of 94.4%, a mean specificity of 92.1% and a mean accuracy of 92.7%. Good correlation of conventional ultrasound findings was found (p<0.001, r=0.585). Inter-observer reliability of SE was in "almost perfect agreement" with a weighted kappa coefficient of 0.84. SE has potential to be clinically useful in the detection of the intratendinous and peritendinous alterations of LHBT and has excellent accuracy and excellent correlation with conventional ultrasound findings.

The Accuracy of Sonoelastography in a Fatty Degeneration of Supraspinatus: A Comparison with Magnetic Resonance Images through Quantitative Assessment

Purpose: Using magnetic resonance imaging (MRI) as the standard of reference, the purpose of this study was to evaluate the accuracy of sonoelastography (SE) for assessment of fatty degeneration of suprasupinatus (SSP). Materials and Methods: A retrospective analysis was conducted in 131 shoulders of 126 consecutive patients who underwent shoulder MRI, and SE. Oblique sagittal images of SSP were obtained using SE; the SE images were evaluated by two orthopedic surgeons using a 256 degree color map image. Results: When the supraspinatus fatty degenerations were based on MRI findings, the sensitivity of SE was 89.47%, specificity 92.85%, and accuracy 91.60%. The interobserver reliability of the SE findings was ‘almost perfect agreement’ with a weighted kappa coefficient of 0.81. By comparison of MRI with the SE findings, the grades of MRI and SE showed positive correlation (r=0.85, p≤0.001). In addition, the occupation ratio and blue region area ratio also showed positive correlation (r=0.69, p≤0.001). Conclusion: SE is valuable in quantitative assessment of the severity of fatty atrophy of the supraspinatus and has excellent accuracy, excellent correlation with MRI and conventional ultrasonography, and excellent interobserver reliability.

Diagnostic Consistency between Sonoelastography and Conventional Sonography of Long Head of the Biceps

BACKGROUND: Sonoelastography (SE) is a new technique that can assess differences in tissue stiffness, the purpose of this study was to evaluate the ability of SE to assess the long head of biceps tendon alteration.METHODS: Forty shoulders of 36 consecutively registered patients with clinical symptoms and conventional ultrasonography findings of biceps tendinitis or tendinosis, and 40 asymptomatic shoulders of 20 healthy volunteers were assessed with SE. Transverse and longitudinal images of long head of biceps tendon were obtained using SE. SE images were performed by one orthopedic surgeon and evaluated by two orthopedic surgeons using an experimentally proven color grading system.RESULTS: The transverse images of SE showed a sensitivity of 87.5%, a specificity of 95.0% and a accuracy of 91.3%, the longitudinal images of SE showed a sensitivity of 92.5%, a specificity of 90.0% and a accuracy of 91.3%. Inter-observer reliability of SE was in 'almost perfect agreement' with a weighted kappa coefficient of 0.83.CONCLUSIONS: SE is valuable in the detection of the intratendinous and peritendinous alterations of biceps tendon, and has excellent accuracy and excellent correlation with conventional ultrasound findings.

Sonoelastography for qualitative and quantitative evaluation of superficial soft tissue lesions: a feasibility study

To evaluate the feasibility of qualitative and quantitative analysis using sonoelastography (SE) for differentiating between benign and malignant superficial soft-tissue lesions. For this prospective study, 32 patients with superficial soft-tissue lesions detected with grey-scale ultrasound and colour and/or power Doppler ultrasound were evaluated between October 2011 and December 2012. Qualitative analysis: visual grading system was adopted according to colour variation (red-soft, green-medium, blue-hard). Quantitative analysis: median and fraction area of each colour were computed within a region of interest. Differences between fraction areas and median values in compression and decompression phases were calculated. Reference standard: histological findings. Twelve out of 32 lesions (37.5%) were malignant. Intraclass correlation coefficient (ICC) was 0.989 (95% confidence interval [CI] 0.980-0.994, P < 0.01) with optimal reliability. Area under the curve was 0.823 (95% CI 0.677-0.969) and 0.958 (95% CI 0.989-1.019) for blue and blue area differences, and 0.777 (95% CI 0.615-0.939) and 0.629 (95% CI 0.426-0.833) for red and red area differences, respectively. Blue variations predicted malignancy more accurately (variation ≥0.431: 100% sensitivity, 80% specificity); the blue area difference was highly accurate. Preliminary results showed good correlations between SE and reference standards. SE could be useful in the evaluation of superficial soft tissue lesions. • Sonoelastography helps clarify ambiguous soft-tissue lesions identified using conventional ultrasound techniques. • Addition of this tool increases the diagnostic accuracy of ultrasound. • Sonoelastography provides both qualitative and quantitative analysis. • Sonoelastography may help clinicians improve patient care.

Differentiating benign from malignant superficial lymph nodes with sonoelastography

The aim of the paper is to provide a comprehensive overview on the applications of real time sonoelastography (SE) in the diagnosis of superficial lymphadenopathy. Some technical aspects of performing SE are presented as a preamble. The typical appearance of benign and malignant nodes is illustrated. The paper discusses and depicts the various elastographic scores in use. It also provides a critical appraisal of the relative strain ratio (SR) or stiffness index. Shear wave elastography, as a novel technique, is mentioned. In conclusion, hardness on more than 50% of the node surface or SR > 1.5 is fair to good indicators of malignancy. Work is still needed both to fully understand the various appearance of disease and to standardize the application.

Real-time sonoelastography of Achilles tendon in patients with ankylosing spondylitis

Real-time sonoelastography (SE) is a new ultrasound-based imaging technique that provides information on tissue elasticity and stiffness. We determined the efficacy of SE for assessing Achilles tendon abnormalities in patients with ankylosing spondylitis (AS). Forty-one consecutive AS patients and 32 asymptomatic healthy subjects were enrolled. Achillodynia was scored on a 0- to 100-mm visual analog scale. A high-resolution ultrasound machine equipped with an elastography-compatible linear probe was used to perform bilateral B-mode ultrasound, Doppler ultrasound, and SE examinations of Achilles tendons. Tendons were divided into proximal, middle, and distal segments. B-mode examinations included tendon thicknesses, echotextures, and enthesopathic findings. SE using color-coded images was performed in the same areas. Normal consistent tendon structures were coded as blue or green, and moderately (yellow) or severely (red) softened areas were considered pathological. The distal third of the Achilles tendons was the most commonly affected part in the AS patients compared with healthy subjects (p = 0.001), whose middle third was more commonly affected. Achillodynia intensity tended to be higher in patients with pathological B-mode or SE examination findings (p = 0.09 and p = 0.07 respectively). Softening detected by SE in the distal third was associated with enthesopathy findings such as calcaneal bone erosions (Fisher's X (2), p = 0.07) and tendinous enlargement (Fisher's X (2), p = 0.001). B-mode and SE findings had moderate to good correlation in the assessment of Achilles tendon abnormalities. Sonoelastography may be useful for the evaluation of tendon abnormalities in patients with AS; in addition; it may be useful for the evaluation of other inflammatory rheumatic conditions.

The utility of transrectal sonoelastography in preoperative prostate cancer assessment

To determine the diagnostic quality of transrectal sonoelastography (SE) in the prediction and localisation of prostate cancer, we prospectively examined patients who had undergone radical prostatectomy in our urology department. From April 2010 to January 2011, 61 patients with biopsy-proven prostate cancer underwent preoperative transrectal gray-scale (b-mode) ultrasound and SE of the prostate. Cancer-suspicious areas were documented for b-mode and SE, dividing the prostate into six topographic sectors. Suspicious areas in both modalities were compared to tumour localisation in the prostatectomy specimen. Sensitivity, specificity, positive- and negative predictive values were calculated for both investigation techniques. Prostate cancer was present in 232 of 366 pathological sectors (62 %). B-mode ultrasound showed 113 suspicious sectors, while SE indicated prostate cancer in 157 areas. The precise localisation of at least one pathologically confirmed cancerous lesion was possible in 42/61 (69 %) patients by b-mode ultrasound and 56/61 (92 %) patients by SE (P<0.005). The sensitivity for b-mode ultrasound was 33 % and specificity 74 %. For SE sensitivity was 53 %, while specificity was 74 %. SE offers a more precise localisation of prostate carcinoma than conventional ultrasound. To investigate the possible advantages of SE in during prostate biopsy and its value in the prediction of extracapsular cancer further studies are required.

Sonoelastography as a Diagnostic Tool in the Assessment of Musculoskeletal Alterations: A Systematic Review

Elasticity imaging is a relatively new ultrasound-based technique for investigating musculoskeletal injury. Sonoelastography (SEL), the most commonly used technique, allows determination of the elastic properties of tissue by applying pressure. To critically evaluate the literature regarding the use of SEL in the diagnosis of tendon and muscle alterations. This review includes a systematic literature search performed on major electronic databases. Eight articles were included. The GRADE approach was used to evaluate the quality of evidence presented in the included articles and the strength of their recommendations. The results on human tendon disorders showed that the SEL findings correlated extremely well with conventional ultrasound (US) findings as well as with magnetic resonance imaging (MRI) and clinical examination. In some articles SEL was found to be even more sensitive than conventional ultrasound and in addition capable of identifying subclinical alterations that conventional ultrasound could not. For skeletal muscle, a close correlation between SEL and US and MRI was found, although there is only one article on the topic. SEL was found to be able to distinguish between healthy and diseased muscles and was potentially more sensitive in identifying early dystrophic changes than US or MRI. Based on this critical evaluation of the literature, SEL seems to be at least as feasible as US and MRI for assessing tendon alterations and able to identify subclinical tendon alterations not visible with conventional US. The findings in the reviewed articles suggest that SEL could become a supplementary imaging technique in the assessment of musculoskeletal alterations, potentially superior to US and MRI. Until more studies are available, SEL has to be viewed as an experimental examination without sufficient supporting evidence to be used as a routine examination equivalent to US and MRI.

Evaluation of Parotid Gland Lesions with Standard Ultrasound, Color Duplex Sonography, Sonoelastography, and Acoustic Radiation Force Impulse Imaging – a Pilot Study

To evaluate the impact of standard ultrasound (US), color duplex sonography (CDS), sonoelastography (SE), and acoustic radiation force impulse (ARFI) imaging in the differentiation of parotid gland lesions. From September 2010 to February 2011, 33 parotid gland lesions of 32 patients were included in this study. Patients underwent high-resolution B-mode US (THI, 9 - 14 MHz), CDS, SE, and ARFI quantification. Then parotidectomy was performed and samples were analyzed by (immuno-) histology. Data was extracted via unpaired t-test and expressed in p-values. There were 12 Wathin's tumors (WT), 11 pleomorphic adenomas (PA), 3 other benign tumors, 3 ductal dilatations, 2 neuroendocrine carcinomas, 1 non-Hodgkin lymphoma, and 1 malignant melanoma metastasis. In B-mode US, acoustic enhancement showed statistical significance between PA and WT (p < 0.005), and CDS determined different vascularization patterns (p < 0.0005). While SE did not visualize any significant difference between PA and WT, ARFI quantification determined different mean values for both entities (p < 0.003). B-mode US, CDS, and ARFI quantification distinguish PA from WT. The predictive value of the modern techniques for the differentiation of benign and malignant parotid lesions has to be assessed in a larger series.

Sonoelastography: the method of choice for evaluation of tissue elasticity

Ultrasound devices and methodologies have been continuously evolving and becoming more important as tools in diagnostic medicine. Recently a new ultrasound diagnostic technique has been developed. Named sonoelastography, the technique enables evaluation of tissue elasticity and is based on differences in stiffness (hardness, compressibility, elasticity) of pathological changes and normal adjacent tissue. Sonoelastography (SE) is also known as Real-time tissue elastography (RTE), Real-time sonoelastography (RTSE), Tissue type imaging (TTI) and Ultrasound Strain Imaging Technology. It has been found useful in many medicine elds and adopted readily by clinicians of different specialties. It gives more information than conventional ultrasound in evaluation of tumors, liver disease, skeletal muscles, rheumatoid nodules and other pathological changes. This review covers the basics of elastography, its applications, instruments, techniques, the scoring system and the indications for elastography.

Application of sonoelastography: Comparison of performance between mass and non-mass lesion

The purpose of this study was to determine the performance of the conventional ultrasonography (US) and sonoelastography (SE) in three conditions of all lesions, confined to mass, and confined to non-mass lesion and to compare the performance of each modality between mass and non-mass lesion. A total 364 patients with 375 lesions were evaluated with US and subsequently SE before performing US-guided biopsy. Two radiologists retrospectively analyzed conventional US and elasticity images by consensus. The US findings were classified as mass or non-mass lesion. With final pathology as reference, in each case of all lesions, masses, and non-mass lesions, areas under the ROC curves (Az) were calculated and compared for the two techniques. The comparison of Az values between the curves for US and SE, and between the curves for mass and non-mass lesion was performed. Among 375 lesions, 104 (28%) lesions were malignant and 271 (72%) lesions were benign. 36 (9.6%) of 375 lesions were classified as non-mass lesion at US. There were statistically significant difference of performance between US and SE in cases of all lesion (p=0.003) and mass (p=0.023). However, there was no statistically significant difference of performance in case of non-mass lesion (p=0.5). Comparisons of the Az values of US and SE between mass and non-mass lesions were not statistically significant (p=0.745, p=0.415, respectively). There was no statistically significant difference of performance of US and SE between mass and non-mass lesion.

Real-Time Sonoelastography: Findings in Patients with Symptomatic Achilles Tendons and Comparison to Healthy Volunteers

Real-time sonoelastography (SE), a newly introduced ultrasound technique, has already shown conclusive results in breast, prostate, and thyroid tumor diagnostics. This study investigated the performance of SE for the differentiation of Achilles tendon alterations of tendinopathy compared to clinical examination and conventional ultrasound (US). Achilles tendons in 25 consecutive patients with chronic Achilles tendinopathy and 25 healthy volunteers were examined clinically by US and by SE. In the healthy volunteers, SE showed the tendon to be hard (93 %), while distinct softening was found in 57 % of the patients. SE showed more frequent involvement of the distal (64 %) and middle third (80 %) than the proximal third (28 %) of the Achilles tendon. Using SE a mean sensitivity of 94 %, specificity of 99 %, and accuracy of 97 % were found when clinical examination was used as the reference standard. The correlation to US was 0.89. Mild softening was found in 7 % of the healthy volunteers and in 11 % of the patients. Our results emphasize that only distinct softening of Achilles tendons is comparable to clinical examination and US findings. However, mild softening might be explained by very early changes in tissue elasticity in the case of Achilles tendinopathy, which should be assessed in follow-up studies.

Role of sonoelastography in non-palpable breast lesions

The purpose of this study was to evaluate the diagnostic utility of sonoelastography in differentiating benign from malignant non-palpable breast lesions. A total of 293 BI-RADS 3-5 (Breast Imaging Reporting And Data System) impalpable breast lesions in 278 women was evaluated with B-mode ultrasound (US) and subsequently with sonoelastography (SE) before performing US-guided biopsy. Among the 293 lesions (size up to 2 cm), 110 (37.5%) were histologically malignant and 183 (62.5%) benign. Lesions that were malignant or showed atypical ductal hyperplasia were referred for surgical excision, as well as 32 benign lesions showing discordance between US/SE results and histology. All other benign lesions had US follow-up at 6/12 months, showing stability. Overall performance of SE was lower than US, with sensitivity and specificity of 80% and 80.9%, respectively, for SE as compared with 95.4% and 87.4% for US. Statistical analysis showed no improvement in the joint use of SE and US over the use of US alone, whose performance, however, was very high in our study. SE is a simple, fast and non-invasive diagnostic method that may be a useful aid to US for less experienced radiologists in the assessment of solid non-palpable breast lesions, especially BI-RADS 3, where specificity was higher (88.7%).

Sonoelastography of the prostate: Comparison with systematic biopsy findings in 492 patients

ObjectiveThe aim of this study was to assess the value of sonoelastography (SE) for prostate cancer detection in comparison with systematic biopsy findings. Material and methodsFour hundred and ninety two PSA screening volunteers (mean age: 61.9±8.6) with an total PSA >1.25ng/mL and a free to total PSA ration of <18% underwent SE of the prostate before 10 core systematic prostate biopsy. Tissue elasticity of the peripheral zone was investigated only. Tissue elasticity was displayed from red (soft) to green (intermediate) and to blue (hard). Only hard lesions (blue) were considered to be suspicious for prostate cancer. The peripheral zone of the prostate was divided in 3 regions on each side: base, mid-gland, apex. A different investigator performed systematic biopsy, and the biopsy findings were compared with the SE findings. ResultsIn 125 of 492 patients (25.4%) systematic biopsy demonstrated prostate cancer. Cancer was detected in 321 of 2952 (11%) outer gland areas (74 in the base, 106 in the mid-gland, 141 in the apex). The Gleason score ranged from 3 to 10 (mean: 6.5). In SE 533 of 2952 (18.1%) suspicious areas were detected and 258 of these areas (48.4%) showed cancer. Most of the false-positive findings (275/533 areas; 51.6%) were associated with chronic inflammation and atrophy especially at the basal prostate areas. The sensitivity by entire organ was calculated with 86% and the specificity 72%. The analysis by outer gland areas showed the highest sensitivity in the apex (79%). The specificity by outer gland areas ranged between 85% and 93%. The correlation between SE findings and biopsy results was high (p<0.001). ConclusionSonoelastography findings showed a good correlation with the systematic biopsy results. The best sensitivity and specificity was found in the apex region. Sonoelastography seems to offer a new approach for differentiation of tissue stiffness of the prostate and may therefore improve prostate cancer detection.

Comparison of sonoelastography guided biopsy with systematic biopsy: impact on prostate cancer detection

A prospective study was performed to determine the value of sonoelastography (SE) targeted biopsy for prostate cancer (PCa) detection. A series of 230 male screening volunteers was examined. Two independent examiners evaluated each subject. One single investigator performed < or =5 SE targeted biopsies into suspicious regions in the peripheral zone only. The stiffness of the lesion was displayed by SE and color-coded from red (soft) to blue (hard). Hard lesions were considered as malignant and targeted by biopsy. Subsequently, another examiner performed ten systematic biopsies. Cancer detection rates of the two techniques were compared. Cancer was detected in 81 of the 230 patients (35%), including 68 (30%) by SE targeted biopsy and in 58 (25%) by systematic biopsy. Cancer was detected by targeted biopsy alone in 23 patients (10%) and by systematic biopsy alone in 13 patients (6%). The detection rate for SE targeted biopsy cores (12.7% or 135 of 1,109 cores) was significantly better than for systematic biopsy cores (5.6% or 130 of 2,300 cores, P < 0.001). SE targeted biopsy in a patient with cancer was 2.9-fold more likely to detect PCa than systematic biopsy. SE targeted biopsy detected more cases of PCa than systematic biopsy, with fewer than half the number of biopsy cores in this prostate-specific antigen screening population.