Korean J Radiol.  2019 Jul;20(7):1176-1185. 10.3348/kjr.2018.0918.

Shear-Wave and Strain Ultrasound Elastography of the Supraspinatus and Infraspinatus Tendons in Patients with Idiopathic Adhesive Capsulitis of the Shoulder: A Prospective Case-Control Study

• Yun SJ
• Jin W
• Cho NS
• Ryu KN
• Yoon YC
• Cha JG
• Park JS
• Park SY
• Choi NY

• KMID: 2467028
• DOI: http://doi.org/10.3348/kjr.2018.0918

Abstract

OBJECTIVE
To compare the elasticity of the supraspinatus tendon (SST) and infraspinatus tendon (IST) in patients with idiopathic adhesive capsulitis of the shoulder (ACS) with those in the control groups and to evaluate the relationship between age and tendon elasticity.
MATERIALS AND METHODS
The Institutional Review Board approved this prospective, case-control study, which was conducted between November 2017 and March 2018, and informed consent was obtained from all participants. Control groups comprised healthy individuals or those with asymptomatic contralateral shoulders. Twenty-five shoulders in 20 participants in the ACS group (14 women; 53.5 ± 7.9 years) and 24 shoulders in 18 participants in the control group (6 women; 52.6 ± 10.5 years) were included. Elastography was performed in the oblique coronal plane at the neutral shoulder position. Mean/maximum/minimum velocity and stiffness from the shear-wave ultrasound elastography (SWE) and strain ratio (subcutaneous fat/target-tendon) from the strain ultrasound elastography (SE) of the SST and IST were evaluated. Statistical analyses were performed using the Mann-Whitney U test, receiver operating characteristic (ROC) curve, and Spearman correlation.
RESULTS
Both velocity and stiffness in SWE were higher, and the strain ratio in SE was lower in participants with symptomatic shoulders than in those with normal shoulders (p < 0.001). SST- and IST-mean velocity, mean stiffness, and strain ratios showed excellent area under the ROC curve (> 0.970). The elastic modulus was little correlated with age (ρ = −0.340-0.239).
CONCLUSION
SWE and SE indicated that SST and IST were stiffer in patients with ACS than in those with normal shoulders regardless of aging.

Keyword

Adhesive capsulitis of the shoulder; Elastography; Ultrasonography; Rotator cuff; Aging

MeSH Terms

Adhesives*
Aging
Bursitis*
Case-Control Studies*
Elastic Modulus
Elasticity
Elasticity Imaging Techniques*
Ethics Committees, Research
Female
Humans
Informed Consent
Prospective Studies*
ROC Curve
Rotator Cuff
Shoulder*
Tendons*
Ultrasonography*
Adhesives

Figure

• 

  Fig. 1 Flow chart for patient selection.ACS = adhesive capsulitis of shoulder

• 

  Fig. 2 Measurement of elastic modulus with shear-wave (A) and strain (B) ultrasound elastography.A. 65-year-old woman with ACS. Circular ROI of size 0.09-cm2 was set in target tendon at 0.5–1 cm from greater tuberosity (ROI1). Maximum, minimum, SD, and mean velocity in meter per second (m/s) and stiffness in kilopascal (kPa) are autogenerated. B. 75-year-old man with normal shoulder. Two circular ROIs were set in target tendon at 0.5–1 cm from greater tuberosity (ROI1) and subcutaneous fat (ROI2). Strain ratio (ROI2/ROI1) is autogenerated. ROI = region of interest, SD = standard deviation, SST = supraspinatus tendon

• 

  Fig. 3 Symptomatic shoulder in ACS group (A) and normal shoulder in control group (B) with shear-wave ultrasound elastography.A. 43-year-old man with ACS. Color in SST (upper) and IST (lower) is yellow to red, which indicates that tendons are stiff (SST-mean velocity, 4.12 m/s; SST-mean stiffness, 50.87 kPa; IST-mean velocity, 5.33 m/s; IST-mean stiffness, 85.33 kPa). B. 47-year-old man with normal shoulder. Color in SST (upper) and IST (lower) is entirely blue, which indicates that tendon is soft (SST-mean velocity, 1.06 m/s; SST-mean stiffness, 3.36 kPa; IST-mean velocity, 0.98 m/s; IST-mean stiffness, 2.88 kPa). IST = infraspinatus tendon

• 

  Fig. 4 Symptomatic shoulder in ACS group (A) and normal shoulder in control group (B) with strain ultrasound elastography.A. 51-year-old man with ACS. Color in SST (upper) and IST (lower) is green to dark blue, which indicates that tendons are stiff (SST-strain ratio, 0.06; IST-strain ratio, 0.05). B. 47-year-old man with normal shoulder. Color in box in SST (upper) and IST (lower) is yellowish, which indicates that tendon is soft (SST-strain ratio, 0.33; IST-strain ratio, 0.33).

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