An exploratory study of two-dimensional shear-wave elastography in the diagnosis of acute compartment syndrome

Abstract

Background Two-dimensional shear-wave elastography (2D-SWE) is an ultrasound elastography technique that uses shear waves to quantitatively measure tissue stiffness and it has recently been developed as a safe, real-time, and noninvasive imaging technique. The purpose of this study was to investigate the value of 2D-SWE in the diagnosis and treatment of acute compartment syndrome (ACS). Methods 2D-SWE was used to measure the elasticity values of the main muscles in the superficial compartments of the calf in 212 healthy volunteers, and the difference in the muscle elasticity values between different gender and age groups were analyzed. Nine patients with clinical suspicion of ACS were included in this study and 2D-SWE was used to measure the elasticity values of the muscles on the affected and unaffected sides, and a comparative analysis was performed. Results The mean elasticity values of the tibialis anterior (TA), peroneus longus (PL), and gastrocnemius medialis (GA) muscles in the relaxed state of the 212 healthy volunteers were 25.4 ± 3.2 kPa, 15.7 ± 1.5 kPa, and 12.1 ± 2.1 kPa, respectively. No statistically significant differences was observed in the elasticity values of the same muscle under the state of relaxation in different gender and age groups (p > 0.05). A statistically significant difference in the elasticity values of the muscle between the affected and unaffected sides in the fasciotomy group (p < 0.05, n = 5) was observed. In contrast, no difference in the elasticity values of the muscle between the affected and unaffected sides in the conservative group (p > 0.05, n = 4) was observed. There was a statistically significant difference in the elasticity values of the muscle on the affected side in the two treatment groups (p < 0.05). Conclusions When the ACS occurs, the muscle elasticity of the affected limb increases significantly. 2D-SWE is expected to be a new noninvasive technique for the assessment of ACS and may provide a potential basis for clinical diagnosis and treatment.

Diagnostic utility of shear wave elastography in musculoskeletal injuries: A narrative review

“…There was no commentary on additional testing to confirm the acute compartment syndrome diagnosis. 14 SWE was effective in differentiating elasticity values on the affected versus unaffected side. 14 Reliability of measures was not assessed in this study.…”

“…14 SWE was effective in differentiating elasticity values on the affected versus unaffected side. 14 Reliability of measures was not assessed in this study. 14…”

“…However, there was no significant difference in SWV between relaxed and isometric contraction of the rectus femoris or vastus lateralis in patients with OSD and healthy controls. 9 Knee osteoarthritis Hamstring muscles • Shear modulus of the hamstrings in patients with knee OA have a higher shear modulus, that correlates with the Western Ontario and McMaster Universities Arthritis Index score 10 Foot/Ankle Achilles tendinopathy Achilles tendon • Regional SWV in the Achilles tendon is lower in the symptomatic limb compared to the contralateral asymptomatic limb with a minimum cutoff of 350 kPa (10 m/s) for healthy tendons 11,12 • SWE is also effective in diagnosing insertional versus midportion Achilles tendinopathy 13 • Individuals with Achilles tendinopathy had lower SWV at the distal insertion 11 • SWE may be able to identify and classify subtypes of Achilles tendinopathy, including activity-dominant, psychosocial-dominant, and structure-dominant, based on tissue viscosity (kPa) 32 Acute compartment syndrome Tibialis anterior (TA), peroneus longus (PL), gastrocnemius medialis (GA) • Acute compartment syndrome can be diagnosed using SWE, as there is an increase in Young's modulus on the affected side as compared to the unaffected side 14 Plantar fasciitis…”

“…6,11,13 Acute compartment syndrome One study evaluated the use of SWE in clinical diagnosis of acute compartment syndrome. 14 Nine cases of acute compartment syndrome were included in the study. The ratio of Young's modulus between the affected and unaffected side ranged from 1.05 to 9.74.…”

Ultrasonography – a novel auxiliary interpretive approach for tuberculin-purified pure protein derivative skin test: a comparative study

“…With the rapid development of the ultrasound apparatus, ultrasonography has been widely applied in the diagnosis of skin lesions, 8–10 assessment of organ or tissue stiffness performance, 11–13 and in other clinical areas. 14–17 In this study, we aimed to apply ultrasonography and manual judgment for the determination of the PPD test result test.…”