Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Skeletal Radiology
Published in: Skeletal Radiology 8/2016

01-08-2016 | Scientific Article

Real-time sonoelastography using an external reference material: test–retest reliability of healthy Achilles tendons

Authors: Alessandro Schneebeli, Filippo Del Grande, Gabriele Vincenzo, Corrado Cescon, Ron Clijsen, Fulvio Biordi, Marco Barbero

Published in: Skeletal Radiology | Issue 8/2016

Login to get access

Abstract

Objective

To establish the test–retest reliability of sonoelastography (SE) on healthy Achilles tendons in contracted and relaxed states using an external reference system.

Materials and Methods

Forty-eight Achilles tendons from 24 healthy volunteers were assessed using ultrasound and real-time SE with an external reference material. Tendons were analyzed under relaxed and contracted conditions. Strain ratios between the tendons and the reference material were calculated. The intraclass correlation coefficient (ICC2.k) and Bland–Altman plot were used to assess test–retest reliability.

Results

The reliability of SE measurements under relaxed conditions ranged from high to very high, with an ICC2.k of 0.84 (95 % CI: 0.64–0.92) for reference material, 0.91 (95 % CI: 0.83–0.95) for Achilles tendons and 0.95 (95 % CI: 0.91–0.97) for Kager fat pads (KFP). The ICC2.k value for skin was 0.30 (95 % CI: –0.26 to 0.61). Reliability for measurements in the contracted state ranged from high to very high, with an ICC2.k of 0.93 (95 % CI: 0.87–0.96) for reference material, 0.72 (95 % CI: 0.50–0.84) for skin, 0.93 (95 % CI: 0.87–0.96) for Achilles tendons, and 0.81 (95 % CI: 0.66–0.89) for KFP. Reliability of the strain ratio (tendon/reference) under relaxed conditions was high with an ICC2.k of 0.87 (95 % CI: 0.75–0.93), and in the contracted state, it was very high with an ICC2.k of 0.94 (95 % CI: 0.90–0.97).

Conclusion

Sonoelastography using an external reference material is a reliable and simple technique for the assessment of the elasticity of healthy Achilles tendons. The use of an external material as a reference, along with strain ratios, could provide a quantitative measure of elasticity.
Literature
1.
Varghese T, Ophir J, Konofagou E, Kallel F, Righetti R. Tradeoffs in elastographic imaging. Ultrason Imaging. 2001;23(4):216–48.CrossRefPubMed
2.
Ophir J, Cespedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991;13(2):111–34.CrossRefPubMed
3.
Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006;239(2):341–50.CrossRefPubMed
4.
Saftoiu A, Vilmann P, Hassan H, Gorunescu F. Analysis of endoscopic ultrasound elastography used for characterisation and differentiation of benign and malignant lymph nodes. Ultraschall Med. 2006;27(6):535–42.CrossRefPubMed
5.
De Zordo T, Chhem R, Smekal V, et al. Real-time sonoelastography: findings in patients with symptomatic Achilles tendons and comparison to healthy volunteers. Ultraschall Med. 2010;31(4):394–400.CrossRefPubMed
6.
De Zordo T, Fink C, Feuchtner GM, Smekal V, Reindl M, Klauser AS. Real-time sonoelastography findings in healthy Achilles tendons. AJR Am J Roentgenol. 2009;193(2):W134–8.CrossRefPubMed
7.
Drakonaki EE, Allen GM, Wilson DJ. Real-time ultrasound elastography of the normal Achilles tendon: reproducibility and pattern description. Clin Radiol. 2009;64(12):1196–202.CrossRefPubMed
8.
Sconfienza LM, Silvestri E, Cimmino MA. Sonoelastography in the evaluation of painful Achilles tendon in amateur athletes. Clin Exp Rheumatol. 2010;28(3):373–8.PubMed
9.
Tan S, Kudas S, Ozcan AS, et al. Real-time sonoelastography of the Achilles tendon: pattern description in healthy subjects and patients with surgically repaired complete ruptures. Skeletal Radiol. 2012;41(9):1067–72.CrossRefPubMed
10.
Turan A, Tufan A, Mercan R, et al. Real-time sonoelastography of Achilles tendon in patients with ankylosing spondylitis. Skeletal Radiol. 2013;42(8):1113–8.CrossRefPubMed
11.
Klauser AS, Miyamoto H, Tamegger M, et al. Achilles tendon assessed with sonoelastography: histologic agreement. Radiology. 2013;267(3):837–42.CrossRefPubMed
12.
Ooi CC, Malliaras P, Schneider ME, Connell DA. “Soft, hard, or just right?” Applications and limitations of axial-strain sonoelastography and shear-wave elastography in the assessment of tendon injuries. Skeletal Radiol. 2014;43(1):1–12.CrossRefPubMed
13.
Yanagisawa O, Niitsu M, Kurihara T, Fukubayashi T. Evaluation of human muscle hardness after dynamic exercise with ultrasound real-time tissue elastography: a feasibility study. Clin Radiol. 2011;66(9):815–9.CrossRefPubMed
14.
Chino K, Akagi R, Dohi M, Fukashiro S, Takahashi H. Reliability and validity of quantifying absolute muscle hardness using ultrasound elastography. PLoS One. 2012;7(9):e45764.CrossRefPubMedPubMedCentral
15.
Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med. 1984;12(3):179–84.CrossRefPubMed
16.
Maffulli N, Wong J, Almekinders LC. Types and epidemiology of tendinopathy. Clin Sports Med. 2003;22(4):675–92.CrossRefPubMed
17.
Kujala UM, Sarna S, Kaprio J. Cumulative incidence of Achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med. 2005;15(3):133–5.CrossRefPubMed
18.
Magnussen RA, Dunn WR, Thomson AB. Nonoperative treatment of midportion Achilles tendinopathy: a systematic review. Clin J Sport Med. 2009;19(1):54–64.CrossRefPubMed
19.
Petersen W, Welp R, Rosenbaum D. Chronic Achilles tendinopathy: a prospective randomized study comparing the therapeutic effect of eccentric training, the AirHeel brace, and a combination of both. Am J Sports Med. 2007;35(10):1659–67.CrossRefPubMed
20.
Kannus P. Etiology and pathophysiology of chronic tendon disorders in sports. Scand J Med Sci Sports. 1997;7(2):78–85.CrossRefPubMed
21.
Jozsa L, Balint BJ, Reffy A, Demel Z. Hypoxic alterations of tenocytes in degenerative tendinopathy. Arch Orthop Trauma Surg. 1982;99(4):243–6.CrossRefPubMed
22.
Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S. Tensile properties of the human femur-anterior cruciate ligament-tibia complex. The effects of specimen age and orientation. Am J Sports Med. 1991;19(3):217–25.CrossRefPubMed
23.
Ariji Y, Katsumata A, Hiraiwa Y, et al. Use of sonographic elastography of the masseter muscles for optimizing massage pressure: a preliminary study. J Oral Rehabil. 2009;36(9):627–35.CrossRefPubMed
24.
25.
Ying M, Yeung E, Li B, Li W, Lui M, Tsoi CW. Sonographic evaluation of the size of Achilles tendon: the effect of exercise and dominance of the ankle. Ultrasound Med Biol. 2003;29(5):637–42.CrossRefPubMed
26.
Havre RF, Elde E, Gilja OH, et al. Freehand real-time elastography: impact of scanning parameters on image quality and in vitro intra- and interobserver validations. Ultrasound Med Biol. 2008;34(10):1638–50.CrossRefPubMed
27.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.CrossRefPubMed
28.
Rankin G, Stokes M. Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses. Clin Rehabil. 1998;12(3):187–99.CrossRefPubMed
29.
Munro BH. Statistical methods for health care research. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.
30.
31.
Muraki T, Ishikawa H, Morise S, et al. Ultrasound elastography-based assessment of the elasticity of the supraspinatus muscle and tendon during muscle contraction. J Shoulder Elbow Surg. 2015;24(1):120–6.CrossRefPubMed
32.
Klauser AS, Faschingbauer R, Jaschke WR. Is sonoelastography of value in assessing tendons? Semin Musculoskelet Radiol. 2010;14(3):323–33.CrossRefPubMed
33.
Morrissey D, Roskilly A, Twycross-Lewis R, et al. The effect of eccentric and concentric calf muscle training on Achilles tendon stiffness. Clin Rehabil. 2011;25(3):238–47.CrossRefPubMed
34.
Aubry S, Risson JR, Kastler A, et al. Biomechanical properties of the calcaneal tendon in vivo assessed by transient shear wave elastography. Skeletal Radiol. 2013;42(8):1143–50.CrossRefPubMed
35.
Peltz CD, Haladik JA, Divine G, Siegal D, van Holsbeeck M, Bey MJ. ShearWave elastography: repeatability for measurement of tendon stiffness. Skeletal Radiol. 2013;42(8):1151–6.CrossRefPubMed
36.
Mahieu NN, Witvrouw E, Stevens V, Van Tiggelen D, Roget P. Intrinsic risk factors for the development of Achilles tendon overuse injury: a prospective study. Am J Sports Med. 2006;34(2):226–35.CrossRefPubMed
Metadata
Title
Real-time sonoelastography using an external reference material: test–retest reliability of healthy Achilles tendons
Authors
Alessandro Schneebeli
Filippo Del Grande
Gabriele Vincenzo
Corrado Cescon
Ron Clijsen
Fulvio Biordi
Marco Barbero
Publication date
01-08-2016
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 8/2016
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-016-2382-y

Other articles of this Issue 8/2016

Skeletal Radiology 8/2016 Go to the issue

Case Report

A rare case of pseudotumor formation associated with methyl methacrylate hypersensitivity in a patient following cemented total knee arthroplasty

Technical Report

Fluoroscopically guided retrocalcaneal bursa steroid injection: description of the technique and pilot study of short-term patient outcomes

Case Report

Periosteal chondroma with spinal cord compression in the thoracic spinal canal: a case report

Scientific Article

Acute myonecrosis on MRI: etiologies in an oncological cohort and assessment of interobserver variability

Scientific Article

Comparison of femoroacetabular impingement-related radiographic features in a convenience sample of Japanese patients with and without herniation pits

Case Report

Fat drops in wrist tendon sheaths on MRI in conjunction with a radius fracture