ELASTO GUIDELINES: PART 2. CLINICAL APPLICATIONS
Future perspectives
As befits a new method, elastography is being used in new
applications which as yet lack sufficient strength of evidence to
justify their inclusion in these Recommendations, though their
exclusion should not be taken as implying that they may not prove
to be of clinical value once more experience is gained. The
topics below are an incomplete list of those that are of clinical
interest but whose clinical value is still to be confirmed.
Elastography of superficial lymph nodes, for example in the
neck or inguinal regions, is a promising application, where an
increase in stiffness would be expected in malignancy but might also occur in inflamed nodes [177, 178].
Intraoperative elastography has been applied to the brain to guide the surgeon to stiffer regions that represent tumours
and improve the precision of their resection [179, 180].
Elastography of the uterine cervix to assess the softening
that precedes normal dilatation before delivery is potentially
important. Premature delivery is a major cause of fetal death,
which could be reduced if a simple and reliable means of
identifying premature softening could be developed [181].
Testicular tumours are harder than the surrounding gland on palpation and this might be a useful application of
elastography to aid the distinction between the commoner malignancies and the rarer less invasive tumours such as Leydig cell tumours, which can be managed with tissue-sparing surgery [182].
Anal incontinence, most commonly an obstetrical injury,
leads to scarring which is stiffer than the normal sphincter muscles;
a preliminary report focusses on the presurgical findings,
with promising results [128] whereas postoperative evaluation was disappointing [183]. Elastography has been used in rectal
and anal carcinomas where it improves the discrimination between adenoma and cancer [129] and the differentiation of T2 and
T3 stages of rectal cancer. Although this improved
differentiation has so far not been evaluated, it seems convincing because
inflammatory changes appear softer than the usually harder tumours.
Perineal ultrasound is an effective method for imaging
perianal inflammatory lesions (e. g. in Crohn's disease) but is too
rarely used. Generally speaking, acute inflammatory lesions are
softer and chronic lesions harder in comparison to the surrounding
tissue [184].
Arterial and plaque stiffness has been studied in
preliminary investigations [135, 185, 186] and might form a clinically
useful way to assess vulnerable plaque.
Promising results have been reported on the clinical use of
SE for tendon disease such as for common extensor origin tendons in order to depict tendon and fascia involvement in lateral
epicondylitis [187], for plantar fascia where stiffness changes
with age and disease [188] and for trigger finger, where there is
increased stiffness of the flexor tendon which decreases after steroid
injections [189]. Preliminary studies also show the potential use
of strain elastography in localising myofascial trigger points
to inject with botulin toxin [190] and for diagnosing and
monitoring of inflammatory myopathies by showing changes in muscle
stiffness in correlation with elevated serum markers [173].
Preliminary data are available on stiffness measurements and shear
wave velocities of normal muscle and tendon using shear wave
techniques [175, 191].
Other applications will no doubt emerge as more experience
is gathered.
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