Advantages of elastography in the diagnosis of obstetric anal sphincter injuries : a narrative review

Drusany Starič, Kristina (author), Bukovec, Petra (author), Salapura, Vladka (author), Norčič, Gregor (author), Habes, Dominik (author), Lukanović, David (author), Jakimovska, Marina (author)

Objective: Obstetric anal sphincter injuries (OASIS) represent a serious complication of vaginal delivery that can result in chronic anal incontinence and reduced quality of life. Accurate diagnosis is essential for optimal repair and prevention of long-term morbidity. This review summarizes current evidence on the advantages of elastography as a diagnostic adjunct for the detection of OASIS. Mechanism: Elastography is an advanced ultrasound (US)-based imaging technique that quantifies tissue stiffness, enabling functional assessment of the anal sphincter complex beyond anatomical visualization. By distinguishing the mechanical properties of healthy muscle, acute tears, and fibrotic tissue, elastography may improve the detection of subtle or occult sphincter defects that conventional endoanal US may miss. Findings in Brief: Shear-wave elastography (SWE) has demonstrated moderate to good intraobserver and interobserver reliability, with reported intraclass correlation coefficients (ICC) that vary by measurement conditions. Preliminary studies indicate that greater sphincter stiffness may be protective against perineal tears, suggesting potential for risk stratification. Elastography is non-invasive, free of ionizing radiation, and suitable for repeated evaluation during recovery. However, its diagnostic superiority over standard US for high-grade OASIS remains unconfirmed, and correlations with functional outcomes, such as incontinence severity, are inconsistent. Key limitations include operator dependency, a steep learning curve, and a lack of standardized acquisition protocols. Integration with artificial intelligence (AI) could improve consistency and diagnostic accuracy. Conclusions: Elastography represents a promising adjunct to traditional imaging for the evaluation and management of OASIS. By providing quantitative, biomechanical insights into sphincter integrity, it holds potential to improve early diagnosis, guide rehabilitation, and support recovery monitoring. However, robust evidence demonstrating superiority over established imaging modalities for the diagnosis of OASIS remains limited. Larger, longitudinal studies are needed to validate the clinical utility of elastography and to standardize the use of this technique in obstetric practice.

• Language: English
• Keywords: obstetric anal sphincter injury, elastography, ultrasound imaging, perineal trauma, pelvic floor
• Work type: Article
• Typology: 1.02 - Review Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2026
• Number of pages: 12 str.
• Numbering: Vol. 53, iss. 5, art. 49998
• PID: 20.500.12556/RUL-185586
• UDC: 618.1
• ISSN on article: 2709-0094
• DOI: 10.31083/CEOG49998
• COBISS.SI-ID: 280854787
• Publication date in RUL: 11.08.2026

Record is a part of a journal

• Title: Clinical and experimental obstetrics & gynecology
• Shortened title: Clin. exp. obstet. gynecol.
• Publisher: IMR Press
• ISSN: 2709-0094
• COBISS.SI-ID: 70125571

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.