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Updated: Oct 2, 2025

A Novel Application of Musculoskeletal Ultrasound Imaging
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REAL-TIME strain elastography: Applications in musculoskeletal system.

Darshana Dilip1, Sanjay M Khaladkar1, Vijetha Chanabasanavar1

  • 1Department of Radio-diagnosis, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth, Pune, India.

Journal of Clinical Orthopaedics and Trauma
|February 25, 2022
PubMed
Summary

Compression sonoelastography (CE) demonstrates high diagnostic accuracy for musculoskeletal conditions, offering a valuable, affordable alternative to MRI for screening and follow-up. This technique aids in diagnosing various pathologies and monitoring treatment effectiveness.

Keywords:
Benign and malignantMusculoskeletal systemSoft tissue tumoursStrain elastographyTendinosisUltrasound

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Area of Science:

  • Musculoskeletal imaging
  • Diagnostic ultrasound techniques
  • Soft tissue biomechanics

Background:

  • Compression sonoelastography (CE) measures tissue deformability to assess elasticity, providing a color-coded elastogram.
  • Elastographic ultrasound (EUS) is crucial for diagnosing and monitoring inflammatory, degenerative, and neoplastic pathologies of soft tissues.
  • EUS aids in targeted biopsies and assessing tendon healing or nerve stiffness.

Purpose of the Study:

  • To evaluate the stiffness of normal tendons, muscles, and nerves.
  • To diagnose conditions like cellulitis, fasciitis, abscesses, tendinopathy, myositis, and muscle/tendon injuries.
  • To differentiate between benign and malignant soft tissue tumors using elastic score (ES) and strain ratio (SR) and correlate with B-mode ultrasound.

Main Methods:

  • A prospective study involving 50 healthy subjects and 50 patients with musculoskeletal pathologies over two years.
  • Utilized both B-mode and compression sonoelastography (CE) for imaging.
  • Statistical analysis included distribution, mean, associations, sensitivity, specificity, and area under the Receiver Operating Characteristic curve (AUROC).

Main Results:

  • A significant association was found between strain ratio (SR) in muscles and tendons with sex.
  • Elastic score (ES) and SR showed significant correlation with B-mode findings.
  • Combined B-mode and CE achieved 100% sensitivity and 90.91% specificity in differentiating benign and malignant masses, with the highest diagnostic accuracy and AUROC.

Conclusions:

  • Compression sonoelastography (CE) exhibits high diagnostic accuracy as a screening tool for musculoskeletal conditions, indicating a need for standardization.
  • Elastographic ultrasound (EUS) is a widely available, fast, and affordable modality beneficial for monitoring chronic musculoskeletal pathologies and treatment response.
  • EUS can potentially reduce the reliance on MRI for certain musculoskeletal assessments.