الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
There are different pathologies that make the tendon is the source of patient’s complaint & the diag¬nostic imaging modalities are often readily available & usually capable of defining the cause of these symptoms.
Imaging of tendons relies mainly upon MRI and ultrasound as powerful tools for their assessment. The imaging appearances are related to the structure of the normal tendon and the changes that occur in disease.
There are several pathologies that may involve a tendon & can be categorized as follows;
1) Tenosynovitis: with multiple underlying causes:
a- Intersection syndromes.
b- Autoimmune e.g. rheumatoid
c- Infective e.g. TB
2) Tendinosis.
3) Traumatic injuries.
4) Masses.
Elastography is an ultrasound-based newer imaging technique that is already being used for the evaluation of breast lesions and hepatic pathology. It is also being introduced for characterizing lesions of the prostate, thyroid, cervix and lymph nodes.
Recently, it has been applied to a variety of musculoskeletal (MSK) pathologies. The MSK applications have been extensively researched.
There are several elastography ultrasound EUS techniques depending on the type of stress applied and the method used to detect tissue displacement and that used to construct the image. In our study we use the strain EUS in diagnosis of different tendon pathologies.
The study included 50 patients of tendon diseases as suspected by clinical examination & later proved by MRI studies. 25 were males & 25 were females. Their ages ranged between 23-67 years (mean age 38 years).
All patients were referred from the orthopedic outpatient clinics. Diagnostic work up was done, including:
• Ultrasound B mode.
• Sonoelastography.
• Conventional MRI.
The final diagnosis of our patients was; 10 patients with partial tear (20%), 8 patients with complete tear (16%), 8 patients with tendinosis (16%), 8 patients with ganglion cyst (16%), 6 patients with tenosynovitis (12%), 4 patients with GCT of tendon sheath (8%), 3 patients with lipoma (6%) and 3 patients with haemangioma (6%).
Regarding tendinopathy, EUS increases the US sensitivity from 37.7% to 75% and accuracy from 90 to 96%, especially in early mild cases of tendinosis.
Also, EUS increases the US sensitivity to 83.3% and accuracy to 96% in diagnosis of tenosynovitis.
Regarding partial tendon tears, our study showed that EUS was very practical tool and increases the US sensitivity to 80% and accuracy to 96%.
However, in complete tears we find that EUS didn’t increases the US ability for diagnosis of complete tendon tears.
In diagnosis of GCT of tendon sheath, our results concluded that EUS increases US sensitivity (from 75% to 100%) and accuracy (from 98% to 100%).
Also, we found that EUS increases US sensitivity of MSK lipomas and soft tissue haemangiomas.
However, our results showed that EUS decreases US sensitivity and accuracy in diagnosis of ganglion.
In conclusion, our results indicate that the Sonoelastography is an easy, applicable method that provides valuable information for the assessment of different tendon pathologies.
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However, further studies with the histopathological correlation need to be performed in order to establish the clinical utility of sonoelastography.