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ECR 2019 / C-3189
Advanced multimodality imaging in degenerative tendon disease: correlation between sonoelastography and MR T2 Mapping imaging qualitative maps
Congress: ECR 2019
Poster No.: C-3189
Type: Scientific Exhibit
Keywords: Tissue characterisation, Comparative studies, Ultrasound, MR, Musculoskeletal soft tissue
Authors: E. cannizzaro, F. Bruno, C. Gianneramo, S. Iafrate, F. Arrigoni, S. Mariani, L. Zugaro, A. Barile, C. Masciocchi; L'aquila/IT



Several studies demonstrated the capability of T2 mapping to detect early biochemical abnormalities that occur in case of tendinopathy[2][8]. Concerning elastosonography, published data showed the uselfuness of this tecnique for detecting the intratendinous and peritendinous alterations, considering the mechanical properties of tissues[3][5][9].


In our study, T2 mapping values, an MR imaging surrogate of collagen pathology, was highly correlated with SE maps, an ultrasound surrogate of decreased elasticity. The association between T2 and SE in localization and grading, a measurable consequence of tendon degeneration, further supports the potential of these metrics as imaging surrogates of tendon quality.


In our study the highest concordance was found for detection of mild-to-severe tendinosis while a lower concordance was found for minimal tendinosis. These results could be due to the lack of accuracy of colour in thoroughly reproducing all continuous value associated with the tendon stiffness[10], a phenomenon which involved especially those minimal difference between normal and pathologic values as in the minimal tendinosis. Our study  showed an high concordance for the middle region of both tendons (crescent area for supraspinatus tendon and mid portion for Achilles tendon) while  poor concordance was found at the musculotendinous junction and insertional area. Indeed, data published showed that evaluation by T2 mapping is more difficult at the level of the medial portions due to the presence of muscle tissue and in the insertion regions [11] [12]  .


The present study has several limitations: first of all, the absence of a control group. Secondly, we used only a qualitative scale evaluation, without considering quantitative parameters such as strain index, kPa values and T2 mapping values; this was due to some technical limits of our equipment. Another limitation is certainly the limited number of patients included in our study population.


In conclusion, our results showed a good correlation and reproducibility in the qualitative assessment of the degree of tendinosis and in the localization of the areas of tendon degeneration using elastosonography and MRI with T2 mapping sequences.


In patients with degenerative tendon disease, US examination with sonoelastography could represent an added value for the assessment and localization of areas of tendon degeneration: this approach could be a potential useful tool in percutaneous US-guided treatments (e.g. needling, PRP injections), to be targeted in these areas.



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