Journal
JOURNAL OF SCIENCE AND MEDICINE IN SPORT
Volume 21, Issue 12, Pages 1200-1205Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.jsams.2018.05.018
Keywords
Achilles tendon; Microvessels; Doppler ultrasound; Sensory threshold; Contrast agent; Medical imaging
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Objectives: The role of neovascularisation in tendinopathy is still poorly understood, potentially due to technical limitations of conventional power Doppler ultrasound. This study aimed to investigate the association between contrast-enhanced ultrasound (CEUS) microvascular volume (MV), Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and intrinsic Achilles tendon tenderness, as well as two different Power Doppler modes. Design: Cross-sectional study. Methods: 20 individuals with uni- or bilateral Achilles tendinopathy completed a VISA-A questionnaire, and underwent microvascular volume measurements of the Achilles tendon mid-portion using both conventional, ultrasensitive (SMI (TM)) power Doppler ultrasound and CEUS. Intrinsic tendon tenderness was assessed with sensation detection threshold to extracorporeal shock waves (ESW). Linear Mixed Model analysis was used to determine the association between microvascular volume (MV), VISA-A, and ESW-detection threshold for both symptomatic and asymptomatic Achilles tendons. Results: There was a significant association between VISA-A and MV (B = -5.3, 95%CI = [-8.5; -2.0], P = 0.0004), and between MV and symptom duration (B = -1.7, 95%CI = [-3.2; -5.0], P = 0.023). No significant associations were found between power Doppler ultrasound and CEUS-based MV or between CEUS-based MV and ESW-detection threshold. In comparison with conventional power Doppler ultra-sound, SMI (TM) showed on average similar detection capacity for neovessels in the mid-portion of the Achilles tendon, whilst being superior for detecting neovessels within Kager's fat pad (t = 3.46, 95%CI = [0.27; 1.03], P < 0.005). Conclusions: Our results indicate that CEUS-based MV of the Achilles tendon is moderately associated with Achilles tendon symptoms. In accordance, CEUS-detected MV could be a novel target for treatment as it seems to be more sensitive than PDU and is correlated with symptoms. (C) 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
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