title: Real-time spatial compound sonography of Achilles tendon in patients with heterozygous familial hypercholesterolaemia and normal physical examination.
abstract: OBJECTIVE
  This study was undertaken to assess the prevalence and ultrasound features of Achilles tendon xanthomas (ATX) in patients with heterozygous familial hypercholesterolemia (HFH) and normal physical examination studied with high-resolution ultrasonography (HRUS) and, secondarily, to evaluate the role of real-time spatial compound sonography (CS) in terms of image quality.
  
  
  METHODS
  Both Achilles tendons of 40 patients with HFH were studied with HRUS and CS. Two experienced radiologists evaluated by consensus the presence of ATX described as (1) tendon thickening and/or (2) focal hypoechoic areas and the quality of images obtained with the two techniques.
  
  
  RESULTS
  Ten out of 80 tendons showed thickening (mean: 11.2 mm). Twelve xanthomas 4.1-9.8 mm were identified in 9/80 tendons of five patients. In 5/80 tendons, both tendon thickening and focal hypoechoic areas were observed. There was no difference in the number of xanthomas detected at conventional US or CS. With respect to image quality, the performance of CS was considered significantly higher than HRUS in 72/80 (90%) cases and equal to HRUS in the remaining 8/80 (10%) (p<0.001).
  
  
  CONCLUSIONS
  CS is an effective tool in the assessment of ATX in patients with HFH and normal physical examination, and provides a better image quality when compared with HRUS.
authors.affiliation: Dipartimento di Biotecnologie Mediche e Medicina Legale-Sezione di Diagnostica per Immagini, Policlinico Universitario, Via del Vespro 127, I-90127 Palermo, Italy. tv.bartolotta@unipa.it
authors.forename: T V
authors.initials: TV
authors.lastname: Bartolotta
authors.forename: A
authors.initials: A
authors.lastname: Taibbi
authors.forename: G
authors.initials: G
authors.lastname: Malizia
authors.forename: G
authors.initials: G
authors.lastname: Mamone
authors.forename: C
authors.initials: C
authors.lastname: Barbagallo
authors.forename: M
authors.initials: M
authors.lastname: Midiri
authors.forename: R
authors.initials: R
authors.lastname: Lagalla
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006579:Heterozygote; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000150:complications* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D010808:Physical Examination; D014463:Ultrasonography; D014973:Xanthomatosis / Q000000981:diagnostic imaging* / Q000209:etiology