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Article

Shear Wave Elastography: A New Frontier in Head and Neck Imaging

Sivan Sathish ORCID ,  Ankita Jain ORCID ,  Vaishali Malik ORCID ,  Vikas Singh ORCID

    Received: 1 May 2026; Revised: 3 June 2026; Accepted: 9 June 2026; Published: 10 June 2026

    Abstract

    Shear Wave Elastography (SWE) has emerged as a transformative ultrasound-based imaging modality for the quantitative assessment of tissue stiffness, providing valuable insights into the biomechanical properties of normal and diseased tissues. Unlike conventional ultrasonography, which primarily relies on morphological evaluation, SWE enables real-time, reproducible, and relatively operator-independent measurements of tissue elasticity. In recent years, its application has expanded considerably within head and neck imaging, where tissue stiffness serves as a potential biomarker for disease characterization, diagnosis, and treatment monitoring. This narrative review provides a comprehensive overview of the physical principles, quantitative parameters, technical considerations, and clinical applications of SWE in the head and neck region. Current evidence supporting its use in thyroid nodules, salivary gland disorders, cervical lymph node evaluation, oral soft tissue lesions, periodontal assessment, and temporomandibular joint and masticatory muscle disorders is discussed. The integration of SWE with conventional B-mode and Doppler ultrasonography has demonstrated improved diagnostic confidence, enhanced lesion characterization, and reduced reliance on invasive diagnostic procedures in selected clinical scenarios. Despite its promising clinical utility, several challenges remain, including variability in acquisition protocols, machine-dependent elasticity measurements, lack of universally accepted cutoff values, and limited standardization across institutions. Nevertheless, ongoing technological advancements and the growing interest in artificial intelligence, radiomics, and multiparametric ultrasound approaches are expected to further enhance the diagnostic and prognostic capabilities of SWE. Overall, SWE represents a valuable non-invasive adjunct to routine head and neck imaging and holds significant potential as a quantitative biomarker in precision medicine.

    Keywords

    References

    1. 1. Marcu, L.G.; Reid, P.; Bezak, E. The promise of novel biomarkers for head and neck cancer from an imaging perspective. Int. J. Mol. Sci. 2018, 19, 2511. DOI: https://doi.org/10.3390/ijms19092511
    2. 2. Sham, M.E.; Nishat, S. Imaging modalities in head-and-neck cancer patients. Indian J. Dent. Res. 2012, 23, 819–821. DOI: https://doi.org/10.4103/0970-9290.111270
    3. 3. Jha, A.K.; Mithun, S.; Sherkhane, U.B.; et al. Emerging role of quantitative imaging (radiomics) and artificial intelligence in precision oncology. Explor. Target Antitumor Ther. 2023, 4, 569–582. DOI: https://doi.org/10.37349/etat.2023.00153
    4. 4. Taljanovic, M.S.; Gimber, L.H.; Becker, G.W.; et al. Shear-wave elastography: Basic physics and musculoskeletal applications. Radiographics 2017, 37, 855–870. DOI: https://doi.org/10.1148/rg.2017160116
    5. 5. Ooi, C.C.; Malliaras, P.; Schneider, M.E.; et al. “Soft, hard, or just right?” Applications and limitations of axial-strain sonoelastography and shear-wave elastography in the assessment of tendon injuries. Skeletal Radiol. 2014, 43, 1–12. DOI: https://doi.org/10.1007/s00256-013-1695-3
    6. 6. Tang, A.; Cloutier, G.; Szeverenyi, N.M.; et al. Ultrasound elastography and MR elastography for assessing liver fibrosis: Part 1, principles and techniques. AJR Am. J. Roentgenol. 2015, 205, 22–32. DOI: https://doi.org/10.2214/AJR.15.14552
    7. 7. Sarvazyan, A.; Hall, T.J.; Urban, M.W.; et al. An overview of elastography—An emerging branch of medical imaging. Curr. Med. Imaging Rev. 2011, 7, 255–282. DOI: https://doi.org/10.2174/157340511798038684
    8. 8. Sultan, S.R. B-mode ultrasound characteristics of thyroid nodules with high-benign probability and nodules with risk of malignancy. Cureus 2023, 15, e39281. DOI: https://doi.org/10.7759/cureus.39281
    9. 9. Țermure, D.A.; Badea, M.E.; Donci, D.D.; et al. Multimodal imaging of cervical lymphadenopathy: Diagnostic value and clinical applications. Med. Pharm. Rep. 2025, 98, 425–439. DOI: https://doi.org/10.15386/mpr-2924
    10. 10. Koch, M.; Sievert, M.; Iro, H.; et al. Ultrasound in inflammatory and obstructive salivary gland diseases: Own experiences and a review of the literature. J. Clin. Med. 2021, 10, 3547. DOI: https://doi.org/10.3390/jcm10163547
    11. 11. Raja Lakshmi, C.; Sudhakara Rao, M.; Ravikiran, A.; et al. Evaluation of reliability of ultrasonographic parameters in differentiating benign and metastatic cervical group of lymph nodes. ISRN Otolaryngol. 2014, 2014, 238740. DOI: https://doi.org/10.1155/2014/238740
    12. 12. Plaza-Manzano, G.; Fernández-de-Las-Peñas, C.; Díaz-Arribas, M.J.; et al. Diagnostic accuracy of ultrasound imaging and shear wave elastography to discriminate patients with chronic neck pain from asymptomatic individuals. Healthcare 2024, 12, 1987. DOI: https://doi.org/10.3390/healthcare12191987
    13. 13. Crespo, A.N.; Chone, C.T.; Fonseca, A.S.; et al. Clinical versus computed tomography evaluation in the diagnosis and management of deep neck infection. Sao Paulo Med. J. 2004, 122, 259–263. DOI: https://doi.org/10.1590/S1516-31802004000600006
    14. 14. Charles-Edwards, E.M.; deSouza, N.M. Diffusion-weighted magnetic resonance imaging and its application to cancer. Cancer Imaging 2006, 6, 135–143. DOI: https://doi.org/10.1102/1470-7330.2006.0021
    15. 15. Ozturk, A.; Grajo, J.R.; Dhyani, M.; et al. Principles of ultrasound elastography. Abdom. Radiol. 2018, 43, 773–785. DOI: https://doi.org/10.1007/s00261-018-1475-6
    16. 16. Kim, S.J.; Park, H.J.; Lee, S.Y. Usefulness of strain elastography of the musculoskeletal system. Ultrasonography 2016, 35, 104–109. DOI: https://doi.org/10.14366/usg.15072
    17. 17. Dietrich, C.F.; Dong, Y.; Cui, X.W.; et al. Ultrasound elastography: A brief clinical history of an evolving technique. Ultrasound Int. Open 2024, 10, a23786926. DOI: https://doi.org/10.1055/a-2378-6926
    18. 18. Dietrich, C.F.; Barr, R.G.; Farrokh, A.; et al. Strain elastography—How to do it? Ultrasound Int. Open 2017, 3, E137–E149. DOI: https://doi.org/10.1055/s-0043-119412
    19. 19. Alrashed, A.I.; Alfuraih, A.M. Reproducibility of shear wave elastography among operators, machines, and probes in an elasticity phantom. Ultrasonography 2021, 40, 158–166. DOI: https://doi.org/10.14366/usg.20011
    20. 20. Ličen, U.; Kozinc, Ž. Using shear-wave elastography to assess exercise-induced muscle damage: A review. Sensors 2022, 22, 7574. DOI: https://doi.org/10.3390/s22197574
    21. 21. Lehoux, M.C.; Sobczak, S.; Cloutier, F.; et al. Shear wave elastography potential to characterize spastic muscles in stroke survivors: Literature review. Clin. Biomech. 2020, 72, 84–93. DOI: https://doi.org/10.1016/j.clinbiomech.2019.11.025
    22. 22. Ferraioli, G.; Barr, R.G.; Farrokh, A.; et al. How to perform shear wave elastography. Part I. Med. Ultrason. 2022, 24, 95–106. DOI: https://doi.org/10.11152/mu-3217
    23. 23. Bruce, M.; Kolokythas, O.; Ferraioli, G.; et al. Limitations and artifacts in shear-wave elastography of the liver. Biomed. Eng. Lett. 2017, 7, 81–89. DOI: https://doi.org/10.1007/s13534-017-0028-1
    24. 24. Ryu, J.; Jeong, W.K. Current status of musculoskeletal application of shear wave elastography. Ultrasonography 2017, 36, 185–197. DOI: https://doi.org/10.14366/usg.16053
    25. 25. Cui, X.W.; Li, K.N.; Yi, A.J.; et al. Ultrasound elastography. Endosc. Ultrasound 2022, 11, 252–274. DOI: https://doi.org/10.4103/EUS-D-21-00151
    26. 26. Xie, J.; Liu, H.; Liu, W.S.; et al. Quantitative shear wave elastography for noninvasive assessment of solid pancreatic masses. Clin. Hemorheol. Microcirc. 2020, 74, 179–187.
    27. 27. Cheng, K.L.; Lai, P.H.; Su, C.L.; et al. Impact of region-of-interest size on the diagnostic performance of shear wave elastography in differentiating thyroid nodules. Cancers 2023, 15, 5214. DOI: https://doi.org/10.3390/cancers15215214
    28. 28. Ye, R.; Xiong, H.H.; Liu, X.; et al. The impact of different regions of interest on shear wave elastography assessment of the meniscus in the knee joint. Acad. Radiol. 2024, 31, 3306–3314. DOI: https://doi.org/10.1016/j.acra.2024.02.012
    29. 29. Moon, J.H.; Hwang, J.Y.; Park, J.S.; et al. Impact of region of interest size on the diagnostic performance of shear wave elastography in differentiating solid breast lesions. Acta Radiol. 2018, 59, 657–663. DOI: https://doi.org/10.1177/0284185117732097
    30. 30. Kozinc, Ž.; Šarabon, N. Shear-wave elastography for assessment of trapezius muscle stiffness: Reliability and association with low-level muscle activity. PLoS One 2020, 15, e0234359. DOI: https://doi.org/10.1371/journal.pone.0234359
    31. 31. Ewertsen, C.; Carlsen, J.; Perveez, M.A.; et al. Reference values for shear wave elastography of neck and shoulder muscles in healthy individuals. Ultrasound Int. Open 2018, 4, E23–E29. DOI: https://doi.org/10.1055/s-0044-102013
    32. 32. Liu, Y.; Xu, W. Application and limitations of ultrasound for the early diagnosis of thyroid cancer: A systematic review and meta-analysis. Am. J. Transl. Res. 2025, 17, 6556–6572. DOI: https://doi.org/10.62347/BNBG2830
    33. 33. Elaggan, A.; Mostafa, A.; Albdair, R.; et al. The value of ultrasonography using thyroid imaging reporting and data systems (TIRADS) in the diagnosis of thyroid cancer among the population of Ha'il, Saudi Arabia. Cureus 2022, 14, e27437. DOI: https://doi.org/10.7759/cureus.27437
    34. 34. Tuan, P.A.; Duc, N.M.; An, M.; et al. The role of shear wave elastography in the discrimination between malignant and benign thyroid nodules. Acta Inform. Med. 2020, 28, 248–253. DOI: https://doi.org/10.5455/aim.2020.28.248-253
    35. 35. Hazem, M.; Zakaria, O.M.; Daoud, M.Y.I.; et al. Accuracy of shear wave elastography in characterization of thyroid nodules in children and adolescents. Insights Imaging 2021, 12, 128. DOI: https://doi.org/10.1186/s13244-021-01074-7
    36. 36. Petersen, M.; Schenke, S.A.; Firla, J.; et al. Shear wave elastography and thyroid imaging reporting and data system (TIRADS) for the risk stratification of thyroid nodules—Results of a Prospective Study. Diagnostics 2022, 12, 109. DOI: https://doi.org/10.3390/diagnostics12010109
    37. 37. Mena, G.; Montalvo, A.; Ubidia, M.; et al. Elastography of the thyroid nodule: Cut-off points between benign and malignant lesions for strain, 2D shear wave real time and point shear wave: A correlation with pathology, ACR TIRADS and Alpha Score. Front. Endocrinol. 2023, 14, 1182557. DOI: https://doi.org/10.3389/fendo.2023.1182557
    38. 38. Kara, T.; Ateş, F.; Durmaz, M.S.; et al. Assessment of thyroid gland elasticity with shear-wave elastography in Hashimoto's thyroiditis patients. J. Ultrasound 2020, 23, 543–551. DOI: https://doi.org/10.1007/s40477-020-00437-y
    39. 39. Astorri, E.; Sutcliffe, N.; Richards, P.S.; et al. Ultrasound of the salivary glands is a strong predictor of labial gland biopsy histopathology in patients with sicca symptoms. J. Oral Pathol. Med. 2016, 45, 450–454. DOI: https://doi.org/10.1111/jop.12387
    40. 40. Rong, X.; Zhu, Q.; Ji, H.; et al. Differentiation of pleomorphic adenoma and Warthin's tumor of the parotid gland: Ultrasonographic features. Acta Radiol. 2014, 55, 1203–1209. DOI: https://doi.org/10.1177/0284185113515865
    41. 41. Wang, J.; Jiang, L. Application value of shear wave elastography in salivary gland tumors. Oral Radiol. 2021, 37, 653–657. DOI: https://doi.org/10.1007/s11282-020-00507-1
    42. 42. Elbeblawy, Y.M.; Mohamed, M.E.A. Strain and shear wave ultrasound elastography in evaluation of chronic inflammatory disorders of major salivary glands. Dentomaxillofac. Radiol. 2020, 49, 20190225. DOI: https://doi.org/10.1259/dmfr.20190225
    43. 43. Atik, I.; Atik, S.; Gul, E. Effectiveness of shear wave elastography for assessing major salivary gland involvement in ankylosing spondylitis. Radiol. Bras. 2025, 58, e20240121. DOI: https://doi.org/10.1590/0100-3984.2024.0121
    44. 44. Tanabe, Y.; Shirai, A.; Ogura, I. Shear wave elastography for parotid glands: Quantitative analysis of shear elastic modulus in relation to age, gender, and internal architecture in patients with oral cancer. J. Imaging 2025, 11, 145. DOI: https://doi.org/10.3390/jimaging11050145
    45. 45. Chang, C.F.; Wang, H.K. Ultrasound shear wave elastography for patients with sialolithiasis undergoing interventional sialendoscopy. Laryngoscope Investig. Otolaryngol. 2023, 8, 76–81. DOI: https://doi.org/10.1002/lio2.1007
    46. 46. Ahuja, A.T.; Ying, M.; Ho, S.Y.; et al. Ultrasound of malignant cervical lymph nodes. Cancer Imaging 2008, 8, 48–56. DOI: https://doi.org/10.1102/1470-7330.2008.0006
    47. 47. Termure, D.A.; Lenghel, M.; Badea, M.E.; et al. Shear wave elastography for distinguishing cervical lymph node malignancy: A prospective, observational study. Biomedicines 2025, 13, 2001. DOI: https://doi.org/10.3390/biomedicines13082001
    48. 48. Azizi, G.; Keller, J.M.; Mayo, M.L.; et al. Shear wave elastography and cervical lymph nodes: Predicting malignancy. Ultrasound Med. Biol. 2016, 42, 1273–1281. DOI: https://doi.org/10.1016/j.ultrasmedbio.2016.01.012
    49. 49. Sun, Y.; Wang, W.; Mi, C.; et al. Differential diagnosis value of shear-wave elastography for superficial enlarged lymph nodes. Front. Oncol. 2022, 12, 908085. DOI: https://doi.org/10.3389/fonc.2022.908085
    50. 50. Wang, B.; Guo, Q.; Wang, J.Y.; et al. Ultrasound elastography for the evaluation of lymph nodes. Front. Oncol. 2021, 11, 714660. DOI: https://doi.org/10.3389/fonc.2021.714660
    51. 51. Chae, S.Y.; Jung, H.N.; Ryoo, I.; et al. Differentiating cervical metastatic lymphadenopathy and lymphoma by shear wave elastography. Sci. Rep. 2019, 9, 12396. DOI: https://doi.org/10.1038/s41598-019-48705-0
    52. 52. Jung, W.; Chung, J.; Lee, J.; et al. Quantifying radiation-induced breast fibrosis by shear-wave elastography in patients with breast cancer: A 12-months-follow-up data of a prospective study. Clin. Transl. Radiat. Oncol. 2024, 46, 100773. DOI: https://doi.org/10.1016/j.ctro.2024.100773
    53. 53. Ogura, I.; Nakahara, K.; Sasaki, Y.; et al. Usefulness of shear wave elastography in the diagnosis of oral and maxillofacial diseases. Imaging Sci. Dent. 2018, 48, 161–165. DOI: https://doi.org/10.5624/isd.2018.48.3.161
    54. 54. Olchowy, C.; Grzech-Leśniak, K.; Hadzik, J.; et al. Monitoring of changes in masticatory muscle stiffness after gum chewing using shear wave elastography. J. Clin. Med. 2021, 10, 2480. DOI: https://doi.org/10.3390/jcm10112480
    55. 55. Xue, F.; Wu, B.Z.; Zhang, R.; et al. The use of shear wave elastography to monitor changes in gingival elasticity associated with initial periodontal therapy in patients with advanced periodontitis: A prospective pilot study. J. Dent. Sci. 2023, 18, 1086–1093. DOI: https://doi.org/10.1016/j.jds.2022.11.014
    56. 56. Sathish, S.; Jain, A. The Sivan three-dimensional cone-beam computed tomography volumetric imaging protocol: A novel dual-mode rendering technique for integrated visualization of temporomandibular joint disc and osseous structures to evaluate temporomandibular joint disorders. Oral Radiol. 2026, 42, 148–161. DOI: https://doi.org/10.1007/s11282-025-00849-8
    57. 57. Paluch, Ł.; Maj, P.; Pietruski, P.; et al. Shear wave elastography in the evaluation of temporomandibular joint disorders. Ultrasound Med. Biol. 2020, 46, 46–54. DOI: https://doi.org/10.1016/j.ultrasmedbio.2019.09.014
    58. 58. Öztürk, M.; Çalışkan, E.; Habibi, H.A. Shear wave elastography of temporomandibular joint disc and masseter muscle stiffness in healthy children and adolescents: A preliminary study. Oral Radiol. 2021, 37, 618–624. DOI: https://doi.org/10.1007/s11282-020-00501-7
    59. 59. Olchowy, A.; Seweryn, P.; Olchowy, C.; et al. Assessment of the masseter stiffness during conservative therapy using shear wave elastography. BMC Musculoskelet. Disord. 2022, 23, 439. DOI: https://doi.org/10.1186/s12891-022-05392-9
    60. 60. Chen, Y.J.; Lin, H.Y.; Chu, C.A.; et al. Assessing thickness and stiffness of superficial/deep masticatory muscles in orofacial pain: An ultrasound and shear wave elastography study. Ann. Med. 2023, 55, 2261116. DOI: https://doi.org/10.1080/07853890.2023.2261116
    61. 61. Güven, F.; Akkuş, A.T.; Dinçkal Yanikoğlu, N.; et al. Shear wave elastography as a diagnostic method for bruxism. Medicine 2025, 104, e46183. DOI: https://doi.org/10.1097/MD.0000000000046183
    62. 62. Toker, C.; Marquetand, J.; Symmank, J.; et al. Shear wave elastography in bruxism—Not yet ready for clinical routine. Diagnostics 2023, 13, 276. DOI: https://doi.org/10.3390/diagnostics13020276
    63. 63. McQueen, A.S.; Bhatia, K.S. Head and neck ultrasound: Technical advances, novel applications and the role of elastography. Clin. Radiol. 2018, 73, 81–93. DOI: https://doi.org/10.1016/j.crad.2017.08.003
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