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

• Published in: Journal of foot and ankle research Vol. 9; no. 1; pp. 30 - n/a
• Main Authors: Nadeau, Marie‐Josée, Desrochers, Amélie, Lamontagne, Martin, Larivière, Christian, Gagnon, Dany H.
• Format: Journal Article
• Language: English
• Published: London BioMed Central 17.08.2016; John Wiley & Sons, Inc
• Subjects: Achilles tendon; Achilles Tendon - diagnostic imaging; Achilles Tendon - pathology; Case-Control Studies; Computer‐assisted image analysis; Diagnostic imaging; Humans; Image Interpretation, Computer-Assisted - methods; Measures; Medical examination; Methods; Musculoskeletal system; Physiological aspects; Quantitative evaluation; Rehabilitation; Reproducibility; Reproducibility of Results; Severity of Illness Index; Tendinopathy; Tendinopathy - diagnostic imaging; Tendinopathy - pathology; Ultrasonography; Ultrasonography - methods; Musculoskeletal system; Computer-assisted image analysis; Measures; Reproducibility; Ultrasonography; Tendinopathy; Achilles tendon; Rehabilitation; Quantitative evaluation
• ISSN: 1757-1146; 1757-1146
• DOI: 10.1186/s13047-016-0164-3

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.