title: Extensor tendinopathy of the elbow assessed with sonoelastography: histologic correlation.
abstract: OBJECTIVE
  To compare agreement between conventional B-mode ultrasound (US) and compression sonoelastography (SEL) of the common extensor tendons of the elbow with histological evaluation.
  
  
  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%).
  
  
  CONCLUSIONS
  Combined imaging of the extensor tendons with both modalities is superior to either modality alone for predicting the presence of pathologic findings on histology.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Department of Radiology, Medical University of Innsbruck, Anich St. 35, 6020, Innsbruck, Austria.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Klauser
authors.affiliation: Department of Radiology, Medical University of Innsbruck, Anich St. 35, 6020, Innsbruck, Austria.
authors.forename: Mathias
authors.initials: M
authors.lastname: Pamminger
authors.affiliation: Department of Radiology and Urology, Jefferson Prostate Diagnostic and Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Ethan J
authors.initials: EJ
authors.lastname: Halpern
authors.affiliation: Department of Radiology, Medical University of Innsbruck, Anich St. 35, 6020, Innsbruck, Austria. dr_m_hamdy2006@hotmail.com.|Department of Diagnostic Radiology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt. dr_m_hamdy2006@hotmail.com.
authors.forename: Mohamed M H
authors.initials: MMH
authors.lastname: Abd Ellah
authors.affiliation: Department of Anatomy, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Moriggl
authors.affiliation: Department of Medical Imaging, Banner- University Medical Center, Tucson, Arizona, USA.
authors.forename: Mihra S
authors.initials: MS
authors.lastname: Taljanovic
authors.affiliation: Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Deml
authors.affiliation: Department of Radiotherapy, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Judit
authors.initials: J
authors.lastname: Sztankay
authors.affiliation: Department of Histology & Embryology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Guenther
authors.initials: G
authors.lastname: Klima
authors.affiliation: Department of Radiology, Medical University of Innsbruck, Anich St. 35, 6020, Innsbruck, Austria.
authors.forename: Werner R
authors.initials: WR
authors.lastname: Jaschke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002102:Cadaver; D054459:Elasticity Imaging Techniques / Q000379:methods*; D004551:Elbow Joint / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity; D013710:Tendons / Q000000981:diagnostic imaging* / Q000473:pathology; D013716:Tennis Elbow / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography
keywords: Epicondylitis; Histology; Sonoelastography; Tendinosis; Ultrasound