Background: Ultrasound imaging is often used by physiotherapists and other healthcare professionals but the reliability of image acquisition with different ultrasound machines is unknown. The objective was to compare the intra-rater, inter-rater and intermachine reliability of thickness measurements of the plantar fascia (PF), Achilles tendon (AT), patellar tendon (PT) and elbow common extensor tendon (ECET) with musculoskeletal ultrasound imaging (MSUS). Methods: Tendon thickness was measured in four anatomical structures (14 participants, 28 images per tendon) by two sonographers and with two different ultrasound machines. Intraclass Correlation Coefficients (ICCs) and Bland-Altman plots were calculated. The standard error of measurement (SEM) and minimum detectable difference (MDD) were calculated. Results: Inter-rater reliability was excellent for AT (ICC=0.98; 95% CI= 0.96-0.99) and very good forPT (ICC=0.85; 95% CI = 0.67-0.93) and ECET (ICC=0.81; 95% CI= 0.72-0.94). Reliability for PF was moderate, with an ICC of 0.63 (CI 95%= 0.20-0.83). Bland-Altman plot for inter-machine reliability showed a mean difference of 1 m for PF measurements and a mean difference of 4 m and 20 m for AT and PT. The relative SEMs were below 7% and the MDCs were below 0.7 mm. Conclusion: The MSUS reliability in measuring thickness of the four tendons is confirmed by the homogeneous readings intra sonographers, between operators and between different machines. Level of evidence: Tendon thickness can be measured reliably on different ultrasound devices, which is an important step forward in the use of this technique in daily clinical practice and research. Level of evidence: III.KEY WORDS: quantitative ultrasound, reliability, tendinopathy, ultrasound imaging. Ultrasound measures of tendon thickness: Intra-rater, Inter-rater and Inter-machine reliability Original articleUltrasound measures of tendon thickness: Intra-rater, Inter-rater and Inter-machine reliability Figure 1. Sequence of intra-, inter-rater and inter-machines reliability procedure.
Background. The aim of this study was to analyze the concurrent validation between the resistance index (RI) obtained by Spectral Doppler (SD) and the vascular resistance (VR) calculated by quantifying pixel color intensity of the power Doppler (PD) signal. Methods. The brachial artery of 30 healthy participants (24.8 yrs; SD = 6.44 yrs) were evaluated with SD to automatically obtain RI and with PD to estimate de VR with de Pourcelot's formula from systolic and diastolic peaks. Three assessments were performed on each participant, obtaining a total of 90 ultrasound assessments of the brachial artery with their respective RI. Processing and analysis were performed ImageJ software were manually selected and extracted from the brachial artery PD images with the highest and lowest signal corresponding to peak systolic and end diastole for each patient. The mean pixel color of the image with the highest signal was considered as the peak systolic velocity and of the image with the lowest signal as the end-diastolic velocity. Results. A high correlation was found between RI and VR (r = 0.92; 95%CI = 0.88 to 0.95; p ≤ 0.001) so there is a very strong concurrent validity between the two measures, and they can be considered equivalents (common variability of 84%). Conclusions. This new method of analyzing DS by quantifying the color intensity of the PD signal pixel is a good predictor of RI and could be useful for VR analysis in musculoskeletal tissues where measurement of RI is complicated such in neovascularization in tendinopathies with multiple Doppler signals.
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