Evaluation of Achilles tendon stiffness during contraction: a comparison of different sonoelastography

Schneebeli, Alessandro and Bortolotto, Chandra and Barbero, Marco and Cescon, Corrado and Racidi, Maria Vittoria and Calliada, Fabrizio (2018) Evaluation of Achilles tendon stiffness during contraction: a comparison of different sonoelastography. UNSPECIFIED. In: XXII Congress of the International Society of Electrophysiology and Kinesiology (ISEK), 30/6-2/7/2018, Dublin.

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AIM: The aim of this study was to evaluate differences in stiffness of Achilles tendon during contraction measured with different sonoelastography devices METHODS: Twenty healthy subject were recruited. Longitudinal sonoelastography images of the left and right Achilles tendon area were acquired with four different ultrasound devices, two strain sonoelastography (Mindray, Toshiba) and two shear wave elastography (Mindray, Supersonic) Achilles tendon of the participants were analysed under different contraction levels in plantar flexion using an ankle ergometer with visual feedback at: 0 kg, 0.5kg, 1 kg, 2 kg, 5 kg and, 10 kg. An external reference material (Zerdine®, CIRS, Inc., Norfolk), with known elastic properties was placed on the subject’s Achilles tendon and included in the b-mode scans for the strain elastography analysis. The external reference material was used to provide a comparison between the examined tissue and a material in which a constant elasticity was present. The range between soft and hard (from red to blue) was divided in 256 steps (0-255), according to the ultrasound image color depth. The median and interquartile range of colors was computed. Strain ratio (Tendon/Reference) were calculated Shear wave images were analysed on the ultrasound device, a region of interest (ROI) was drawn in the tendon and shear elastic modulus (kPa) were extracted. Non parametric test (Friedman test) was used to compare stiffness difference during contraction for each of the ultrasound device. RESULTS: Strain ratios and elasticity (kPa) values at difference contraction level are summarized in the figure. Mindray strain sonoelastography show a decrease tendon elasticity (increase stiffness) during contraction from 1.46±0.64 to 0.35±0.13. Toshiba strain sonoelastography show a decrease tendon elasticity (increase stiffness) from 1.20±0.67 to 0.55±0.20. Mindray shear wave elastography show a decrease stiffness during contraction from 37.34±16.14 kPa to 16.14±2.75 kPa. Supersonic shear wave elastography show an increase stiffness between the first two contraction levels from 410.4±103.8 kPa to 479.8±75.1 kPa and a decreased stiffness for the higher contraction levels from 442.8±103.7 kPa to 294.2±64.4 kPa. CONCLUSION: Strain elastography with reference material is a technology able to intercept stiffness changes between the different contraction level on the other hand shear wave elastography seems to have technical problem when Achilles tendon is under load. Incoherence between the results of the two technologies should be further investigated. ACKNOWLEDGEMENT: We thank the staff and student of the Policlinico San Matteo for participating in the study.

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