使用踝关节磁共振成像检测跟腱肌腱病的诊断影像模态比较
Comparison of diagnostic image modalities for the detection of Achilles tendon tendinopathy using ankle magnetic resonance imaging.
作者信息
Lee Joohyun, Lee Jee Young, Kang Keum Nae, Park Soyoon, Jang Jae Ni, Park Sukhee, Kim Young Uk
机构信息
Department of Anesthesia and Pain Medicine, CHA Ilsan Medical Center, CHA University, Ilsan, Republic of Korea.
Department of Korean Medicine, Integrative Cancer Center, CHA Ilsan Medical Center, CHA University, Ilsan, Republic of Korea.
出版信息
Front Physiol. 2025 May 23;16:1550799. doi: 10.3389/fphys.2025.1550799. eCollection 2025.
BACKGROUND
A thickened Achilles tendon (AT) is one of the important morphological changes observed in Achilles tendinopathy (ATTP). Previous research studies have demonstrated that both Achilles tendon thickness (ATT) and Achilles tendon cross-sectional area (CSA) (ATCSA) are correlated with ATTP in subjects. However, the comparative value of ATT and ATCSA in relation to ATTP is not clear, and no studies have calculated the optimal clinical threshold values of ATT and ATCSA. The goal of this research was to assess ATT and ATCSA and determine which parameter is more sensitive in predicting ATTP.
METHODS
AT lesions were studied in 31 subjects with ATTP and 36 asymptomatic subjects who underwent ankle magnetic resonance imaging (A-MRI) and showed no evidence of ATTP. Axial T1-weighted A-MRI images were obtained at the AT level. We measured the ATT and ATCSA at the junction of the soleus and gastrocnemius aponeurosis using an image analysis program. The ATT was defined as the thickest point at the AT margin. The ATCSA was defined as the total cross-sectional area of the AT at the region showing the most pronounced inflammatory lesions. In addition, a subgroup analysis by sex was performed to evaluate the gender-specific diagnostic performance of ATT and ATCSA.
RESULTS
The average ATT was 3.83 ± 0.76 mm in the control group and 5.42 ± 0.97 mm in the ATTP group. The average ATCSA was 46.49 ± 7.12 mm in the control group and 82.59 ± 29.71 mm in the ATTP group. ATTP subjects had significantly higher ATT (p < 0.001) and ATCSA (p < 0.001) than the control subjects. ROC curve analysis showed that the optimal threshold value of the ATCSA was 57.20 mm. The responsiveness of ATCSA was 87.1%, and its precision was 88.9%. The optimal threshold value of the ATT was 4.64 mm. The responsiveness of ATT was 80.6%, and its precision was 80.6%. We compared the area under the curve (AUC) for two analyzed diagnostic methods. The ATCSA's AUC is 0.95 (95% CI: 088-1.00), and the ATT's AUC is 0.91 (95% CI: 0.84-0.97).
CONCLUSION
Although both ATCSA and ATT were significantly correlated with ATTP, the ATCSA was a more sensitive measurement parameter.
背景
跟腱增厚是跟腱病（ATTP）中观察到的重要形态学变化之一。先前的研究表明，跟腱厚度（ATT）和跟腱横截面积（CSA）（ATCSA）均与受试者的跟腱病相关。然而，ATT和ATCSA相对于跟腱病的比较价值尚不清楚，且尚无研究计算出ATT和ATCSA的最佳临床阈值。本研究的目的是评估ATT和ATCSA，并确定哪个参数在预测跟腱病方面更敏感。
方法
对31例跟腱病患者和36例无症状受试者的跟腱病变进行研究，这些无症状受试者接受了踝关节磁共振成像（A-MRI）且未显示跟腱病的证据。在跟腱水平获取轴向T1加权A-MRI图像。我们使用图像分析程序在比目鱼肌和腓肠肌腱膜交界处测量ATT和ATCSA。ATT定义为跟腱边缘最厚处。ATCSA定义为在显示最明显炎症病变区域的跟腱总横截面积。此外，进行了按性别分组的亚组分析，以评估ATT和ATCSA的性别特异性诊断性能。
结果
对照组的平均ATT为3.83±0.76mm，跟腱病组为5.42±0.97mm。对照组的平均ATCSA为46.49±7.12mm，跟腱病组为82.59±29.71mm。跟腱病受试者的ATT（p<0.001）和ATCSA（p<0.001）显著高于对照组。ROC曲线分析显示，ATCSA的最佳阈值为57.20mm。ATCSA的反应性为87.1%，其精确度为88.9%。ATT的最佳阈值为4.64mm。ATT的反应性为80.6%，其精确度为80.6%。我们比较了两种分析诊断方法的曲线下面积（AUC）。ATCSA的AUC为0.95（95%CI：0.88-1.00），ATT的AUC为0.91（95%CI：0.84-0.97）。
结论
尽管ATCSA和ATT均与跟腱病显著相关，但ATCSA是更敏感的测量参数。
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