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Miller T1, Huang M1, Ying M2, Pang M1
1Hong Kong Polytechnic University, Rehabilitation Science, Hong Kong, Hong Kong, 2Hong Kong Polytechnic University, Health Technology and Informatics, Hong Kong, Hong Kong
Background: An increasing number of studies have used ultrasound elastography to investigate biomechanical properties of the musculoskeletal system. While there are several different ultrasound elastography techniques capable of providing either quantitative or qualitative measures of these properties, each differs in frequency content, method of excitation and interface. Using dynamic radiation force techniques involving a singular handheld transducer to generate displacement and wave propagation, it is possible to determine the viscoelasticity of musculoskeletal tissues with accuracy and with a limited amount of operator error.
Purpose: The objective of this review was to investigate the reliability and validity of dynamic ultrasound elastography techniques involving displacement, shear wave ultrasound radiation force or acoustic pulse to determine muscle, tendon or fascia stiffness among in-vivo subjects with or without concomitant pathologies.
Methods: A systematic search of MEDLINE, EMBASE, CINAHL, SportDiscus, and Cochrane Library databases was performed in accordance with the PRISMA guidelines. Using Covidence online data extraction and screening software, two reviewers independently screened the titles and abstracts of each reference in order to determine propriety for inclusion. Inclusions and relevant hand-searched publications from reference lists were entered into the full-text screening before being selected for inclusion in the final review. A third member of the review team was consulted to reach a consensus regarding any discrepancies or disagreements. Two reviewers conducted the data extraction independently. The authors of studies with missing or omitted data were contacted and included with the contingency of a reply within a timeframe of 10 days. Rating of methodological quality for included studies was conducted using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Data synthesis involved tabulating the findings according to the type of ultrasound elastography technique employed. Relevant data categorization included subject demographics, measurement site, and reported convergent, divergent or concurrent validity and / or reliability or reproducibility of stiffness measurements taken.
Results: The systematic search yielded a total of 1,661 citations that met the inclusion criteria after duplicates were removed. An additional 1,583 citations were removed during title and abstract screening. The remaining 78 plus 129 hand searched citations were also included in the full-text review. A total of 69 articles were included for final review. The majority of studies were either cross-sectional or pre-post intervention designs. The methodological quality rating for most ranged from poor to fair due, in large part, to inadequate sample size. Most studies employing the use of the shear wave elastography technique demonstrated good to excellent reliability (intraclass correlation coefficient >0.75). Validity was difficult to determine due to the limited and heterogeneous use of concurrent comparators between studies.
Conclusion(s): Overall, dynamic radiation force ultrasound elastography techniques are a reliable means of evaluating in-vivo musculoskeletal stiffness across a range of subject demographics.
Implications: As this diagnostic modality becomes increasingly ubiquitous, ultrasound elastography will have tremendous clinical value in determining response to treatment, and in monitoring progressive musculoskeletal changes related to age and chronic disease.
Keywords: Musculoskeletal, Ultrasound, Elastography
Funding acknowledgements: Tiev Miller and Meizhen Huang are supported by full-time post-graduate scholarship from The Hong Kong Polytechnic University
Purpose: The objective of this review was to investigate the reliability and validity of dynamic ultrasound elastography techniques involving displacement, shear wave ultrasound radiation force or acoustic pulse to determine muscle, tendon or fascia stiffness among in-vivo subjects with or without concomitant pathologies.
Methods: A systematic search of MEDLINE, EMBASE, CINAHL, SportDiscus, and Cochrane Library databases was performed in accordance with the PRISMA guidelines. Using Covidence online data extraction and screening software, two reviewers independently screened the titles and abstracts of each reference in order to determine propriety for inclusion. Inclusions and relevant hand-searched publications from reference lists were entered into the full-text screening before being selected for inclusion in the final review. A third member of the review team was consulted to reach a consensus regarding any discrepancies or disagreements. Two reviewers conducted the data extraction independently. The authors of studies with missing or omitted data were contacted and included with the contingency of a reply within a timeframe of 10 days. Rating of methodological quality for included studies was conducted using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Data synthesis involved tabulating the findings according to the type of ultrasound elastography technique employed. Relevant data categorization included subject demographics, measurement site, and reported convergent, divergent or concurrent validity and / or reliability or reproducibility of stiffness measurements taken.
Results: The systematic search yielded a total of 1,661 citations that met the inclusion criteria after duplicates were removed. An additional 1,583 citations were removed during title and abstract screening. The remaining 78 plus 129 hand searched citations were also included in the full-text review. A total of 69 articles were included for final review. The majority of studies were either cross-sectional or pre-post intervention designs. The methodological quality rating for most ranged from poor to fair due, in large part, to inadequate sample size. Most studies employing the use of the shear wave elastography technique demonstrated good to excellent reliability (intraclass correlation coefficient >0.75). Validity was difficult to determine due to the limited and heterogeneous use of concurrent comparators between studies.
Conclusion(s): Overall, dynamic radiation force ultrasound elastography techniques are a reliable means of evaluating in-vivo musculoskeletal stiffness across a range of subject demographics.
Implications: As this diagnostic modality becomes increasingly ubiquitous, ultrasound elastography will have tremendous clinical value in determining response to treatment, and in monitoring progressive musculoskeletal changes related to age and chronic disease.
Keywords: Musculoskeletal, Ultrasound, Elastography
Funding acknowledgements: Tiev Miller and Meizhen Huang are supported by full-time post-graduate scholarship from The Hong Kong Polytechnic University
Topic: Outcome measurement; Outcome measurement
Ethics approval required: No
Institution: The Hong Kong Polytechnic University
Ethics committee: Human Subjects Ethics Sub-Committee of Hong Kong Polytechnic University
Reason not required: This study was a systematic review of existing literature and did not involve Ethics Committee approval
All authors, affiliations and abstracts have been published as submitted.
