Ultrasound shearwave elastography to characterize muscles of healthy and cerebral palsy children
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Updated: Nov 17, 2025
A Novel Application of Musculoskeletal Ultrasound Imaging
Published on: September 17, 2013
Pauline Lallemant-Dudek1,2, Claudio Vergari3, Guillaume Dubois3
1Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France. pauline.lallemant@trs.aphp.fr.
Insights
Shear wave elastography (SWE) demonstrates reliable measurements in children. Spastic muscles in cerebral palsy (CP) show increased stiffness, particularly the gastrocnemius under passive stretching.
Area of Science:
- Biomedical Engineering
- Pediatric Musculoskeletal Research
- Ultrasound Technology
Background:
- Shear wave elastography (SWE) is a non-invasive ultrasound method for assessing soft tissue mechanical properties.
- Understanding muscle stiffness in children, especially those with cerebral palsy (CP), is crucial for diagnosis and treatment.
- Establishing reliable SWE protocols in pediatric populations is essential for clinical application.
Purpose of the Study:
- To evaluate the reliability and reproducibility of SWE in young children.
- To establish reference shear modulus values for healthy pediatric muscles.
- To compare muscle stiffness between healthy, spastic, and non-spastic muscles in children with CP.
Main Methods:
- Reproducibility of SWE was assessed on the biceps brachii and medial gastrocnemius in 7 healthy children by 3 operators.
- A comparison study included a control group (29 healthy children), a spastic CP group (16 children), and a non-spastic CP group (14 children).
- Shear modulus measurements were taken at rest and during passive stretching.
Main Results:
- High intra- and inter-operator reliability was observed for SWE in both biceps and gastrocnemius muscles (CVs ranging from 11.2% to 14.9%).
- No significant differences in shear modulus were found between groups at rest.
- Under passive stretching, non-spastic CP biceps were stiffer than controls (p=0.033), and spastic gastrocnemius showed significantly higher shear modulus than controls (p=0.0003) and non-spastic CP muscles (p=0.017).
- 50% of CP medial gastrocnemius muscles exhibited abnormally high shear moduli when stretched.
Conclusions:
- SWE is a reliable technique for assessing muscle mechanical properties in children.
- Children with cerebral palsy exhibit altered muscle stiffness, with spastic muscles being significantly stiffer, especially under passive stretching.
- SWE can differentiate between healthy and affected muscles in CP, offering potential for improved diagnosis and management.
Abstract:
Shear wave elastography (SWE) is an ultrasound technique to obtain soft tissue mechanical properties. The aim of this study was to establish the reliability of SWE in young children, define reference data on healthy ones and compare the shear modulus of healthy and spastic muscles from cerebral palsy (CP). The reproducibility is evaluated: at rest, on 7 children without any musculoskeletal pathology by 3 different operators, on 2 muscles: biceps brachii long head and medial gastrocnemius. The comparison study was made, on the same 2 muscles, at rest and under passive stretching, with a control group (29 healthy children), a spastic group (spastic muscles of 16 children from CP) and a non-spastic group (non-spastic muscles of 14 children from CP). The intra-operator reliability and inter-operator reliability, in terms of standard deviation, were 0.6 kPa (11.2% coefficient of variation (CV)) and 0.8 kPa (14.9% CV) for the biceps, respectively, and 0.4 kPa (11.5% CV) and 0.5 kPa (13.8% CV) for the gastrocnemius. At rest, no significant difference was found. Under passive stretching, the non-spastic CP biceps were significantly stiffer than the control ones (p = 0.033). Spastic gastrocnemius had a higher shear modulus than in the control muscles (p = 0.0003) or the non-spastic CP muscles (p = 0.017). CP stretched medial gastrocnemius presented an abnormally high shear moduli for 50% of patients.
