Ultrasound Elastography: Functional Imaging Enhancing Physical Examination

Howard Dobson, BVMS, DVSc

As clinicians, performing a physical examination of the patient is fundamental to be able to make a diagnosis on which our treatment decisions are made. As a diagnostic test, physical examination has its limitations, as do all diagnostic tests. Diagnostic imaging has added to our ability to make a diagnosis for over a century. At the outset, imaging only provided anatomical data; for example, a fracture was present. Later, functional imaging was developed. One of the earliest examples was excretory urography, answering basic questions regarding kidney function. Several forms of functional imaging are now available, ranging from nuclear imaging with a wide variety of clinical and research functions, from identifying areas of increased bone metabolism responsible for lameness to quantifying receptor occupancy by novel drugs in the brain, to Doppler ultrasound to measure blood flow, and magnetic resonance imaging being used to quantify pain responses. Tissue elastography is used to measure the elasticity or hardness or softness of tissues, and this issue includes a timely review of ultrasound elastography as its use becomes more widely available in veterinary practice.[1]

Tissue elastography can be added to either magnetic resonance imaging or ultrasound equipment. For magnetic resonance imaging, additional hardware and software are required, which makes it less practical for veterinary practice. In contrast, ultrasound elastography is now commonly available, at least on the higher-end ultrasound machines, making it easily accessible in veterinary practice. The review by da Silva and colleagues in this issue is an excellent primer for both clinicians and researchers who wish to explore ultrasound elastography. The study includes a very readable review of the relevant physics and is well-referenced for those who wish to delve deeper into the background. This is followed by a review of 10 published studies in veterinary species involving the musculoskeletal system. A PubMed search for publications involving the use of ultrasound elastography involving musculoskeletal tissues in any species resulted in 2,469 hits, with 1,131 having been published in the last 5 years. As is so often the case, our human colleagues were the first out of the starting gate, but the time is ripe for broader use of ultrasound elastography in veterinary orthopaedics. Many more clinical research studies will be required before the clinical utility of ultrasound elastography in veterinary orthopaedics can be fully established.

da Silva and colleagues describe all of the variations of ultrasound elastography equipment that have been or are in current clinical use across different organ systems. In practical terms, for ultrasonographic elastography of the musculoskeletal system, there are two choices: Strain elastography and shear wave elastography. Strain elastography has been available for longer, but it has the disadvantage that, in the musculoskeletal system, freehand compression is applied to the tissues using the ultrasound transducer by the operator.[2] In shear wave elastography, the tissue strain is applied using the ultrasound beam itself, making shear wave elastography much more repeatable, particularly when the technique is not being used frequently by the same operator. In addition, shear wave elastography is more amenable to quantitative analysis than strain elastography.[2]

Publication History

Article published online:
16 January 2026

• References

• 1 da Silva WPR, Ribeiro RR, Oliveira IM, Borges NC. Elastography and applications in the musculoskeletal system in veterinary medicine: From physical bases to image formation. Vet Comp Orthop Traumatol 2026; 39 (01) 1-13
• 2 Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound elastography: Review of techniques and clinical applications. Theranostics 2017; 7 (05) 1303-1329