Simone Schrading MD, Presenter: Nothing to Disclose

Christiane Katharina Kuhl MD, Abstract Co-Author: Nothing to Disclose

Matthias Gatz, Abstract Co-Author: Nothing to Disclose

Timm Dirrichs, Abstract Co-Author: Nothing to Disclose

Valentin Quack, Abstract Co-Author: Nothing to Disclose

The evaluation of tendinopathy as well as that of epicondylitis humeri are usually done with B-mode ultrasound (US) and power Doppler. SWE has been shown to be useful to evaluate tissue elasticity. Aim of this study was to evaluate the diagnostic utility of complementary SWE in patients with Achilles or patellar tendinopathy or epicondylitis humeri who undergo B-mode and power Doppler US.

A total 92 patients (35 with tendinopathy of the Achilles, 30 of the patellar tendon, and 27 with epicondylitis humeri) were systematically examined with B-mode US using a high-resolution linear 15 MHz probe (Aixplorer, Supersonic). Neovascularization was determined by power Doppler. In all patients, at least 3 SWE maps were acquired. Quantitative, ROI-based analysis of tendon elasticity was done. SWE values < 50kPa had been established previously to indicate pathologically “soft” tendons.

In 59/92 symptomatic tendons (64%), pathologic changes at B-mode US were detected (thickening, hypo- or hyperechoic areas and calcifications and/or neovascularization). In 77/92 (84%), SWE exhibited pathologically “soft” values (mean 37 kPa, ± 10.2). B-mode and Doppler appeared normal In 33/92 tendons (36%); these were 11/35 Achilles tendons (31%), 10/30 patellar tendons (33%) and 12/27 patients with epicondylitis humeri (44%). SWE exhibited pathologically soft tissue values in 28 of these 33 B-mode-normal-appearing tendons (91%). This included 10 of the 11 symptomatic, but B-mode negative Achilles tendons (91%), 10 of the 10 symptomatic, but B-mode-negative patellar tendons, and 8 of the 12 symptomatic, but B-mode negative elbow tendons (67%). Overall sensitivity for displaying a correlate for clinically symptomatic Achilles, patellar, and elbow tendinopathy was 69%, 67% and 56% for B-mode and Doppler US. Adding SWE increased the sensitivity significantly to 97%, 100%, and 85%, respectively.

SWE provides diagnostic information that is complementary to that of B-mode and power Doppler ultrasound, and helps significantly improve US sensitivity for diagnosing tendinopathy.

SWE reveals a pathologic correlate for clinical tendinopathy in over two-thirds of patients with normal B-mode and power Doppler US.

Schrading, S, Kuhl, C, Gatz, M, Dirrichs, T, Quack, V, Shear Wave Elastography (SWE) in the Evaluation of Tendinopathies.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011628.html