Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
Department of Life Sciences, School of Allied Health, University of Leicester, Leicester, UK.
J Ultrasound Med. 2024 Apr;43(4):713-722. doi: 10.1002/jum.16396. Epub 2023 Dec 22.
Ultrasound is the preferred imaging method in the diagnostic process of Achilles tendinopathy (AT). Ultrasound tissue characterization (UTC) is a frequently used, standardized and valid method to assess tendon geometry in AT patients. It is unknown whether UTC is reliable for measuring Achilles tendon thickness. The aim of the study was to assess intra- and inter-rater reliability of Achilles tendon thickness measurements using UTC in both asymptomatic individuals and patients with AT, and to evaluate if the reliability of thickness measurements differs between the midportion and insertional area.
Exactly 50 patients with AT and 50 asymptomatic individuals were included. Using the conventional US and standardized UTC procedure maximum thickness was measured in the midportion and insertion region. To determine inter- and intra-rater reliabilities, the intraclass correlation coefficient (ICC) was used.
The ICC values for inter- and intra-rater reliability were classified as "excellent," for the AT group (0.93 [95% CI: 0.88-0.96] and 0.95 [0.92-0.97]) and asymptomatic participants (0.91 [0.87-0.94] and 0.94 [0.92-0.96]). The reliability of measuring tendon thickness in the midportion region was "excellent," with both inter-rater (0.97 [0.95-0.98]) and intra-rater (0.98 [0.96-0.99]) ICC values indicating high levels of agreement. In the insertional region, ICC values for inter-rater (0.79 [0.69-0.87]) and intra-rater (0.89 [0.84-0.93]) reliability were "moderate to good."
We showed excellent reliability for measuring the US thickness of the midportion and good reliability of measuring the insertional region in patients with AT. Significantly lower ICCs were observed for the reliability of thickness measurements in the insertional region when compared with the midportion.
在跟腱病（AT）的诊断过程中，超声是首选的影像学方法。超声组织特征（UTC）是一种常用的、标准化的、有效的方法，用于评估 AT 患者的跟腱几何形状。目前尚不清楚 UTC 测量跟腱厚度是否可靠。本研究旨在评估在无症状个体和 AT 患者中使用 UTC 测量跟腱厚度的测量者内和测量者间的可靠性，并评估厚度测量的可靠性在中段和插入部位是否存在差异。
共纳入 50 名 AT 患者和 50 名无症状个体。使用常规超声和标准化 UTC 程序，在中段和插入部位测量最大厚度。为了确定测量者内和测量者间的可靠性，使用了组内相关系数（ICC）。
对于 AT 组（0.93[95%置信区间：0.88-0.96]和 0.95[0.92-0.97]）和无症状参与者（0.91[0.87-0.94]和 0.94[0.92-0.96]），测量者间和测量者内的 ICC 值均被归类为“优秀”。在中段区域测量肌腱厚度的可靠性为“优秀”，测量者间（0.97[0.95-0.98]）和测量者内（0.98[0.96-0.99]）的 ICC 值均显示出高度的一致性。在插入部位，测量者间（0.79[0.69-0.87]）和测量者内（0.89[0.84-0.93]）的 ICC 值为“中度至良好”。
我们发现，在 AT 患者中，测量中段的超声厚度具有优秀的可靠性，测量插入部位的可靠性为良好。与中段相比，插入部位厚度测量的可靠性 ICC 值明显较低。
