Extensor tendinopathy of the elbow assessed with sonoelastography: histologic correlation

Andrea S. Klauser, Mathias Pamminger, Ethan J. Halpern, Mohamed M H Abd Ellah, Bernhard Moriggl, Mihra Taljanovic, Christian Deml, Judit Sztankay, Guenther Klima, Werner R. Jaschke

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Purpose: To compare agreement between conventional B-mode ultrasound (US) and compression sonoelastography (SEL) of the common extensor tendons of the elbow with histological evaluation. Materials and methods: Twenty-six common extensor tendons were evaluated in 17 cadavers (11 females, median age 85 years and 6 males, median age 80 years). B-mode US was graded into: Grade 1, homogeneous fibrillar pattern; grade 2, hypoechoic areas and/or calcifications <30%; and grade 3 > 30%. SEL was graded into: Grade 1 indicated blue (hardest) to green (hard); grade 2 yellow (soft); and grade 3 red (softest). B-mode US, SEL, and a combined grading score incorporating both were compared to histological findings in 76 biopsies. Results: Histological alterations were detected in 55/76 biopsies. Both modalities showed similar results (sensitivity, specificity, and accuracy 84%, 81%, and 83% for B-mode US versus 85%, 86%, and 86% for SEL, respectively, P > 0.3). However, a combination of both resulted in significant improvement in sensitivity (96%, P < 0.02) without significant change in specificity (81%, P < 0.3), yielding an improved overall accuracy (92%). Conclusion: Combined imaging of the extensor tendons with both modalities is superior to either modality alone for predicting the presence of pathologic findings on histology. Key Points: • Combination of B-mode US and SEL proved efficiency in diagnosing lateral epicondylitis.• Combination of B-mode US and SEL in lateral epicondylitis correlates to histology.• Combination of both modalities provides improved sensitivity without loss of specificity.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalEuropean Radiology
DOIs
StateAccepted/In press - Jan 5 2017

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Elasticity Imaging Techniques
Tennis Elbow
Tendons
Histology
Biopsy
Elbow
Cadaver
Elbow Tendinopathy
Sensitivity and Specificity

Keywords

  • Epicondylitis
  • Histology
  • Sonoelastography
  • Tendinosis
  • Ultrasound

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Klauser, A. S., Pamminger, M., Halpern, E. J., Abd Ellah, M. M. H., Moriggl, B., Taljanovic, M., ... Jaschke, W. R. (Accepted/In press). Extensor tendinopathy of the elbow assessed with sonoelastography: histologic correlation. European Radiology, 1-7. https://doi.org/10.1007/s00330-016-4711-x

Extensor tendinopathy of the elbow assessed with sonoelastography : histologic correlation. / Klauser, Andrea S.; Pamminger, Mathias; Halpern, Ethan J.; Abd Ellah, Mohamed M H; Moriggl, Bernhard; Taljanovic, Mihra; Deml, Christian; Sztankay, Judit; Klima, Guenther; Jaschke, Werner R.

In: European Radiology, 05.01.2017, p. 1-7.

Research output: Contribution to journalArticle

Klauser, AS, Pamminger, M, Halpern, EJ, Abd Ellah, MMH, Moriggl, B, Taljanovic, M, Deml, C, Sztankay, J, Klima, G & Jaschke, WR 2017, 'Extensor tendinopathy of the elbow assessed with sonoelastography: histologic correlation', European Radiology, pp. 1-7. https://doi.org/10.1007/s00330-016-4711-x
Klauser, Andrea S. ; Pamminger, Mathias ; Halpern, Ethan J. ; Abd Ellah, Mohamed M H ; Moriggl, Bernhard ; Taljanovic, Mihra ; Deml, Christian ; Sztankay, Judit ; Klima, Guenther ; Jaschke, Werner R. / Extensor tendinopathy of the elbow assessed with sonoelastography : histologic correlation. In: European Radiology. 2017 ; pp. 1-7.
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abstract = "Purpose: To compare agreement between conventional B-mode ultrasound (US) and compression sonoelastography (SEL) of the common extensor tendons of the elbow with histological evaluation. Materials and methods: Twenty-six common extensor tendons were evaluated in 17 cadavers (11 females, median age 85 years and 6 males, median age 80 years). B-mode US was graded into: Grade 1, homogeneous fibrillar pattern; grade 2, hypoechoic areas and/or calcifications <30{\%}; and grade 3 > 30{\%}. SEL was graded into: Grade 1 indicated blue (hardest) to green (hard); grade 2 yellow (soft); and grade 3 red (softest). B-mode US, SEL, and a combined grading score incorporating both were compared to histological findings in 76 biopsies. Results: Histological alterations were detected in 55/76 biopsies. Both modalities showed similar results (sensitivity, specificity, and accuracy 84{\%}, 81{\%}, and 83{\%} for B-mode US versus 85{\%}, 86{\%}, and 86{\%} for SEL, respectively, P > 0.3). However, a combination of both resulted in significant improvement in sensitivity (96{\%}, P < 0.02) without significant change in specificity (81{\%}, P < 0.3), yielding an improved overall accuracy (92{\%}). Conclusion: Combined imaging of the extensor tendons with both modalities is superior to either modality alone for predicting the presence of pathologic findings on histology. Key Points: • Combination of B-mode US and SEL proved efficiency in diagnosing lateral epicondylitis.• Combination of B-mode US and SEL in lateral epicondylitis correlates to histology.• Combination of both modalities provides improved sensitivity without loss of specificity.",
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AU - Pamminger, Mathias

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AU - Abd Ellah, Mohamed M H

AU - Moriggl, Bernhard

AU - Taljanovic, Mihra

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N2 - Purpose: To compare agreement between conventional B-mode ultrasound (US) and compression sonoelastography (SEL) of the common extensor tendons of the elbow with histological evaluation. Materials and methods: Twenty-six common extensor tendons were evaluated in 17 cadavers (11 females, median age 85 years and 6 males, median age 80 years). B-mode US was graded into: Grade 1, homogeneous fibrillar pattern; grade 2, hypoechoic areas and/or calcifications <30%; and grade 3 > 30%. SEL was graded into: Grade 1 indicated blue (hardest) to green (hard); grade 2 yellow (soft); and grade 3 red (softest). B-mode US, SEL, and a combined grading score incorporating both were compared to histological findings in 76 biopsies. Results: Histological alterations were detected in 55/76 biopsies. Both modalities showed similar results (sensitivity, specificity, and accuracy 84%, 81%, and 83% for B-mode US versus 85%, 86%, and 86% for SEL, respectively, P > 0.3). However, a combination of both resulted in significant improvement in sensitivity (96%, P < 0.02) without significant change in specificity (81%, P < 0.3), yielding an improved overall accuracy (92%). Conclusion: Combined imaging of the extensor tendons with both modalities is superior to either modality alone for predicting the presence of pathologic findings on histology. Key Points: • Combination of B-mode US and SEL proved efficiency in diagnosing lateral epicondylitis.• Combination of B-mode US and SEL in lateral epicondylitis correlates to histology.• Combination of both modalities provides improved sensitivity without loss of specificity.

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