Evaluation of achilles tendinopathy using Real Time Sonoelastography: Comperatif Study

AIM: The aim of this study is to search for diagnostic value of sonoelastography in Achilles tendinopathy in comparison with grey scale and Doppler sonography.MATERIALS AND METHODS: Twenty one symptomatic cases which were clinically suggestive of Achilles tendinopathy and 20 asymptomatic volunteers were involved in this study. All cases were evaluated with grey scale sonography, Doppler US and sonoelastography. Proximal, middle and distal segments in 82 tendons in 41 symptomatic and asymptomatic cases were evaluated separately in short and long axis views. All images were recorded digitally. Images were evaluated by two radiologists and scored in consensus. On grey scale examination cases were grouped according to diameter, internal echo texture and contour properties as; grade 1, normal-appearing tendon (parallel margins, homogeneous echo texture); grade 2, enlarged tendon (bowed margins, homogeneous echo texture); or grade 3, (heterogenous tendon containing hypoechoic areas with or without tendon enlargement). On color Doppler US case were grouped into two according to presence or absence of flow. With sonoelastography tendons were classified as; Type 1-normal (blue-green), Type 2 medium stiffness-normal (slight red coloration within mostly blue-green tendon) and Type 3 soft-pathological (larger amount of red coloration within tendon. Mean strain index values were calculated for all segments in each case.RESULTS: There was no statistically significant correlation between presence of symptoms and sex, body mass index, Achilles tendon diameter. Statistically significant increase in presence symptoms with increasing age was observed.In healthy volunteers 37 of the cases (67,2%) were Type 1-stiff, 15 (27,3%) were Type 2-medium stiffness, and 3 (5,5%) were Tip 3 soft. In cases with Achilles tendinopathy 9 (33,3 %) were Type 1-stiff, 4 (14,8%) were Type 2-medium stiffness, and 14 (51,9%) were Type 3-soft. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the sonoelastography in Achilles tendinopathy were 51,9 %, 94,5 %, 82,4 %, 80 % and 80,5% respectively. The same values for the grey scale imaging were calculated as 51,9 %, 90,9 %, 73,7 %, 79,4 % and 78 % respectively. For Doppler examination sensitivity was 25,9 %, specificity was 100 %, positive predictive value was 100 %, negative predictive value was 73,3 % and accuracy was 75,6 %.The strain index cut-off value for the middle 1/3 segment of the tendon in which incidence of tendinopathy is the highest was calculated as 1,4 Diagnostic performances of both grey-scale and real time sonoelastography were superior to color Doppler sonography. Positive predictive value of real time sonoelastography was higher than the grey scale sonography, suggesting a higher diagnostic efficiency making the test advantageous in accurate diagnosis.CONCLUSION: In the evaluation Achilles tendinopathies, real time sonoelastography increases the diagnostic performance when used in conjunction with grey scale imaging. Long term studies with larger study population are needed to reveal the diagnostic value of sonoelastography in early tendionapthy cases.