Department of Imaging, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126, Turin, Italy.
Department of Orthopaedic, Traumatology and Rehabilitation, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126, Turin, Italy.
Knee Surg Sports Traumatol Arthrosc. 2018 Jul;26(7):2051-2058. doi: 10.1007/s00167-017-4710-8. Epub 2017 Oct 27.
Mid-portion Achilles tendinopathy is characterized by a proliferation of small vessels, called neovascularization, which can be demonstrated by power Doppler sonography (PD). Neovascularization can be correlated with diagnosis and consequent therapies focused on vascular supply. Published data regarding the relationship between neovascularisation and symptoms, such as pain and disability, are contradictory. The hypothesis that contrast-enhanced ultrasound (CEUS) could detect with more sensibility than PD the new vessel ingrowth in human degenerated Achilles tendons and therefore the correlation of neovascularization with pain and disability, was evaluated.
Thirty consecutive patients of recalcitrant Achilles tendinopathy were studied with ultrasound greyscale (US), PD, CEUS and magnetic resonance imaging. Neovascularization was recorded as percentage on the whole extension of examined area. The vascularization time was recorded as venous and arterial type. Imaging data were classified both concurrently with the examination and in a secondary blinded assessment; any difference in the subjective assessment was discussed and a consensus view formed. Pain and disability were assessed by Western Ontario McMaster Universities Arthritis Index (WOMAC) and EuroQuality of life 5-dimension-5-level questionnaire and visual analogue scale (EQ-VAS). All results were analysed with suitable statistical methods.
76.7% of cases were degenerated; 23.3% had also partial discontinuity of the fibres. PD detected vascularization in 54% of cases, whereas CEUS in 83% of cases: in 13 cases, PD did not detect vascularization. The vascularization time was rapid (< 20 s, arterial type) in 60% of cases. WOMAC pain mean value is 6.4 and SD 3.4; WOMAC total score mean value is 21.6 and SD 12.8. EQ-VAS mean value is 56 and SD 18.3. No statistically significant correlation emerged between vascularization and pain/disability.
CEUS showed a greater ability to detect neovessels than PD in chronic Achilles tendinopathies. Nevertheless in 30 consecutive tendinopathies, no correlation between pain/disability and neovascularization was found: the role of multiple neovessels continue to be unclear. The possibility to discriminate arterial from venous vessels ('vascularization time') could be useful to understand the pathophysiology of tendinopathies and its healing process.
Diagnostic study.
II.
中段跟腱腱病的特征是小血管增生，称为新生血管形成，可以通过功率多普勒超声（PD）来显示。新生血管形成可以与诊断以及随后针对血管供应的治疗相关联。关于新生血管形成与疼痛和残疾等症状之间的关系，已有研究结果相互矛盾。本研究假设，对比增强超声（CEUS）可以比 PD 更敏感地检测人类退行性跟腱中的新血管生长，从而评估新生血管形成与疼痛和残疾的相关性。
对 30 例复发性跟腱腱病患者进行了超声灰度（US）、PD、CEUS 和磁共振成像检查。将新生血管形成的百分比记录为检查区域的整个延伸范围。记录血管化时间为静脉和动脉类型。对影像学数据进行了同步和二次盲法评估；对主观评估的任何差异进行了讨论并达成了共识。使用 Western Ontario McMaster Universities 关节炎指数（WOMAC）和欧洲生活质量 5 维度 5 水平问卷和视觉模拟量表（EQ-VAS）评估疼痛和残疾。所有结果均采用适当的统计方法进行分析。
76.7%的病例为退行性病变；23.3%的病例纤维也有部分不连续。PD 在 54%的病例中检测到血管化，而 CEUS 在 83%的病例中检测到血管化：在 13 例病例中，PD 未检测到血管化。血管化时间在 60%的病例中较快（<20 秒，动脉类型）。WOMAC 疼痛平均值为 6.4，标准差为 3.4；WOMAC 总分平均值为 21.6，标准差为 12.8。EQ-VAS 平均值为 56，标准差为 18.3。在慢性跟腱腱病患者中，CEUS 比 PD 更能检测到新生血管，但在 30 例连续腱病患者中，未发现疼痛/残疾与新生血管之间存在相关性：新生血管的作用仍不清楚。区分动脉和静脉血管（“血管化时间”）的可能性有助于了解腱病的病理生理学及其愈合过程。
诊断研究。
II 级。
