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. 2016 Aug 17:9:30.
doi: 10.1186/s13047-016-0164-3. eCollection 2016.

Quantitative ultrasound imaging of Achilles tendon integrity in symptomatic and asymptomatic individuals: reliability and minimal detectable change

Marie-Josée Nadeau  1 , Amélie Desrochers  2 , Martin Lamontagne  3 , Christian Larivière  4 , Dany H Gagnon  1
Affiliations

Quantitative ultrasound imaging of Achilles tendon integrity in symptomatic and asymptomatic individuals: reliability and minimal detectable change

Marie-Josée Nadeau et al. J Foot Ankle Res. .

Abstract

Background: Quantifying the integrity of the Achilles tendon (AT) is a rehabilitation challenge. Adopting quantitative ultrasound measurements (QUS measurements) of the AT could fill this gap by 1) evaluating the test-retest reliability and accuracy of QUS measurements of the AT; 2) determining the best protocol for collecting QUS measurements in clinical practice.

Methods: A total of 23 ATs with symptoms of Achilles tendinopathy and 63 asymptomatic ATs were evaluated. Eight images were recorded for each AT (2 visits × 2 evaluators × 2 images). Multiple sets of QUS measurements were taken: geometric (thickness, width, area), first-order statistics (computed from a grayscale histogram distribution: echogenicity, variance, skewness, kurtosis, entropy) and texture features (computed from co-occurrence matrices: contrast, energy, homogeneity). A generalizability study quantified the reliability and standard error of measurement (accuracy) of each QUS measurement, and a decision study identified the best measurement taking protocols.

Results: Geometric QUS measurements demonstrated excellent accuracy and reliability. QUS measurements computed from the grayscale histogram distribution revealed poor accuracy and reliability. QUS measurements derived from co-occurrence matrices showed variable accuracy and moderate to excellent reliability. In clinical practice, using an average of the results of three images collected by a single evaluator during a single visit is recommended.

Conclusions: The use of geometric QUS measurements enables quantification of AT integrity in clinical practice and research settings. More studies on QUS measurements derived from co-occurrence matrices are warranted.

Keywords: Achilles tendon; Computer-assisted image analysis; Measures; Musculoskeletal system; Quantitative evaluation; Rehabilitation; Reproducibility; Tendinopathy; Ultrasonography.

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Figures

Fig. 1
Fig. 1
a ROI of a healthy AT in longitudinal view; b ROI of a healthy AT in transverse view; c grayscale histogram derived from the ROI of image (b); d Pathologic AT in longitudinal view; e Pathologic AT in transverse view with arrows indicating the AT’s thickness at different locations in the sagittal plane; f grayscale histogram derived from the ROI of image (e)
Fig. 2
Fig. 2
General criteria for inclusion and exclusion of participants and participants’ characteristics
Fig. 3
Fig. 3
Summary of image recording protocol
See this image and copyright information in PMC

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