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


This work is licensed under a Creative Commons Attribution 4.0 International License.
Received: 1 May 2026; Revised: 3 June 2026; Accepted: 9 June 2026; Published: 10 June 2026
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:
Elastography Head and Neck Imaging Quantitative Ultrasound Shear Wave Elastography Tissue StiffnessReferences
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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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