Ultrasound Int Open 2017; 03(04): E137-E149
DOI: 10.1055/s-0043-119412
© Georg Thieme Verlag KG Stuttgart · New York

Strain Elastography - How To Do It?

Christoph F. Dietrich1, Richard G. Barr2, André Farrokh3, Manjiri Dighe4, Michael Hocke5, Christian Jenssen6, Yi Dong7, Adrian Saftoiu8, Roald Flesland Havre9
  • 1Caritas-Krankenhaus, Innere Medizin 2, Bad Mergentheim, Germany
  • 2Radiology, Northeastern Ohio Medical University, Rootstown, United States
  • 3Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
  • 4Department of Biology, University of Washington, Radiology, Seattle, United States
  • 5HELIOS Klinikum Meiningen, Internal Medicine II, Meiningen, Germany
  • 6Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Klinik für Innere Medizin, Wriezen, Germany
  • 7Zhongshan Hospital, Ultrasound, Shanghai, China
  • 8University of Medicine and Pharmacy of Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania
  • 9Department of Medicine, Haukeland University Hospital, Bergen, Norway
Further Information

Publication History

received 28 May 2017
revised 27 August 2017

accepted 29 August 2017

Publication Date:
07 December 2017 (online)


Tissue stiffness assessed by palpation for diagnosing pathology has been used for thousands of years. Ultrasound elastography has been developed more recently to display similar information on tissue stiffness as an image. There are two main types of ultrasound elastography, strain and shear wave. Strain elastography is a qualitative technique and provides information on the relative stiffness between one tissue and another. Shear wave elastography is a quantitative method and provides an estimated value of the tissue stiffness that can be expressed in either the shear wave speed through the tissues in meters/second, or converted to the Young’s modulus making some assumptions and expressed in kPa. Each technique has its advantages and disadvantages and they are often complimentary to each other in clinical practice. This article reviews the principles, technique, and interpretation of strain elastography in various organs. It describes how to optimize technique, while pitfalls and artifacts are also discussed.