Assessment of Achilles enthesitis in the spondyloarthropathies by colour Doppler energy ultrasound in the context of the 'enthesis organ'.
OBJECTIVE
To identify the characteristic features of Achilles enthesitis of the spondyloarthropathies (SpA) detectable by colour Doppler energy ultrasound (CDEU) in the context of the 'enthesis organ'.


METHODS
Seventy patients with SpA and 15 healthy subjects were clinically evaluated and underwent CDEU examination of the Achilles entheses. The CDEU images were evaluated according to five distinctive CDEU features of enthesitis in the context of the enthesis organ.


RESULTS
Fifty-six of the 70 SpA patients (80%) showed at least one abnormal finding of the enthesitis on CDEU examination, affecting 91 of 140 Achilles entheses examined (65%). Only 22 of 140 Achilles entheses (15.7%) showed abnormal vascularization in the peri-sesamoidal and periosteal areas or in the area of enthesis fibrocartilage. In addition, 67 (47.9%) and 18 (12.9%) of 140 Achilles entheses examined showed cortical bone irregularities and erosions, respectively, at areas of the periosteal and the enthesis fibrocartilage. Sixteen (88.9%) of 18 clinically detected Achilles enthesitis and six (75%) of eight Achilles entheses with swelling on clinical examination presented corresponding abnormalities on CDEU examination. The Doppler twinkling artefact (TA) was observed consistently in all normal entheses and completely disappeared upon stabilization of the probe application. The C-reactive protein (CRP) level was higher in the patients with cortical bone erosion than in those without erosion.


CONCLUSIONS
This study demonstrates the characteristic features of enthesitis detectable by CDEU in the context of the enthesis organ and shows a good correlation with clinical as well as with laboratory findings.
Li
C-A
CA
Department of Diagnostic Radiology, Chonbuk National University Medical School and Research Institute of Clinical Medicine, Jeonju, Republic of Korea.
Kim
H O
HO
Lee
S Y
SY
Lee
Sang-Il
SI
D000125:Achilles Tendon / Q000000981:diagnostic imaging*; D000328:Adult; D002097:C-Reactive Protein; D016009:Chi-Square Distribution; D005260:Female; D051445:Fibrocartilage / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007249:Inflammation / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D025242:Spondylarthropathies / Q000000981:diagnostic imaging*; D018709:Statistics, Nonparametric; D052256:Tendinopathy / Q000000981:diagnostic imaging*; D014463:Ultrasonography
D002097:C-Reactive Protein