Ultrasound Doppler Flow in Patients With Chronic Midportion Achilles Tendinopathy: Is Surface Area Quantification a Reliable Method?

Abstract

Objectives Ultrasound assessments of patients with chronic midportion Achilles tendinopathy include determining the degree of neovascularization using Doppler flow. A frequently used measure to quantify neovascularization is the modified Öhberg score. It is unknown whether the semiquantitative modified Öhberg score (0–4+) has higher reliability than a quantified measure of Doppler flow (0–100%). The purpose of this cross‐sectional study was to evaluate the interobserver reliability of the modified Öhberg score and a surface area quantification (SAQ) method for Doppler flow in patients with chronic midportion Achilles tendinopathy. Methods Two observers examined the degree of Doppler flow independently using SAQ and the modified Öhberg score during a single consultation. The intraclass correlation coefficient, standard error of measurement, and minimal detectable difference were determined to evaluate the reliability and measurement properties of the SAQ method and the modified Öhberg score. Results In total, 28 consecutive patients with chronic midportion Achilles tendinopathy participated. The intraclass correlation coefficient for interobserver reliability of the SAQ method was 0.81 (95% confidence interval, 0.58–0.91), compared to 0.64 (95% confidence interval, 0.45–0.81) for the modified Öhberg score. The standard error of measurement and minimal detectable difference values for the SAQ method were 2.9% and 8.0%, respectively, and for the modified Öhberg score, they were 0.55 and 1.53 points. Conclusions The SAQ method shows good reliability to evaluate the degree of Doppler flow in patients with chronic midportion Achilles tendinopathy, and it overcomes the ceiling effect of the modified Öhberg score. Future research should focus on the relationship between the SAQ method and clinical outcomes and use this method to monitor treatment responses.

Multimodal Ultrasound Versus MRI for the Diagnosis and Monitoring of Achilles Tendinopathy: A Prospective Longitudinal Study

“…Interestingly, previous studies stated a wider range of sensitivity (47%-100%) and reduced specificity (0%-50%) for PD-US, which might be partly based on selection bias and high neovascularization rates in active populations with high-loaded tendons. 18 , 41 , 46 , 49 Moreover, previous studies that reported reduced specificity included the asymptomatic side of unilateral AT as a healthy nonpathological control, which might have influenced findings since (subclinical) pathological findings in UTC, B-mode, and PD-US are also present in the asymptomatic side. 8 , 39 , 41 On the other hand, there are some methodological aspects of the present study that might have contributed to higher diagnostic values for PD-US, since the threshold for positive PD-US findings was adjusted to Öhberg grade 2 to avoid a high rate of false-positive results.…”

Do High-Volume Injections Affect the Ultrasonographic Neovascularization in Chronic Achilles Tendinopathy? A Randomized Placebo-Controlled Clinical Trial

“…Another important difference between these studies is that we used the reliable quantitative SAQ method instead of the modified Öhberg score, which overcomes limitations of this semiquantitative scoring systems. 21 We are the first to investigate the correlation between the baseline Doppler flow, the change in Doppler flow using a quantitative measurement, and the change in patient-reported outcome. We did not detect any correlation between baseline Doppler flow or change in Doppler flow and both the VISA-A questionnaire and the VAS 10-hop-score.…”

“…6 We used the following predefined settings for PDUS: mechanical index 1.28, thermal index 1.2, pulse repetition frequency 1.0 kHz, and gain 50. 21 The size of the color box was standardized for every patient at 4.6 cm 2 (depth 1.7 cm; width 2.7 cm). The upper bound of the color box was put on the dorsal side of the Achilles tendon.…”

Efficacy of high-volume injections with and without corticosteroid compared with sham for Achilles tendinopathy: a protocol for a randomised controlled trial

“… 37 Doppler signal will be assessed by quantifying pixel count. 38 This outcome is important to assess whether tendon adaptation and change in Doppler signal is a potential mechanism of the HVI.…”