Limits...
Sonoelastography in the musculoskeletal system: Current role and future directions

View Article: PubMed Central - PubMed

ABSTRACT

Ultrasound is an essential modality within musculoskeletal imaging, with the recent addition of elastography. The elastic properties of tissues are different from the acoustic impedance used to create B mode imaging and the flow properties used within Doppler imaging, hence elastography provides a different form of tissue assessment. The current role of ultrasound elastography in the musculoskeletal system will be reviewed, in particular with reference to muscles, tendons, ligaments, joints and soft tissue tumours. The different ultrasound elastography methods currently available will be described, in particular strain elastography and shear wave elastography. Future directions of ultrasound elastography in the musculoskeletal system will also be discussed.

No MeSH data available.


Related in: MedlinePlus

Pleomorphic sarcoma of the distal thigh. Transverse B mode image with colour Doppler (A) shows a disorganised tumour with wide variation in echotexture and limited Doppler flow. The shear wave velocity elastogram (B) also shows a wide variation in stiffness with some regions of absent measurements, seen as the black areas on the image (arrow), possibly owing to the very dense/stiff nature of the tumour. The axial proton density fat suppressed magnetic resonance image (C) shows a large tumour in the anterior compartment of the thigh with very varied signal.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5120246&req=5

Figure 7: Pleomorphic sarcoma of the distal thigh. Transverse B mode image with colour Doppler (A) shows a disorganised tumour with wide variation in echotexture and limited Doppler flow. The shear wave velocity elastogram (B) also shows a wide variation in stiffness with some regions of absent measurements, seen as the black areas on the image (arrow), possibly owing to the very dense/stiff nature of the tumour. The axial proton density fat suppressed magnetic resonance image (C) shows a large tumour in the anterior compartment of the thigh with very varied signal.

Mentions: In musculoskeletal soft tissue tumours, elastography has been used to prospectively assess lesions to attempt to differentiate between benign and malignant pathologies. Malignant lesions have been shown to be stiffer on strain elastography compared with benign lesions on a semi-quantitative scale, similar to lesions outside of the musculoskeletal system[50]. However, a recently published study by the group in Leeds assessing the role of shear wave elastography in musculoskeletal tumours has been unable to replicate these early findings, with the authors concluding that there is currently no additional role for shear wave elastography in soft tissue tumours compared with B mode imaging[51]. The authors found no statistically significant association between shear wave velocity and malignancy. According to the strain elastography study, one may have expected malignant tumours to be stiffer than benign tumours and thus have a tendency for higher shear wave velocities. Possibly the discordant results are accounted for by the tumour case mix, different elastography technique or study design. Soft tissue tumours are very heterogeneous on B mode imaging (Figure 7) compared with breast lesions and it is probable that further studies will replicate the findings of the Leeds group, showing a large overlap in the shear wave velocity measurements between benign and malignant soft tissue lesions. In the immediate future imaging characteristics alone, even with the addition of elastography, are unlikely to replace biopsy for the diagnosis of malignant vs benign lesions. Similar to tendons, the role of elastography in soft tissue tumours is likely to be in identifying a heterogeneous, disorganised internal substance suggesting an aggressive nature or de-differentiation, vs a smooth homogeneous pattern of a non-aggressive lesion. This could be used to guide biopsy by potentially identifying aggressive regions within a lesion, or to identify malignant degeneration in a previously diagnosed benign lesion.


Sonoelastography in the musculoskeletal system: Current role and future directions
Pleomorphic sarcoma of the distal thigh. Transverse B mode image with colour Doppler (A) shows a disorganised tumour with wide variation in echotexture and limited Doppler flow. The shear wave velocity elastogram (B) also shows a wide variation in stiffness with some regions of absent measurements, seen as the black areas on the image (arrow), possibly owing to the very dense/stiff nature of the tumour. The axial proton density fat suppressed magnetic resonance image (C) shows a large tumour in the anterior compartment of the thigh with very varied signal.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120246&req=5

Figure 7: Pleomorphic sarcoma of the distal thigh. Transverse B mode image with colour Doppler (A) shows a disorganised tumour with wide variation in echotexture and limited Doppler flow. The shear wave velocity elastogram (B) also shows a wide variation in stiffness with some regions of absent measurements, seen as the black areas on the image (arrow), possibly owing to the very dense/stiff nature of the tumour. The axial proton density fat suppressed magnetic resonance image (C) shows a large tumour in the anterior compartment of the thigh with very varied signal.
Mentions: In musculoskeletal soft tissue tumours, elastography has been used to prospectively assess lesions to attempt to differentiate between benign and malignant pathologies. Malignant lesions have been shown to be stiffer on strain elastography compared with benign lesions on a semi-quantitative scale, similar to lesions outside of the musculoskeletal system[50]. However, a recently published study by the group in Leeds assessing the role of shear wave elastography in musculoskeletal tumours has been unable to replicate these early findings, with the authors concluding that there is currently no additional role for shear wave elastography in soft tissue tumours compared with B mode imaging[51]. The authors found no statistically significant association between shear wave velocity and malignancy. According to the strain elastography study, one may have expected malignant tumours to be stiffer than benign tumours and thus have a tendency for higher shear wave velocities. Possibly the discordant results are accounted for by the tumour case mix, different elastography technique or study design. Soft tissue tumours are very heterogeneous on B mode imaging (Figure 7) compared with breast lesions and it is probable that further studies will replicate the findings of the Leeds group, showing a large overlap in the shear wave velocity measurements between benign and malignant soft tissue lesions. In the immediate future imaging characteristics alone, even with the addition of elastography, are unlikely to replace biopsy for the diagnosis of malignant vs benign lesions. Similar to tendons, the role of elastography in soft tissue tumours is likely to be in identifying a heterogeneous, disorganised internal substance suggesting an aggressive nature or de-differentiation, vs a smooth homogeneous pattern of a non-aggressive lesion. This could be used to guide biopsy by potentially identifying aggressive regions within a lesion, or to identify malignant degeneration in a previously diagnosed benign lesion.

View Article: PubMed Central - PubMed

ABSTRACT

Ultrasound is an essential modality within musculoskeletal imaging, with the recent addition of elastography. The elastic properties of tissues are different from the acoustic impedance used to create B mode imaging and the flow properties used within Doppler imaging, hence elastography provides a different form of tissue assessment. The current role of ultrasound elastography in the musculoskeletal system will be reviewed, in particular with reference to muscles, tendons, ligaments, joints and soft tissue tumours. The different ultrasound elastography methods currently available will be described, in particular strain elastography and shear wave elastography. Future directions of ultrasound elastography in the musculoskeletal system will also be discussed.

No MeSH data available.


Related in: MedlinePlus