Reproducibility of a Shear Wave Elastography Procedure for Assessing the Piriformis Muscle Stiffness in a Sample of...

Background/Objectives: Shear wave elastography (SWE) may provide an objective method for quantifying piriformis muscle stiffness, but its clinical and research use requires evidence that the measurement procedure is reliable. This study aimed to determine the intra- and inter-examiner reliability of a standardized SWE protocol for assessing piriformis muscle stiffness and to provide measurement error thresholds for clinical interpretation. Methods: Twenty-one healthy volunteers were assessed bilaterally by two examiners with different levels of ultrasound experience. The piriformis muscle was identified in the long axis beneath the gluteus maximus, and SWE images were acquired using a standardized protocol. Each side was measured twice by each examiner, resulting in 168 ultrasound images. Reliability was analyzed using side-specific observations (n = 42). Intraclass correlation coefficients (ICCs), standard errors of measurement (SEMs) and minimal detectable changes (MDCs) were calculated for shear modulus and shear wave speed. Results: Inter-examiner reliability was good for single measurements, with ICCs of 0.872 for shear modulus and 0.813 for shear wave speed. When the average of two measurements was used, ICCs were similar, reaching 0.876 and 0.832, respectively. Inter-examiner MDC values ranged from 6.1 to 6.2 kPa for shear modulus and from 0.37 to 0.39 m/s for shear wave speed. Intra-examiner reliability was excellent for both examiners, with ICCs ranging from 0.938 to 0.979. Test-retest MDC values ranged from 2.7 to 3.3 kPa for shear modulus and from 0.19 to 0.22 m/s for shear wave speed. Conclusions: SWE provides good inter-examiner and excellent intra-examiner reliability for assessing piriformis muscle stiffness using a standardized acquisition protocol. Longitudinal assessments should preferably be performed by the same examiner, and changes should be interpreted in relation to SEM and MDC values, particularly in multi-examiner settings where absolute measurement error is larger. These thresholds reflect measurement error and should not be interpreted as evidence of diagnostic validity or responsiveness to treatment.