Use of Ultrasound Elastography in the Assessment of the Musculoskeletal System

Abstract

SummaryThis article presents possible applications of ultrasound elastography in musculoskeletal imaging based on the available literature, as well as the possibility of extending indications for the use of elastography in the future. Ultrasound elastography (EUS) is a new method that shows structural changes in tissues following application of physical stress. Elastography techniques have been widely used to assess muscles and tendons in vitro since the early parts of the twentieth century. Only recently with the advent of new technology and creation of highly specialized ultrasound devices, has elastography gained widespread use in numerous applications.The authors performed a search of the Medline/PubMed databases for original research and reviewed publications on the application of ultrasound elastography for musculoskeletal imaging.All publications demonstrate possible uses of ultrasound elastography in examinations of the musculoskeletal system. The most widely studied areas include the muscles, tendons and rheumatic diseases. There are also reports on the employment in vessel imaging.The main limitation of elastography as a technique is above all the variability of applied pressure during imaging, which is operator-dependent. It would therefore be reasonable to provide clear guidelines on the technique applied, as well as clear indications for performing the test. It is important to develop methods for creating artifact-free, closed-loop, compression-decompression cycles.The main advantages include cost-effectiveness, short duration of the study, non-invasive nature of the procedure, as well as a potentially broader clinical availability. There are no clear guidelines with regard to indications as well as examination techniques.Ultrasound elastography is a new and still poorly researched method. We conclude, however, that it can be widely used in the examinations of musculoskeletal system. Therefore, it is necessary to conduct large, multi-center studies to determine the methodology, indications and technique of examination.

Shearwave elastography of the knee menisci

“…Fewer studies involved ligaments like the transverse carpal ligaments (55.2 kPa). [13][14][15][16][17] Important peripheral nerves were also evaluated by elastography like the median nerve with a mean elasticity at the carpal tunnel reaching 32 kPa. [ 18] The values of mean elasticity of the menisci obtained in our study are expected to be increase or decrease in different types of pathologies according the degree of stiffness.…”

Potential of PET-MRI for imaging of non-oncologic musculoskeletal disease

“…Additionally, there are many other imaging methods that have shown potential for solving some of the complex problems discussed above that were not discussed (2). This includes single-photon emission computed tomography (SPECT) for imaging of infection or bone turnover (115), high-resolution peripheral quantitative computed tomography (pQCT) for assessment of bone mineral density (116), as well as ultrasound (117) and optical methods (118).…”

Emerging Technological Advances in Musculoskeletal Ultrasound

“…In addition to evaluating tendon disorders, sonoelastography has also been used to evaluate skeletal muscle disorders. Preliminary studies have described the utility of sonoelastography in objectively evaluating myopathies, spasticity, and myofascial trigger points and in guiding botulinum toxin injections for spasticity [15]. Although the Modified Ashworth Scale (MAS) and Modified Tardieu Scale are commonly used to grade muscle spasticity, both involve subjective rather than objective assessments.…”