title: Diagnostic performance of axial-strain sonoelastography in confirming clinically diagnosed Achilles tendinopathy: comparison with B-mode ultrasound and color Doppler imaging.
abstract: This primary aim of this study was to evaluate the diagnostic performance of axial-strain sonoelastography (ASE), B-mode ultrasound (US) and color Doppler US in confirming clinically symptomatic Achilles tendinopathy. The secondary aim was to establish the relationship between the strain ratio during sonoelastography and Victorian Institute of Sport Assessment-Achilles (VISA-A) scores. The VISA-A questionnaire is a validated clinical rating scale that evaluates the symptoms and dysfunction of the Achilles tendon. One hundred twenty Achilles tendons of 120 consecutively registered patients with clinical symptoms of Achilles tendinopathy and another 120 gender- and age-matched, asymptomatic Achilles tendons of 120 healthy volunteers were assessed with B-mode US, ASE and color Doppler US. Symptomatic patients had significantly higher strain ratio scores and softer Achilles tendon properties compared with controls (p < 0.001). The strain ratio was moderately correlated with VISA-A scores (r = -0.62, p < 0.001). The diagnostic accuracy of B-mode US, ASE and color Doppler US in confirming clinically symptomatic Achilles tendinopathy was 94.7%, 97.8% and 82.5% respectively. There was excellent correlation between the clinical reference standard and the grade of tendon quality on ASE (κ = 0.91, p < 0.05), compared with B-mode US (κ = 0.74, p < 0.05) and color Doppler imaging (κ = 0.49, p < 0.05). ASE is an accurate clinical tool in the evaluation of Achilles tendinopathy, with results comparable to those of B-mode US and excellent correlation with clinical findings. The strain ratio may offer promise as a supplementary tool for the objective evaluation of Achilles tendon properties.
authors.affiliation: Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton Campus, Melbourne, Victoria, Australia; Department of Diagnostic Radiology, Singapore General Hospital, Singapore; Imaging at Olympic Park, Melbourne, Victoria, Australia. Electronic address: gdrocc@sgh.com.sg.
authors.forename: Chin Chin
authors.initials: CC
authors.lastname: Ooi
authors.affiliation: Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton Campus, Melbourne, Victoria, Australia.
authors.forename: Michal Elisabeth
authors.initials: ME
authors.lastname: Schneider
authors.affiliation: Imaging at Olympic Park, Melbourne, Victoria, Australia; Centre for Sports and Exercise Medicine, William Harvey Research Institute, Barts and the London, School of Medicine and Dentistry, Queen Mary, University of London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Malliaras
authors.affiliation: Imaging at Olympic Park, Melbourne, Victoria, Australia.
authors.forename: Martine
authors.initials: M
authors.lastname: Chadwick
authors.affiliation: Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton Campus, Melbourne, Victoria, Australia; Imaging at Olympic Park, Melbourne, Victoria, Australia.
authors.forename: David Alister
authors.initials: DA
authors.lastname: Connell
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D052256:Tendinopathy / Q000000981:diagnostic imaging*; D013718:Tensile Strength; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult
keywords: Achilles tendon; Elasticity imaging techniques; Tendinopathy; Ultrasonography