Reliability of shear wave elastography ultrasound to assess the supraspinatus tendon: An intra and inter-rater in vivo study

Abstract

Introduction Shear wave elastography ultrasound is a relatively new technique that evaluates the tissue elasticity by applying an acoustic radiation force impulse. It is undetermined how reliable this modality is in assessing rotator cuff tendons. The aim of this study, therefore, was to evaluate the reliability of shear wave elastography ultrasound to assess the stiffness of normal and tendinopathic supraspinatus tendons. Methods An inter- and intra-rater reliability trial was carried out using shear wave elastography to assess the supraspinatus tendon at its distal insertion, by measuring shear wave velocity and elasticity. Twenty participants with a mean age of 37 (21–69) years old were evaluated. Ten subjects with normal supraspinatus tendon and 10 subjects with tendinopathic tendon were selected. The Virtual Touch Imaging Quantification program was used to generate the acoustic radiation force impulse and to obtain the elastography data. Three raters with different experience in conventional ultrasound were used for the inter-rater trial in normal tendons and the most experienced rater examined all subjects for the intra-rater reliability evaluation. Each rater obtained three readings in three different examinations per subject over a one-week period. Results The mean (±SEM) shear wave velocity for the normal supraspinatus tendon was 9.96 ± 0.02 m/s (=297 kPa), while in the tendinopathic supraspinatus tendon was 8.3 ± 0.2 m/s (=207 kPa) (p < 0.001). The intra-rater trial agreement was excellent, with an intraclass correlation coefficient = 0.96. In the inter-rater testing, the mean shear wave velocity in normal tendons was 9.90 ± 0.07 m/s (=294 kPa), with intraclass correlation coefficient = 0.45. Conclusion Shear wave elastography ultrasound was able to show that tendinopathic tendons were less stiff than normal tendons. It was a reliable imaging technique to assess the supraspinatus tendon, especially when used by a single experienced musculoskeletal sonographer.

Ultrasound shear wave elastography and its association with rotator cuff tear characteristics

“…Unfortunately, differentiating between these factors so that the underlying tissue material properties can be assessed remains challenging, which necessitates highly controlled testing conditions. Even so, SWE measurement reliability under in vivo conditions is typically low to moderate, 5 , 24 , 43 underscoring the sensitivity of SWE measurements to these factors and others (eg, anisotropy).…”

Sonoelastography of the Shoulder: A Narrative Review

“…A statistically significant difference was observed in their study between the two age groups, and SWE modulus showed a significant decrease in the over 60 years old age group. Hackett et al evaluated the reliability of SWE to evaluate the stiffness of normal and tendinopathic supraspinatus tendons (5). They assessed inter-and intra-rater reliability for performing SWE by three raters with different experiences in the conventional US and obtaining three readings in three different examinations per subject over a 1-week period.…”

“…This method measures the shear wave speed to evaluate mechanical properties of tissues to visualize tissue displacements to allow the examiner to infer information regarding the tissular biomechanics (1)(2)(3). Both methods are operator-dependent and have yielded favorable inter-rater reliability (4,5). This narrative review serves as an update on the novel literature concerning the usage of SE of the shoulder since 2018 until to date.…”

Influence of Examiners’ Experience and Region of Interest Location on Semiquantitative Elastography Validity and Reliability

“…After an extensive literature search, several recently published studies were found that assessed the reliability estimates for elastography in different soft tissues structures, Ref. [17] including nerves [18], muscles [19], tendons [20,21] and arteries [22]. Features were assessed with quantitative elastography (including transverse velocity, transverse stiffness, cranio-caudal velocity and cranio-caudal stiffness, showing a poor repeatability of measurements with wide limits of agreement) and semi-quantitative elastography assessing SRs [8,9].…”