Sonoelastography as a Diagnostic Tool in the Assessment of Musculoskeletal Alterations: A Systematic Review

Abstract

Elasticity imaging is a relatively new ultrasound-based technique for investigating musculoskeletal injury. Sonoelastography (SEL), the most commonly used technique, allows determination of the elastic properties of tissue by applying pressure.

Purpose: To critically evaluate the literature regarding the use of SEL in the diagnosis of tendon and muscle alterations.

Materials and Methods: This review includes a systematic literature search performed on major electronic databases. Eight articles were included. The GRADE approach was used to evaluate the quality of evidence presented in the included articles and the strength of their recommendations.

Results: The results on human tendon disorders showed that the SEL findings correlated extremely well with conventional ultrasound (US) findings as well as with magnetic resonance imaging (MRI) and clinical examination. In some articles SEL was found to be even more sensitive than conventional ultrasound and in addition capable of identifying subclinical alterations that conventional ultrasound could not. For skeletal muscle, a close correlation between SEL and US and MRI was found, although there is only one article on the topic. SEL was found to be able to distinguish between healthy and diseased muscles and was potentially more sensitive in identifying early dystrophic changes than US or MRI.

Conclusion: Based on this critical evaluation of the literature, SEL seems to be at least as feasible as US and MRI for assessing tendon alterations and able to identify subclinical tendon alterations not visible with conventional US. The findings in the reviewed articles suggest that SEL could become a supplementary imaging technique in the assessment of musculoskeletal alterations, potentially superior to US and MRI. Until more studies are available, SEL has to be viewed as an experimental examination without sufficient supporting evidence to be used as a routine examination equivalent to US and MRI.

Zusammenfassung

Die Darstellung der Elastizität ist eine relativ neue ultraschallbasierte Technik, um muskuloskelettale Verletzungen zu untersuchen. Die Sonoelastografie (SEL) ist die am häufigsten verwendete Technik, indem sie die Bestimmung der elastischen Eigenschaften von Geweben durch die Anwendung von Druck ermöglicht.

Ziel: Die kritische Bewertung der Literatur in Bezug auf den Einsatz von SEL bei der Diagnose von Veränderungen an Sehnen und Muskeln.

Material und Methoden: Diese Übersicht umfasst eine systematische Literatursuche, die mit den wichtigsten elektronischen Datenbanken durchgeführt wurde. 8 Publikationen wurden ausgewählt. Der GRADE-approach wurde verwendet, um die Qualität der Beweise, die in den eingeschlossenen Artikeln präsentiert werden, und den Härtegrad zu beurteilen.

Ergebnisse: Die Ergebnisse bei den menschlichen Sehnenerkrankungen zeigten, dass die SEL-Befunde äußerst gut mit der konventionellen Sonografie (US) sowie mit der Kernspintomografie (MRI) und der klinischen Untersuchung korrelieren. In einigen Artikeln wurde die SEL sogar noch sensitiver als der konventionelle Ultraschall bewertet und war in der Lage, Veränderungen festzustellen, die mittels herkömmlichen US nicht zu entdecken waren. Beim Skelettmuskel wurde eine enge Übereinstimmung zwischen SEL, US und MRI gefunden, obwohl es nur eine einzige Publikation auf diesem Gebiet gab. Die SEL war in der Lage, zwischen gesunden und erkrankten Muskeln zu differenzieren, und erwies sich bei der Feststellung früher dystrophischer Veränderungen unter Umständen sensitiver als US und MRI.

Schlussfolgerung: Aufgrund der kritischen Durchsicht der Literatur scheint die SEL eine mindestens ebenso praktikable Technik wie US und MRI zu sein, um Veränderungen der Sehnen zu bewerten, und kann subklinische Sehnenveränderungen, die im herkömmlichen US nicht sichtbar sind, feststellen. Die Befunde in den begutachteten Artikeln legen nahe, dass die SEL ein ergänzendes, dem US und MRI möglicherweise überlegenes, bildgebendes Verfahren für die Bewertung muskuloskelettaler Veränderungen ist. Bis weitere Studien verfügbar sind, muss die SEL gleichberechtigt zu US und MRI als experimentelle Untersuchung ohne ausreichend unterstützende Beweise angesehen werden.

Key words

elastography - sonoelastography - musculoskeletal - diagnostic - review

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