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Sonoelastography - Uses, Procedure, and More

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Sonoelastography is a specialized imaging technique used to assess tissue stiffness, thereby determining any underlying pathology.

Written byDr. Nikitha Narayanan

Medically reviewed byDr. Muhammad Shoyab

Published At July 8, 2022
Reviewed AtJune 4, 2024

Introduction

Elastography is a non-invasive technique to differentiate the elasticity of diseased and normal tissue. It is used in different modalities of radiology, which include ultrasound and magnetic resonance imaging out of which sonoelastography is the most commonly used of all modalities. Sonoelsatography is an effective and valuable technique for the detection of the intratendinous and peritendinous alterations of lateral epicondylitis. They help differentiate between control and diseased extensor tendon origins with high sensitivity and strong correlation with ultrasound findings.

What Is Sonoelastography?

Sonoelastography is a novel sonographic imaging technique that is used to assess the mechanical properties of tissue such as its elasticity and stiffness. Like sonography, sound waves detect the tissue's stiffness and elasticity in response to a mechanical strain. The change in the soft tissue elasticity from the standard range helps detect any underlying pathologies. A tumor or pathology is considered stiffer than its corresponding normal tissues. Since the tumors are stiffer, they deform less than the surrounding tissues when applying mechanical strain. This difference in elasticity provides the base for diagnosis. This procedure is also known as ultrasound elastography.

What Is the Principle Involved?

The basic principle in sonoelastography is tissue elasticity. Tissue elasticity can be defined as tissue deformability, which can be determined as hardness, stiffness, or compressibility. Tissue stiffness can be calculated using Young’s modulus or modulus of elasticity. It is defined as stress (force applied) divided by strain (deformation). Low-frequency vibrations are sent into the soft tissue. An ultrasound is used to measure the speed with which these vibrations travel through the tissue, which is then assessed by the computer to create a visual map depicting the elasticity of the tissue.

Where Is Sonoelastography Used?

Sonoelastography is widely used to diagnose conditions associated with the liver, breast, thyroid, prostate, kidney, lymph nodes, muscles, and tendons.

1. Liver:

  • Sonoelastography is the first choice in diagnosing liver disease as it is non-invasive and gives a chance to avoid biopsy.

  • It is used in chronic liver diseases, fibrosis, and liver cirrhosis.

  • It is also used to monitor the response to treatment.

  • It can identify the risk of complications that are associated with liver diseases.

2. Muscle and Bone:

  • It is used to differentiate inflammatory diseases from traumatic and neoplastic conditions.

  • It is used in tendon imaging.

  • Used in diagnosis of Achilles tendon disorder, lateral epicondylitis, patellar tendinopathy.

3. Breasts:

  • Sonoelastography is considered the first choice for the diagnosis of breast lumps.

  • Ultrasound elastography is used to diagnose benign and malignant breast neoplasms. Malignant tumors are more complex and stiffer when compared to their standard and benign counterpart.

  • It has superior diagnostic accuracy when compared to conventional ultrasound.

  • Increased specificity and sensitivity.

4. Thyroid:

  • It is used to assess thyroid nodules to characterize their neoplastic origin.

5. Kidney:

6. It is widely used in the detection of prostate cancer.

7. Lymph Nodes:

  • Ultrasound elastography could be a non-invasive diagnostic aid to characterize benign, malignant, and metastatic lymph nodes.

8. Cervical Elastography:

  • Sonoelastography of the internal cervical opening is considered an auxiliary diagnostic tool for predicting preterm delivery in pregnant women.

What Are the Preparations Needed?

  • No special preparations are required.

  • Patients are advised to wear comfortable clothing.

  • Before the procedure, they are advised to remove all the jewelry and other valuables.

  • Ideally, patients will be advised to fast 6 to 8 hours before the procedure.

  • Patients are advised to avoid sugary food and beverages during liver examinations, as they may affect the procedure.

  • For gallbladder examination, patients are advised to avoid fatty food.

  • Pregnant women are advised to inform the doctor before the procedure.

  • If patients are taking any prescription medicines, they are advised to inform the radiologist before the procedure.

How Is the Procedure Performed?

  • Sonoelastography is usually done on an outpatient basis.

  • The patient will be advised to lie down on the examination table.

  • The examination site is exposed.

  • A gel is put on the skin over the area to be scanned.

  • The gel helps the transducer make secure contact with the body.

  • A transducer (small microphone-like device) will be placed on the area to be examined.

  • The transducer emits sound waves that are inaudible to the human ear.

  • An ultrasound probe is placed on the skin's surface near the area to be examined.

  • The probe should be held with continuous pressure and should not be moved.

  • This probe sends painless, low-frequency vibrations to the tissue to be examined.

  • The transducer would be moved back and forth over the examination area.

  • The image is captured by the computer and displayed as a real-time picture.

How Are the Results Interpreted?

The degree of elasticity and the corresponding pathological changes can be determined in one of the following two ways:

1.Numerical method

The value of elasticity is scored based on young’s modulus. Value of elasticity< 20kPa are considered benign, and those >20kPa are considered malignant.

2. Color (encoding) method

Color (encoding) method

What Are the Instructions to Be Followed After the Procedure?

This procedure is non-invasive and painless. Patients can go on with their normal activities immediately.

What Are the Benefits of This Procedure?

  • Non-invasive.

  • Painless.

  • Quick and well tolerated by the patients.

Are There Any Risks to the Test?

Ultrasound examination has no known risks to human beings.

What is The Diagnostic Accuracy of Sonoelastography in Different Diseases?

Sonoelsatography is a rapid and noninvasive technique with high sensitivity and specificity for the detection of many diseases. Tissue elasticity will not only vary across different tissues but also seem to reflect disease-induced alterations in tissue properties. Recently, real-time sonoelastography has been applied to normal and pathological tissues in muscle and tendon disorders, and it has shown promising results and new potential.

Conclusion:

The use of sonography in the medical field is advancing day by day. Hence, the need for innovations in this technique is also deemed essential. Sonoelastography is one such technique that has complimented various other diagnostic aids. Its non-invasive nature and high diagnostic sensitivity have made it a first choice for liver diseases, breast lumps, and prostate cancer. A proper standardization of this technique will ensure its vital role in various clinical applications, diagnostic purposes, and treatment evaluations.

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Frequently Asked Questions

Elastography ultrasound is a set of techniques that relies on sound waves to analyze the stiffness of liver tissue, whereas stiffness is considered a sign of liver fibrosis. It is a modern revolutionary means of older imaging called sonographic imaging. This method requires minimal invasion.
 
Liver elastography is a test used to analyze and measure the stiffness of the liver. Here, a surface ultrasound probe is used on the minimal volume of live tissue present under the rib cage. This ultrasound probe exerts a pulse of low frequency. So, sound wave transmission in liver elastography is wholly a painless process. It is primarily used to diagnose a condition called liver fibrosis. 
The significant principle of elastography can be described in the following ways.
- Perturbing the organ tissue by means of the quasi-static, transient, or consonant mechanical source.
- Measuring the resultant mechanical response.
- Suspecting the biomechanical properties of underlying organ tissue. 
 
Liver fibrosis results when the normal healthy liver tissue becomes scarred and not active for its task. The chronic forms of liver fibrosis could result in liver cirrhosis and other liver damage. The mild to moderate or early stages of liver fibrosis can be well-manageable and the damages can be reversed with the treatment targeting the underlying cause. So, it is achievable to cure or reverse the condition of liver fibrosis. 
The following are the potential benefits of liver elastography.
- It can be used to differentiate between the early and advanced stages of liver fibrosis.
- Assess the liver fibrosis stages.
- Helps in the treatment decision-making for liver cirrhosis.
- Helps in the prediction of liver disease complications.
- Aids in monitoring or analyzing the response of the liver to intervention. 
 
Many clinical studies suggest that it is possible and feasible to detect the presence and complications of liver cirrhosis. So, it is considered a promising and minimally invasive means for the prediction of cirrhosis of the liver in people with underlying chronic liver diseases. It can also be used in further instances with the following and management of the condition. 
The treatment for liver fibrosis is based on the underlying cause of the condition such as hepatitis c virus, autoimmune hepatitis, chronic liver disease, and others. The treatment options can be one or a combination of the following aids according to the underlying condition.
- ACE inhibitors include Ramipril and Lisinopril.
-  Antiviral medications.
- Immunosuppressive therapy.
- Alcohol abstinence.
- Liver transplantation.
- Other medications.
Reversal of fibrosis is possible with the intervention of the primary cause of liver injury or damage which could make allowances for whole resolution and recovery of fibrosis. The evidence from clinical studies shows that liver fibrosis is a reversible one and recovery is feasible with cirrhosis cases. The removal of the causative agent is a significant treatment in reversing liver deterioration.
Liver elastography is used to predict liver stiffness in cases of liver fibrosis with underlying conditions such as cirrhosis, hepatitis C, and chronic liver diseases. The score of liver elastography ranges between 2 to 75 or 75.5 kPa. The normal results indicate a score from 2 to 7 kPa. An increase in the score more than the normal limits indicate the presence of liver concern.
Liver fibrosis is the term used to describe the scarring of the normal healthy liver tissues resulting in stiffness. As the injury, infection or damage progresses, the scar tissue gradually substitutes the normal functioning ones. The scarring of the liver results in a sequence with distinct extents and degrees. Fibrosis is considered the primary and first stage of liver scarring.
Nutritionally, a great choice for combating liver fibrosis is getting adhere to healthy dietary patterns. The following sources could help reduce the condition of liver fibrosis.
- White meat.
- Nuts.
- Fruits.
- Vegetables.
- Low-fat diaries.
- Vegetable oils.
 
Liver fibrosis happens when the normal healthy liver tissue substitutes with the scarring ones after an injury or infection. The scarring can be mild to severe degrees occurring to distinct extents. The chronic forms of liver fibrosis can cause total damage rusting in potentially severe complications. Though scarring liver conditions precipitate permanent damage, one can lead a long life with means of potential interventions. 
 
It is possible to live a long life with liver fibrosis, though scarring of liver tissue induces severe and permanent damage. Liver fibrosis can progress into a range of liver diseases. One of these conditions called liver cirrhosis has an unfavorable prognosis with a life expectancy of ten to fifteen years. 
Clinical studies suggest that liver fibrosis can be reversed with the elimination of the causative agent and treatment for the underlying condition. Nevertheless, certain ways are there to address liver health by natural means.
- Adding coffees.
- Loss of excess weight.
- Active exercises.
- Avoid added sugars.
- Reduce the cholesterol level.
- Try a healthy diet.
 
Liver fibrosis is known for the excessive buildup of extracellular matrix proteins in several forms of chronic liver diseases. So, scarring of the liver tissue results. Liver fibrosis can be reversed in most cases. But, it is considered a serious issue when it progresses into the advanced stage resulting in liver cirrhosis, portal hypertension, and total liver failure. 
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Dr. Muhammad Shoyab from iCliniq
Dr. Muhammad Shoyab

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