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Jeong JY, Khil EK, Seo W. Prospective Evaluation of Normal Supraspinatus Muscle Using Shear Wave Elastography: Comparison With Symptomatic Tendon Tears. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39016110 DOI: 10.1002/jum.16528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/03/2024] [Accepted: 07/07/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE This study aimed to evaluate normal supraspinatus (SS) muscle elasticity using shear wave elastography (SWE) in an asymptomatic group, analyze its correlation with demographic factors and ultrasound (US) grayscale grade, and compare the elasticity between normal SS muscles and symptomatic SS muscles with tendon tears. METHODS A prospective study was conducted with 101 adult patients with normal SS muscle scheduled for surgery due to a contralateral shoulder with SS tendon tear. Both shoulders underwent US examinations, including SWE. The SWE values, including mean and median elasticity, as well as the elasticity ratio, were analyzed for their correlation with demographic characteristics and grayscale grades. A comparison of SWE values was performed between the normal and symptomatic SS muscle groups. RESULTS The mean SWE modulus of the normal SS muscle was 27.87 kPa (±49.04), with an elasticity ratio of approximately 1.52 (±0.03). Males exhibited slightly higher elasticity ratios compared with females (1.61 vs 1.45, P = .016). The interobserver agreement for all SWE measurements was excellent (>0.8). Grayscale grade increased with age, showing a similar pattern in females (P < .001). However, no significant correlation was observed between SWE values and grayscale grade in the normal SS muscle group. SWE values in normal SS muscles were significantly lower than those with tendon tears (P < .001). CONCLUSIONS SWE provides objective measurements of normal SS muscle elasticity. Gender-based variations were observed, with males exhibiting slightly higher elastography ratios. SWE values were significantly lower in asymptomatic SS muscles compared with those with tendon tears.
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Affiliation(s)
- Jeung Yeol Jeong
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Republic of Korea
| | - Eun Kyung Khil
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Republic of Korea
- Department of Radiology, Fastbone Orthopedic Hospital, Hwaseong-si, Republic of Korea
| | - Woorim Seo
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Republic of Korea
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Lin TY, Chang KV, Wu WT, Özçakar L. A systematic review on sonoelastography for rotator-cuff post-repair assessment. Asian J Surg 2024; 47:2097-2105. [PMID: 38383203 DOI: 10.1016/j.asjsur.2024.02.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/02/2023] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
Surgical repair of rotator cuff tears is performed routinely; however, the risks of re-tears and the associated consequences are significant. Sonoelastography, an imaging modality that evaluates the mechanical properties of tissues, can examine the dynamic transitions in rotator cuff stiffness following retear and investigate the relationship between these changes and the occurrences of retears. This systematic review aimed to summarize the role of perioperative sonoelastography in repaired rotator cuffs. A comprehensive search of the PubMed, Embase, and Cochrane databases was conducted, covering studies published until June 19, 2023. The Newcastle-Ottawa scale was used for quality assessment. The key information extracted from each study included the injury/surgery type, follow-up duration, sonoelastography mode, and main sonoelastographic findings. Eleven eligible studies comprising 355 patients were included. All studies focused on supraspinatus muscles and tendons with previous arthroscopic repairs. During the postoperative 1st - 6th months, muscle stiffness increased in the supraspinatus and decreased in the ipsilateral deltoid. Failure to recover supraspinatus muscle elasticity might be indicative of potential tendon re-tear; however, it is imperative to first establish correlations with other imaging modalities. Conflicting findings have been observed regarding stiffening or softening of the supraspinatus tendon after surgical repair. The preoperative stiffness of the supraspinatus tendon did not correlate with postoperative tendon integrity or function.
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Affiliation(s)
- Ting-Yu Lin
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Kanak M, Pawłuś N, Mostowy M, Piwnik M, Domżalski M, Lesman J. Sonographic Characterization of the Pericruciate Fat Pad with the Use of Compression Elastography-A Cross-Sectional Study among Healthy and Post-Injured Patients. J Clin Med 2024; 13:2578. [PMID: 38731107 PMCID: PMC11084231 DOI: 10.3390/jcm13092578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/03/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Background: The pericruciate fat pad (PCFP) in the knee joint is still insufficiently studied despite its potential role in knee pathologies. This is the first reported study which aimed to clarify the characteristics of the PCFP in healthy individuals and contrast them with cases of post-traumatic injuries. Methods: Conducted as a retrospective cross-sectional study (n = 110 knees each) following STROBE guidelines, it employed grayscale ultrasound with echogenicity measurement, compression elastography with elasticity measurement, and Color Doppler for blood flow assessment. Results: PCFP showed a homogenic and hyperechoic echostructure. The echogenicity of the PCFP was higher than that of the posterior cruciate ligament (PCL) (p < 0.001, z-score = 8.97) and of the medial head of gastrocnemius (MHG) (p = 0.007, z-score = 2.72) in healthy knees, but lower than subcutaneous fat (SCF) (p < 0.001, z-score = -6.52). Post-injury/surgery, PCFP echogenicity surpassed other structures (p < 0.001; z-score for PCL 12.2; for MHG 11.65 and for SCF 12.36) and notably exceeded the control group (p < 0.001, z-score = 8.78). PCFP elasticity was lower than MHG and SCF in both groups, with significantly reduced elasticity in post-traumatic knees (ratio SCF/PCFP 15.52 ± 17.87 in case group vs. 2.26 ± 2.4 in control group; p < 0.001; z-score = 9.65). Blood flow was detected in 71% of healthy PCFPs with three main patterns. Conclusions: The main findings, indicating increased echogenicity and reduced elasticity of PCFP post-trauma, potentially related to fat pad fibrosis, suggest potential applications of echogenicity and elasticity measurements in detecting and monitoring diverse knee pathologies. The description of vascularity variations supplying the PCFP adds additional value to the study by emphasizing the clinically important role of PCFP as a bridge for the middle genicular artery on its way to the inside of the knee joint.
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Affiliation(s)
- Michał Kanak
- Department of Orthopaedics and Traumatology, Veterans’ Memorial Teaching Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland
| | - Natalia Pawłuś
- Department of Orthopaedics and Traumatology, Veterans’ Memorial Teaching Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland
| | - Marcin Mostowy
- Department of Orthopaedics and Traumatology, Veterans’ Memorial Teaching Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland
| | | | - Marcin Domżalski
- Department of Orthopaedics and Traumatology, Veterans’ Memorial Teaching Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland
| | - Jędrzej Lesman
- Department of Orthopaedics and Traumatology, Veterans’ Memorial Teaching Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland
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Nasr AJ, Pierson CJ, Tzen YT, Khazzam M, Jain NB, Lin YS. Emerging Role of Quantitative Ultrasound-Based Imaging Techniques for Characterizing Rotator Cuff Tears: A Scoping Review. Diagnostics (Basel) 2023; 13:2011. [PMID: 37370906 DOI: 10.3390/diagnostics13122011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Rotator cuff myosteatosis following cuff tears is very common and one of the most important prognostic factors in clinical management. Quantitative ultrasound-based imaging techniques (QUBIT) are frequently used along with magnetic resonance imaging (MRI) to evaluate rotator cuff fatty degeneration. However, the examination of rotator cuff tissue integrity by QUBIT is lacking a standardized imaging protocol and procedural methodologies. In this scoping review, we synthesized the current state of QUBIT against the reference imaging modalities in patients with rotator cuff tears. The literature search was extracted from 963 studies, with 22 studies included in the final review in accordance with the preferred reporting items for systematic reviews and meta-analyses extensions for scoping reviews. The selected studies included human participants and focused on measuring at least one prognostic or diagnostic factor using ultrasonography-based imaging with reference to MRI. The findings suggest both conventional B-mode ultrasound and shear wave elastography imaging were comparable to MRI-based imaging techniques for the evaluation of fatty infiltration and rotator cuff tear characterization. This review establishes guidelines for reporting shoulder-specific QUBIT aimed at developing a standardized imaging protocol. The objective was to enhance the diagnostic and prognostic capabilities of QUBIT in the clinical setting.
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Affiliation(s)
- Andrew J Nasr
- Department of Applied Clinical Research, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Chris J Pierson
- Department of Applied Clinical Research, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Yi-Ting Tzen
- Department of Applied Clinical Research, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Michael Khazzam
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Nitin B Jain
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Yen-Sheng Lin
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
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Liang JF, Feng MC, Wang J, Chen DX, Guan JY, Luo PP. Usefulness of Shear Wave Elastography in Determining the Tumor Extent of Basal Cell Carcinomas. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:971-976. [PMID: 36149339 DOI: 10.1002/jum.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/29/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the value of shear wave elastography (SWE) in determining tumor extent of basal cell carcinomas (BCC), and thereby determine the optimal surgical margins (OSM). METHODS 10 patients (40 surgical margins) with BCC were collected, the visual observation boundaries (VOB) were marked, and the SWE parameters of soft tissues were measured 1 mm intervals in "3, 6, 9, 12" clock directions, starting from VOB. Then tumors were resected with a 5 mm surgical margin outward expansion of VOB. All specimens were examined pathologically 1 mm intervals from VOB in four clock directions. With the positive margins furthest from the tumor as the real tumor boundaries (RTB) and the negative margins closest to the tumor as the optimal surgical margins (OSM). The SWE parameters were compared between these two groups. RESULTS The elasticity ratio (Eratio ) of average young's modulus between region of interest and adjacent normal soft tissue had statistically significant differences between groups (P = .000), while other parameters show no difference. The Eratio of RTB and OSM were 1.22 ± 0.14 and 0.99 ± 0.07. The area under the ROC curve was .947. Taking 1.075 as the threshold of Eratio for the diagnosis of tumor extent, the sensitivity, specificity and accuracy were 87.5%, 90.0% and 90.0%. The surgical margins designed according to OSM were better than those designed according to VOB + 5 mm (P = .000). CONCLUSIONS The Eratio of SWE is helpful in determining tumor extent of BCC. This is beneficial for surgical margin designing.
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Affiliation(s)
- Jian-Feng Liang
- Department of Ultrasound, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, China
| | - Ming-Chu Feng
- Department of Ultrasound, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, China
| | - Jing Wang
- Department of Pathology, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, China
| | - Dong-Xiang Chen
- Department of Dermatology, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, China
| | - Jian-Ying Guan
- Department of Dermatology, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, China
| | - Ping-Ping Luo
- Department of Ultrasound, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, China
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Editor's Notebook: June 2022. AJR Am J Roentgenol 2022; 218:929-930. [PMID: 35593673 DOI: 10.2214/ajr.22.27640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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