Microvascular volume in symptomatic Achilles tendons is associated with VISA-A score

S. F.E. Praet, J. H. Ong, C. Purdam, M. Welvaert, G. Lovell, L. Dixon, J. E. Gaida, J. Anglim, S. Manzanero, N. Vlahovich, D. Hughes, G. Waddington

Research output: Contribution to journalArticle

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Abstract

Objectives: The role of neovascularisation in tendinopathy is still poorly understood, potentially due to technical limitations of conventional power Doppler ultrasound. This study aimed to investigate the association between contrast-enhanced ultrasound (CEUS) microvascular volume (MV), Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and intrinsic Achilles tendon tenderness, as well as two different Power Doppler modes. Design: Cross-sectional study. Methods: 20 individuals with uni- or bilateral Achilles tendinopathy completed a VISA-A questionnaire, and underwent microvascular volume measurements of the Achilles tendon mid-portion using both conventional, ultrasensitive (SMI™) power Doppler ultrasound and CEUS. Intrinsic tendon tenderness was assessed with sensation detection threshold to extracorporeal shock waves (ESW). Linear Mixed Model analysis was used to determine the association between microvascular volume (MV), VISA-A, and ESW-detection threshold for both symptomatic and asymptomatic Achilles tendons. Results: There was a significant association between VISA-A and MV (B = −5.3, 95%CI = [−8.5; −2.0], P = 0.0004), and between MV and symptom duration (B = −1.7, 95%CI = [−3.2; −5.0], P = 0.023). No significant associations were found between power Doppler ultrasound and CEUS-based MV or between CEUS-based MV and ESW-detection threshold. In comparison with conventional power Doppler ultrasound, SMI™ showed on average similar detection capacity for neovessels in the mid-portion of the Achilles tendon, whilst being superior for detecting neovessels within Kager's fat pad (t = 3.46, 95%CI = [0.27; 1.03], P < 0.005). Conclusions: Our results indicate that CEUS-based MV of the Achilles tendon is moderately associated with Achilles tendon symptoms. In accordance, CEUS-detected MV could be a novel target for treatment as it seems to be more sensitive than PDU and is correlated with symptoms.

Original languageEnglish
Article number1853
Pages (from-to)1185-1191
Number of pages7
JournalJournal of Science and Medicine in Sport
Volume21
Issue number12
DOIs
Publication statusPublished - 2018

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Achilles Tendon
Sports
Doppler Ultrasonography
Tendinopathy
Tendons
Adipose Tissue
Linear Models
Cross-Sectional Studies
Power (Psychology)

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Praet, S. F.E. ; Ong, J. H. ; Purdam, C. ; Welvaert, M. ; Lovell, G. ; Dixon, L. ; Gaida, J. E. ; Anglim, J. ; Manzanero, S. ; Vlahovich, N. ; Hughes, D. ; Waddington, G. / Microvascular volume in symptomatic Achilles tendons is associated with VISA-A score. In: Journal of Science and Medicine in Sport. 2018 ; Vol. 21, No. 12. pp. 1185-1191.
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title = "Microvascular volume in symptomatic Achilles tendons is associated with VISA-A score",
abstract = "Objectives: The role of neovascularisation in tendinopathy is still poorly understood, potentially due to technical limitations of conventional power Doppler ultrasound. This study aimed to investigate the association between contrast-enhanced ultrasound (CEUS) microvascular volume (MV), Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and intrinsic Achilles tendon tenderness, as well as two different Power Doppler modes. Design: Cross-sectional study. Methods: 20 individuals with uni- or bilateral Achilles tendinopathy completed a VISA-A questionnaire, and underwent microvascular volume measurements of the Achilles tendon mid-portion using both conventional, ultrasensitive (SMI™) power Doppler ultrasound and CEUS. Intrinsic tendon tenderness was assessed with sensation detection threshold to extracorporeal shock waves (ESW). Linear Mixed Model analysis was used to determine the association between microvascular volume (MV), VISA-A, and ESW-detection threshold for both symptomatic and asymptomatic Achilles tendons. Results: There was a significant association between VISA-A and MV (B = −5.3, 95{\%}CI = [−8.5; −2.0], P = 0.0004), and between MV and symptom duration (B = −1.7, 95{\%}CI = [−3.2; −5.0], P = 0.023). No significant associations were found between power Doppler ultrasound and CEUS-based MV or between CEUS-based MV and ESW-detection threshold. In comparison with conventional power Doppler ultrasound, SMI™ showed on average similar detection capacity for neovessels in the mid-portion of the Achilles tendon, whilst being superior for detecting neovessels within Kager's fat pad (t = 3.46, 95{\%}CI = [0.27; 1.03], P < 0.005). Conclusions: Our results indicate that CEUS-based MV of the Achilles tendon is moderately associated with Achilles tendon symptoms. In accordance, CEUS-detected MV could be a novel target for treatment as it seems to be more sensitive than PDU and is correlated with symptoms.",
keywords = "Achilles tendon, Contrast agent, Doppler ultrasound, Medical imaging, Microvessels, Sensory threshold",
author = "Praet, {S. F.E.} and Ong, {J. H.} and C. Purdam and M. Welvaert and G. Lovell and L. Dixon and Gaida, {J. E.} and J. Anglim and S. Manzanero and N. Vlahovich and D. Hughes and G. Waddington",
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Praet, SFE, Ong, JH, Purdam, C, Welvaert, M, Lovell, G, Dixon, L, Gaida, JE, Anglim, J, Manzanero, S, Vlahovich, N, Hughes, D & Waddington, G 2018, 'Microvascular volume in symptomatic Achilles tendons is associated with VISA-A score', Journal of Science and Medicine in Sport, vol. 21, no. 12, 1853, pp. 1185-1191. https://doi.org/10.1016/j.jsams.2018.05.013

Microvascular volume in symptomatic Achilles tendons is associated with VISA-A score. / Praet, S. F.E.; Ong, J. H.; Purdam, C.; Welvaert, M.; Lovell, G.; Dixon, L.; Gaida, J. E.; Anglim, J.; Manzanero, S.; Vlahovich, N.; Hughes, D.; Waddington, G.

In: Journal of Science and Medicine in Sport, Vol. 21, No. 12, 1853, 2018, p. 1185-1191.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Microvascular volume in symptomatic Achilles tendons is associated with VISA-A score

AU - Praet, S. F.E.

AU - Ong, J. H.

AU - Purdam, C.

AU - Welvaert, M.

AU - Lovell, G.

AU - Dixon, L.

AU - Gaida, J. E.

AU - Anglim, J.

AU - Manzanero, S.

AU - Vlahovich, N.

AU - Hughes, D.

AU - Waddington, G.

PY - 2018

Y1 - 2018

N2 - Objectives: The role of neovascularisation in tendinopathy is still poorly understood, potentially due to technical limitations of conventional power Doppler ultrasound. This study aimed to investigate the association between contrast-enhanced ultrasound (CEUS) microvascular volume (MV), Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and intrinsic Achilles tendon tenderness, as well as two different Power Doppler modes. Design: Cross-sectional study. Methods: 20 individuals with uni- or bilateral Achilles tendinopathy completed a VISA-A questionnaire, and underwent microvascular volume measurements of the Achilles tendon mid-portion using both conventional, ultrasensitive (SMI™) power Doppler ultrasound and CEUS. Intrinsic tendon tenderness was assessed with sensation detection threshold to extracorporeal shock waves (ESW). Linear Mixed Model analysis was used to determine the association between microvascular volume (MV), VISA-A, and ESW-detection threshold for both symptomatic and asymptomatic Achilles tendons. Results: There was a significant association between VISA-A and MV (B = −5.3, 95%CI = [−8.5; −2.0], P = 0.0004), and between MV and symptom duration (B = −1.7, 95%CI = [−3.2; −5.0], P = 0.023). No significant associations were found between power Doppler ultrasound and CEUS-based MV or between CEUS-based MV and ESW-detection threshold. In comparison with conventional power Doppler ultrasound, SMI™ showed on average similar detection capacity for neovessels in the mid-portion of the Achilles tendon, whilst being superior for detecting neovessels within Kager's fat pad (t = 3.46, 95%CI = [0.27; 1.03], P < 0.005). Conclusions: Our results indicate that CEUS-based MV of the Achilles tendon is moderately associated with Achilles tendon symptoms. In accordance, CEUS-detected MV could be a novel target for treatment as it seems to be more sensitive than PDU and is correlated with symptoms.

AB - Objectives: The role of neovascularisation in tendinopathy is still poorly understood, potentially due to technical limitations of conventional power Doppler ultrasound. This study aimed to investigate the association between contrast-enhanced ultrasound (CEUS) microvascular volume (MV), Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and intrinsic Achilles tendon tenderness, as well as two different Power Doppler modes. Design: Cross-sectional study. Methods: 20 individuals with uni- or bilateral Achilles tendinopathy completed a VISA-A questionnaire, and underwent microvascular volume measurements of the Achilles tendon mid-portion using both conventional, ultrasensitive (SMI™) power Doppler ultrasound and CEUS. Intrinsic tendon tenderness was assessed with sensation detection threshold to extracorporeal shock waves (ESW). Linear Mixed Model analysis was used to determine the association between microvascular volume (MV), VISA-A, and ESW-detection threshold for both symptomatic and asymptomatic Achilles tendons. Results: There was a significant association between VISA-A and MV (B = −5.3, 95%CI = [−8.5; −2.0], P = 0.0004), and between MV and symptom duration (B = −1.7, 95%CI = [−3.2; −5.0], P = 0.023). No significant associations were found between power Doppler ultrasound and CEUS-based MV or between CEUS-based MV and ESW-detection threshold. In comparison with conventional power Doppler ultrasound, SMI™ showed on average similar detection capacity for neovessels in the mid-portion of the Achilles tendon, whilst being superior for detecting neovessels within Kager's fat pad (t = 3.46, 95%CI = [0.27; 1.03], P < 0.005). Conclusions: Our results indicate that CEUS-based MV of the Achilles tendon is moderately associated with Achilles tendon symptoms. In accordance, CEUS-detected MV could be a novel target for treatment as it seems to be more sensitive than PDU and is correlated with symptoms.

KW - Achilles tendon

KW - Contrast agent

KW - Doppler ultrasound

KW - Medical imaging

KW - Microvessels

KW - Sensory threshold

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M3 - Article

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