Shear-wave sonoelastography evaluation of Achilles tendons after surgery

Transcription

1 Shear-wave sonoelastography evaluation of Achilles tendons after surgery Poster No.: C-1507 Congress: ECR 2012 Type: Authors: Keywords: DOI: Scientific Paper G. Ivanac, D. Lemac, M. Cavka, B. Brkljacic; Zagreb/HR Musculoskeletal soft tissue, Ultrasound, Diagnostic procedure, Athletic injuries /ecr2012/C-1507 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 7

2 Purpose Elastography is a new dynamic technique that uses ultrasound to estimate the stiffness of tissues by measuring the degree of distortion under application of external force. Elastography has been mostly applied in studies of liver and breast pathology and most elasography techniques utilize external compression. Shear wave elastography (SWE) generates, captures and quantifies velocity of the shear wave and enables quantitative analysis of lesion elasticity by producing real-time quantitative color coded map of local tissue elasticity. In our study sonoelastographic features of Achilles tendons after surgery were compared with healthy contralateral tendons using SWE. Methods and Materials Fourteen patients (average age 44 years) with complete Achilles tendon rupture were examined by single physician 7-79 months (mean 35.4) after surgery by B-mode, color- Doppler, and shear-wave sonoelastography (Supersonic Aixplorer scanner, linear 15 MHz transducer). Findings were compared to normal contralateral tendons. Tendon thickness was measured, degree of vascularisation was evaluated and resistance-index (RI) measured when possible. Elastographic patterns were cathegorized qualitatively into four groups: 1) completely blue; 2) inhomogeneous, mixed blue and red (Fig. 2); 3) predominantly red; 4) completely red - stiff (Fig. 1). Maximum, minimum and mean elasticity values in kpa were measured. Tendons were divided into thirds. Results Healthy tendons demonstrated no vascularisation, their thickness was mm (proximal to distal third), and elastographic patterns were in the range. Mean elasticity values for distal, middle and proximal third in kpa were 258.9±17.7; 250±18.4; 191.8±19.8. Operated tendons had visible vascularisation in 4/14 (29%) patients with average RI of 0.52 (Fig. 3); their thickness was mm and elastographic pattern was cathegorized as 1.9. Mean elasticity values in kpa for distal, middle and proximal third were 212±20.8; Page 2 of 7

3 190±18.8; 182±22 in stiff parts and 60±9.1; 7.2±4; 35±15.3 in elastic parts of operated tendons. We used small parts preset for SWE stadies of breast as well as for musculoskeletal stadies since we obtanied very good B-mode quality of images. However using musculoskeletal preset we noted that elasticity values in kpa for healthly tendons are higher and we will further stady the effect of various scanner presets on measured values obtanied. Images for this section: Fig. 1: This is example of normal, homogeneous, stiff tedon, with mean E-value of three hundred killopascals - this is pattern four in our study, completely red, stiff tendon. Page 3 of 7

4 Fig. 2: This is example of pattern two - tendon after operation is inhomogeneous, with stiff and less stiff parts. Page 4 of 7

5 Fig. 3: Operated tendons had visible vascularisation in 29% patients with average RI of 0.52; Page 5 of 7

6 Conclusion Tendons after surgery demonstrate reduced stiffness compared to normal contralateral tendons. They are also significantly thicker, and sometimes vascularized with lowresistance waveforms. Shear-wave elastography can be used in addition to conventional and Doppler ultrasound to follow patients after Achilles tendon surgery. References 1. Richards PJ, Win T and Jones PW. The distribution of microvascular response in Achilles tendonopathy assessed by colour and power Doppler. Radiol 2005;34(6): Margetic P, Miklic D, Rakic-Ersek V, Doko Z, Lubina ZI, Brkljacic B. Comparison of ultrasonographic and intraoperative findings in Achilles tendon rupture. Coll Antropol 2007;31(1): Bleakney RR, Tallon C, Wong JK, Lim KP, Maffulli N. Long-term ultrasonographic features of the Achilles tendon after rupture. J Sport Med. 2002;12(5): Thermann H, Frerichs O, Holch M, Biewener A. Healing of Achilles tendon, an experimental study: part 2--Histological, immunohistological and ultrasonographic analysis. Foot Ankle Int Jul;23(7): Möller M, Kälebo P, Tidebrant G, Movin T, Karlsson J. The ultrasonographic appearance of the ruptured Achilles tendon during healing: a longitudinal evaluation of surgical and nonsurgical treatment, with comparisons to MRI appearance. Surg Sports Traumatol Arthrosc Jan;10(1): Zordo T, Fink C, Feuchtner GM et al. Real-Time sonoelastography findings in healthy Achilles tendons. AJR 2009;193: Personal Information Gordana Ivanac, MD, PhD University Hospital Dubrava, Department of Radiology Page 6 of 7

7 A. G. Suska Zagreb Croatia gordana.augustan@zg.t-com.hr Page 7 of 7