Korean J Radiol.  2011 Jun;12(3):365-375. 10.3348/kjr.2011.12.3.365.

Musculoskeletal Applications of Elastography: a Pictorial Essay of Our Initial Experience

Affiliations
  • 1Focus Diagnostics, Department of Radiology, Focus Diagnostic Center, Punjagutta, Andhra Pradesh, India. lalithamanohar@rediffmail.com

Abstract

Elastography is an ultrasound-based newer imaging technique that is currently being used for the evaluation of breast lesions and hepatic pathology. It is also being evaluated for characterizing lesions of the prostate, thyroid, cervix and lymph nodes. We have applied real-time sonoelastography to a variety of musculoskeletal pathologies and here we report the findings of elastography for the evaluation of various musculoskeletal pathologies. Elastography of musculoskeletal lesions is not yet being routinely used in clinical practice, but it is being extensively researched.

Keyword

Elastography; Musculoskeletal; Achilles tendon; Supraspinatus; Synovium

MeSH Terms

Elasticity Imaging Techniques/*methods
Humans
Musculoskeletal Diseases/*ultrasonography

Figure

  • Fig. 1 Transverse real time sonoelastography view and B mode image of distal Achilles tendon in healthy asymptomatic young adult, and it shows distal Achilles tendon (arrows) with predominant blue areas representing hardness.

  • Fig. 2 Transverse real time sonoelastography image in asymptomatic geriatric patient shows distal Achilles tendon (arrows) with predominant green areas representing intermediate stiffness.

  • Fig. 3 Longitudinal real time sonoelastography image shows distal Achilles tendon in symptomatic geriatric patient with predominant red areas indicating softness.

  • Fig. 4 Normal supraspinatous tendon. A. Real time coronal sonoelastography view and B mode image of supraspinatous tendon in healthy asymptomatic young adult shows supraspinatus tendon with predominant blue areas (thick arrows on bursal surface) representing hardness (thin arrows on articular surface). B. Coronal short tau inversion recovery (STIR) MRI of same patient in A reveals normal supraspinatus tendon (arrows). G = glenoid, H = humerus

  • Fig. 5 Supraspinatous tendinosis. A. Real time coronal sonoelastography view and B mode image of supraspinatous tendon in elderly patient and, it shows mildly bulky supraspinatus tendon (long arrows on bursal surface, short arrows on articular surface) with green and red colors representing firm to soft areas. B. Coronal T1-weighted MRI of same patient in A reveals bulky supraspinatus tendon (arrows) with tendinosis. G = glenoid, H = humerus, IS = infraspinatus, SS = supraspinatus

  • Fig. 6 Real time coronal sonoelastography view and B mode image in young patient with post traumatic tear, showing blue color in most of supraspinatus (thin arrows) tendon with traces of green and red at site of tear (thick arrow). H = humerus

  • Fig. 7 Elbow tuberculosis. A. Real time sonoelastography view and B mode image in middle aged patient with tuberculosis of elbow. Hypertrophied synovium (arrow) shows predominant firm to soft consistency, i.e., predominant red color with patchy green areas. LC = lateral condyle B. MRI in same patient as in A reveals hypertrophied synovium (arrows). H = humerus, R = radius

  • Fig. 8 Rheumatoid arthritis of wrist. A. Real time sonoelastography view and B mode image in middle aged patient with rheumatoid arthritis of wrist. Hypertrophied synovium (arrows) shows predominant firm to soft nature, which is represented by predominant red color with patchy green areas. B. MRI in same patient as in A reveals hypertrophied synovium (arrows).

  • Fig. 9 Hemangioma. A. Transverse real time sonoelastography view and B mode image in young adult with small hemangioma (arrows) in distal forearm. It shows predominant red to green areas representing soft to firm nature. B. Axial fat saturation MRI of distal forearm in same patient as in A reveals hyperintense intramuscular hemangioma (arrows).

  • Fig. 10 Median nerve neurofibroma. A. Real time sonoelastography image of median nerve neurofibroma (arrows) in patient of neurofibromatosis. Lesion shows predominant green color representing uniform firmness. B. Axial MRI reveals median nerve neurofibroma (arrows). B = brachialis, BA = brachial artery, L = lateral epicondyle, M = medial epicondyle, O = olecranon, UN = ulnar nerve

  • Fig. 11 Transverse real time sonoelastography view and B mode image in young adult, with small ganglion cyst (arrows) in dorsal aspect of wrist showing predominant red areas representing soft nature.

  • Fig. 12 Triceps myositis. A. Transverse real time sonoelastography view and B mode image in middle aged lady showing bulky lateral head of triceps (arrows) with predominant green areas representing firmness. H = humerus B. Axial short tau inversion recovery (STIR) MRI reveals bulky lateral head of triceps with hyperintense signals. B = brachialis, Lo T = long head of triceps, LT = lateral head of triceps

  • Fig. 13 Lipoma arborescens. A. Transverse real time sonoelastography view and B mode image of knee in middle aged man showing villous lipomatous proliferations in predominant red color with few areas of green suggesting soft to firm consistency. B. Axial T1-weighted MRI of same patient as in A showing villous lipomatous proliferations (arrows) with moderate effusion. F = femur, P = patella

  • Fig. 14 Ulnar neuritis. A. Transverse real time sonoelastography view and B mode image in elderly man showing bulky ulnar nerve (neuritis) with predominant red areas (arrows) representing softness with loss of normal firmness. MC = medial epicondyle of humerus B. Axial short tau inversion recovery (STIR) MRI of same patient as in A showing thickened edematous ulnar nerve (arrow). B = brachialis muscle, BV = basilic vein, CV = cephalic vein, L = lateral supracondylar ridge, LT = lateral head of triceps, M = medial supracondylar ridge

  • Fig. 15 Pigmented villonodular synovitis. A. Longitudinal real time sonoelastography view and B mode image of knee in middle aged lady with pigmented villo-nodular synovitis (arrows) in region of Hoffa's fat pad showing predominant red and green areas that represent soft to firm nature. PT = patellar tendon, T = tibia B. Sagittal T1-weighted MRI in same patient as in A showing lesion to be homogenously hypointense on T1-weighted sequence (arrow, patellar tendon). F = femur, Fi = fibula, P = patella, T = tibia


Cited by  1 articles

Sonoelastography on Supraspinatus Muscle-Tendon and Long Head of Biceps Tendon in Korean Professional Baseball Pitchers
Joo Han Oh, Joon Yub Kim, Do Hoon Kim, Yong Il Kim, Jae Ho Cho
Korean J Sports Med. 2016;34(1):28-35.    doi: 10.5763/kjsm.2016.34.1.28.


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