Evaluation of supraspinatus tendon teras with elastosonography in comparison to US and MRI . Our experience

INTRODUCTION: Elastosonography is a new promising ultrasound tool that can evaluate soft-tissue elasticity, in particular of the tendons. The purpose of this study was to value the elasticity of the supraspinatus tendon in shoulders with clinically suspected unilateral rotator cuff tear, and to compare the findings with those of US and MRI. MATHERIALS AND METHODS: 36 shoulders of 18 patients (mean age 46 years; range: 32 – 58 years) were examined by Elastosonography using the EUB – Hitachi 7500 Japan. Electronic array transducer of 13 MHz was used. By Elastosonography, we have evaluated the tendon fibers with a seminquantitative score of different colors representing stiff tissue (blue) to more soft tissue (green, yellow, red). The findings of Elastosonography in the affected side (18/36) were compared to those of grey scale (B-mode) and to those of a subsequent MRI exam. RESULTS: In the affected shoulder of the patients, partial tears were assessed as areas of color changes (yellow and red) not reaching the bursal or articular aspects, as in full-thickness tears. Elastosonography showed 10/18 partial tears, and 8/18 full-thickness tears; in contrast, B-mode showed 12/18 partial tears, and 6/18 full-thickness tears. MRI confirmed the findings of Elastosonography. Tendons of the contralateral healthy shoulder (18/18) were almost invariably blue or green, consistent with normal stiff tendon tissue, matching with the grey scale findings of normal tendon fibrillar echotexture. DISCUSSION: Elastosonography correctly diagnosed a full-thickness tear in 2 cases, while B-mode did not, because of the presence of granulation tissue that simulated degenerated tendon fibers changing the lesion grading from a full-thickness to a partial-thickness tear. In all patients, Elastosonography findings correlated well with MR image, although the size of the tear in some case was larger with MR, presumably because of the additional high signal of perilesional oedema. CONCLUSIONS: Elastosonography is a sensitive method for diagnosis of supraspinatus tendon tears. Detection of tissue softening could add some confidence in the diagnosis of a complete tear in cases of doubtful B-mode images, and this might have an impact on therapeutic decisions.