Defining normal enthesis stiffness range in a healthy adult population

• Published in: British journal of radiology Vol. 98; no. 1167; p. 469
• Main Authors: Mahazer, Mohammad Khairi Jahidi, Leong, Sook Sam, Wong, Jeannie Hsiu Ding, Rozalli, Faizatul Izza, Yahya, Fariz, Tee, Ying Chew, Mohd Razalli, Mazuin, Vijayananthan, Anushya, Baharuddin, Hazlyna
• Format: Journal Article
• Language: English
• Published: England 01.03.2025
• Subjects: Achilles Tendon - diagnostic imaging; Achilles Tendon - physiology; Adult; Age Factors; Aged; Elasticity Imaging Techniques - methods; Female; Healthy Volunteers; Humans; Male; Middle Aged; Observer Variation; Reference Values; Young Adult; shear wave velocity; confounding factors; entheses; reliability; shear wave elastography
• DOI: 10.1093/bjr/tqae250

This study explores the correlation between volunteer demographics with enthesis stiffness and intra- and interobserver agreements using shear wave elastography (SWE). Ninety-eight healthy volunteers were recruited. SWE was performed on quadriceps, suprapatellar, infrapatellar, and Achilles entheses. The stiffness measurements were measured in shear wave velocity (SWV). Mann-Whitney test revealed insignificant difference in SWV among gender. Wilcoxon signed-rank test showed significant difference in SWV between left and right Achilles entheses. Spearman correlation test revealed moderate negative correlation between SWV and age group in quadriceps (ρ, -0.45, P < .01), and weak negative correlation in suprapatellar (ρ, -0.31, P < .01), and left Achilles (ρ, -0.29, P < .01). Multiple linear regression analysis showed subjects' demographic significantly predicted quadriceps, suprapatellar, and left Achilles entheses stiffness with only age statistically significantly to the prediction (P < .05). Kruskal-Wallis showed significant differences in SWV for quadriceps (P = .01), suprapatellar (P = .03), and left Achilles (P = .01) among different age groups. Good interobserver [0.79-0.86 (95% CI, 0.32-0.94)] and interobserver agreement [0.78-0.89 (95% CI, 0.62-0.95)] were found in all the entheses. SWE emerges as a reproducible method for entheses stiffness quantification, with the study highlighting age as a significant factor impacting SWV in quadriceps, suprapatellar, and left Achilles entheses. Among the studied entheses, SWV for Achilles enthesis is the highest in all age groups. The study significantly contributes to the understanding of enthesis stiffness by exploring the influence of gender, BMI, and age.