Simultaneous 2D gray-scale and color variance imaging. (A and B) Normal upper trapezius muscle. The normal muscle appears isoechoic and has uniform color variance (TIS=0). (C and D) Muscle with a palpable MTrP. A hypoechoic region and a well-defined focal decrease of color variance indicating a localized stiffer region is visible (TIS=1). (E and F) Muscle with a palpable MTrP. Multiple hypoechoic regions and multiple focal nodules are visible (TIS=2). Abbreviation: TIS, tissue imaging score. (In: Sikdar S, Shah JP, Gebreab T, et al. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil. Nov 2009;90(11):1829-1838, used with permission).