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High resolution ultrasound for imaging complications of muscle injury: Is there an additional role for elastography?

Eleni E. Drakonaki
Eleni E. Drakonaki
, 
Iwona Sudoł-Szopińska
Iwona Sudoł-Szopińska
, 
Christos Sinopidis
Christos Sinopidis
 and 
Panagiotis Givissis
Panagiotis Givissis
   | Jun 28, 2019
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Article Category: review
Published Online: Jun 28, 2019
Page range: 137 - 144
Received: Oct 11, 2018
Accepted: Jan 30, 2019
DOI: https://doi.org/10.15557/jou.2019.0020
Keywords
© 2019 Eleni E. Drakonaki et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Ultrasound appearance of normal healing of a grade II muscle injury (partial tear) at the rectus femoris muscle near the superficial aponeurosis. There is a hypoechoic area filled with fluid (calipers) 3 days after injury (A). Three weeks later, the gap has filled with mildly hypoechoic tissue (asterisk) (B)
Ultrasound appearance of normal healing of a grade II muscle injury (partial tear) at the rectus femoris muscle near the superficial aponeurosis. There is a hypoechoic area filled with fluid (calipers) 3 days after injury (A). Three weeks later, the gap has filled with mildly hypoechoic tissue (asterisk) (B)

Fig. 2.

Ultrasound appearances of scar tissue. Axial US image of the normal (A) and symptomatic (B) rectus femoris muscle of a 25-year-old football player one month after injury. There is significant thickening of the central aponeurosis with associated echogenic scar tissue (asterisk on B ) with subtle neovascularity on Doppler imaging. Comparison to the asymptomatic side (arrow in A ) highlights the difference in thickness and echogenicity. Longitudinal US image of the symptomatic (C) and contralateral asymptomatic (D) medial gastrocnemius muscle of a 22-years-old football player. There is subtle echogenic thickening of the aponeurosis of the muscle (white arrow) compared to the asymptomatic side, indicating the presence of minimal scar tissue
Ultrasound appearances of scar tissue. Axial US image of the normal (A) and symptomatic (B) rectus femoris muscle of a 25-year-old football player one month after injury. There is significant thickening of the central aponeurosis with associated echogenic scar tissue (asterisk on B ) with subtle neovascularity on Doppler imaging. Comparison to the asymptomatic side (arrow in A ) highlights the difference in thickness and echogenicity. Longitudinal US image of the symptomatic (C) and contralateral asymptomatic (D) medial gastrocnemius muscle of a 22-years-old football player. There is subtle echogenic thickening of the aponeurosis of the muscle (white arrow) compared to the asymptomatic side, indicating the presence of minimal scar tissue

Fig. 3.

Real-time strain elastography of scar tissue. Axial US (A) and strain elastography (B) images of rectus femoris muscle of a 33-year-old football player with significant echogenic scar tissue at the central aponeurosis (asterisk on A ) with associated significant acoustic shadowing. The corresponding elastogram shows reduced strain (blue) at the area of scar tissue compared to the normal appearance of the remaining muscle (mosaic pattern of green and red). Longitudinal US image of the symptomatic medial gastrocnemius muscle of a 22-years-old football player. There is subtle echogenic thickening of the aponeurosis of the muscle (white arrow) indicating the presence of minimal scar tissue. The corresponding elastogram shows reduced strain (blue) along the musculo-aponeurotic junction
Real-time strain elastography of scar tissue. Axial US (A) and strain elastography (B) images of rectus femoris muscle of a 33-year-old football player with significant echogenic scar tissue at the central aponeurosis (asterisk on A ) with associated significant acoustic shadowing. The corresponding elastogram shows reduced strain (blue) at the area of scar tissue compared to the normal appearance of the remaining muscle (mosaic pattern of green and red). Longitudinal US image of the symptomatic medial gastrocnemius muscle of a 22-years-old football player. There is subtle echogenic thickening of the aponeurosis of the muscle (white arrow) indicating the presence of minimal scar tissue. The corresponding elastogram shows reduced strain (blue) along the musculo-aponeurotic junction

Fig. 4.

Myositis ossificans in a 17-year-old boy with a tender palpable mass at the middle of the arm that gradually appeared within 2 weeks. X-ray of the humeral bone was unremarkable (A) . Axial T2 fat-saturated MR image (B) shows an inhomogeneous intramuscular lesion close to the humeral periosteum with scarce low signal foci and an intact humeral diaphysis. Axial (C) and longitudinal US images (D) clearly depict the presence of intramuscular calcifications (asterisk) in a laminar pattern parallel to the diaphysis with associated neovascularity, typical of myositis ossificans. Upon enquiring, a history of blunt trauma during a football match was finally recalled 3 weeks prior to the examination
Myositis ossificans in a 17-year-old boy with a tender palpable mass at the middle of the arm that gradually appeared within 2 weeks. X-ray of the humeral bone was unremarkable (A) . Axial T2 fat-saturated MR image (B) shows an inhomogeneous intramuscular lesion close to the humeral periosteum with scarce low signal foci and an intact humeral diaphysis. Axial (C) and longitudinal US images (D) clearly depict the presence of intramuscular calcifications (asterisk) in a laminar pattern parallel to the diaphysis with associated neovascularity, typical of myositis ossificans. Upon enquiring, a history of blunt trauma during a football match was finally recalled 3 weeks prior to the examination

Fig. 5.

Muscle hernia in a 40-year-old man with a tender palpable mass at the tibia following blunt trauma with a rock, more painful after walking (arrow in A ). There is protrusion of muscle fibers through a defect in the epimysium with associated neovascularity probably due to venous congestion (B). Real time strain elastography including B-mode image (C) and the corresponding elastogram (D) show the presence of reduced strain (blue corresponds to high stiffness) at the area of the muscle hernia, highlighting the protrusion/entrapment of tissue at the area of herniation. Dynamic examination of this case is shown in Video 1 (available at www.jultrason.pl)
Muscle hernia in a 40-year-old man with a tender palpable mass at the tibia following blunt trauma with a rock, more painful after walking (arrow in A ). There is protrusion of muscle fibers through a defect in the epimysium with associated neovascularity probably due to venous congestion (B). Real time strain elastography including B-mode image (C) and the corresponding elastogram (D) show the presence of reduced strain (blue corresponds to high stiffness) at the area of the muscle hernia, highlighting the protrusion/entrapment of tissue at the area of herniation. Dynamic examination of this case is shown in Video 1 (available at www.jultrason.pl)

Fig. 6.

Intramuscular cyst/seroma in 45-year-old woman 3 months after blunt trauma (A). There is an intramuscular fluid-filled area containing anechoic fluid (asterisk in A ). There is also a small muscle tear perpendicular to the muscle fibers (arrow). US-guided aspiration using an 18G needle (arrow) of the residual hypoechoic hematoma containing echogenic material in a 50-year-old male (B)
Intramuscular cyst/seroma in 45-year-old woman 3 months after blunt trauma (A). There is an intramuscular fluid-filled area containing anechoic fluid (asterisk in A ). There is also a small muscle tear perpendicular to the muscle fibers (arrow). US-guided aspiration using an 18G needle (arrow) of the residual hypoechoic hematoma containing echogenic material in a 50-year-old male (B)

Fig. 7.

Muscle atrophy. Axial (A) and longitudinal (B) images of muscle atrophy secondary to chronic injury that led to muscle wasting. There is increased echogenicity of the atrophic muscle corresponding to fatty infiltration
Muscle atrophy. Axial (A) and longitudinal (B) images of muscle atrophy secondary to chronic injury that led to muscle wasting. There is increased echogenicity of the atrophic muscle corresponding to fatty infiltration
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