Ultrasound shear wave elastography for the assessment of pelvic floor muscle stiffness: technical and analytical challenges in practice.

Shear wave elastography (SWE) is an established technique for evaluating thyroid, liver, and breast pathologies. This non-invasive, real-time diagnostic method has also shown value for assessing the mechanical properties of skeletal muscle. However, the specific challenges of pelvic floor evaluation remain insufficiently addressed. Although SWE may appear straightforward, it involves considerable technical and analytical complexity and carries a substantial risk of misinterpretation. This review aims to increase awareness of challenges in SWE image acquisition and analysis, potential pitfalls, common artifacts, and other technical considerations relevant to pelvic floor muscle assessment. By addressing these issues, this review is intended to promote quality and consistency in future SWE research and to highlight areas requiring further investigation.