• Document: US and US Elastography of the Musculoskeletal System Upper and Lower Limb
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US and US Elastography of the Musculoskeletal System Upper and Lower Limb Elena Drakonaki MD, PhD, PostDoc Consultant MSK Radiologist Independent Practice Heraklion, Greece Radcliff NHS Trust, Oxford, UK MSK imaging EUROSON SCHOOL 2014, Athens www.drakonaki.gr Xray-fluoroscopy CT MR Ultrasonography Advantages Limitations Real time multiplanar imaging Long learning curve Dynamic examination Bone marrow & Cartilage Contralateral comparison Intraarticular structures No radiation Cheap, practical & widely available Soft tissue & joint intervention MSK imaging EUROSON SCHOOL 2014, Athens www.drakonaki.gr What makes US so special? Allows clinical examination imaging & intervention High Resolution US EUROSON SCHOOL 2014, Athens www.drakonaki.gr A new generation of US scanners Probes High spatial resolution High resolution Compounding High frequency (10-18ΜΗz) Speckle reducing algorithms Ergonomic probes Harmonics 3D/4D probes Sensitive power/colour Doppler New techniques EUROSON SCHOOL 2014, Athens Elastography www.drakonaki.gr Clinical applications in MSK: Achilles Plantar fascia Epicondylitis Muscle Small tendons Rotator cuff Strain EUS ARFI Shear wave New techniques EUROSON SCHOOL 2014, Athens www.drakonaki.gr Fusion imaging: a new dimension St Lukes radiology team Oxford UK US-guided MSK intervention EUROSON 2013, Stuttgart www.drakonaki.gr Spine Intervention Injection into SI Joint Hard to visualise with US High Resolution MSK US EUROSON SCHOOL 2014, Athens www.drakonaki.gr Clinical Indications Standard Radiographs + High resolution US Bone and Joint Tendon, Nerve, Ligament, Synovium First line imaging tool Alternative or supplementary to MR Klauzer et al. Clinical indications for musculoskeletal ultrasound: a consensus paper of the European Society of Musculoskeletal Radiology. Εur Radiol 2012 High Resolution MSK US EUROSON SCHOOL 2014, Athens www.drakonaki.gr Accuracy US Clinical opinion* Solid masses 82.1% 64.2% *Reference centre Cystic masses 100% 86.1% for upper limb disorders Tendon disorders 86.5% 68.7% Nerve disorders 100% 100% Synovitis 100% 25% OA, Fractures 100% 33.3% Foreign Body 100% 83.3% No abnormality 84.6% 15.4% TOTAL 164/178 (92.1%) 126/178 (70.8%) Allen GM, Drakonaki EE et al. High-resolution ultrasound in the diagnosis of upper limb disorders: A tertiary referral centre experience. J Hand Surg 2008 High Resolution MSK US EUROSON SCHOOL 2014, Athens www.drakonaki.gr Accuracy US MR Epicondylitis 67-100% 83-100% Miller et al J Clin Ultrasound 2002 Partial RC tears 90% 90% Vlychou et al, Acta radiol 2009 *Partial RC tears 89% 67% Rutten et al, Eur Radiol 2010 Full-thick RC tears 95% 100% Rutten et al, Eur Radiol 2010 *Achlilles tendinopathy 100% 62.5% Κamel et al, J Rheumatol 2003 RA changes hand/wrist 80-96%

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