Validation of High-Resolution peripheral Quantitative Computed Tomography-Derived Achilles Tendon Properties Against Diagnostic Ultrasound

Hugo J W Fung; Angela M Cheung; Sunita Mathur; Eva Szabo; Andy K O Wong

Validation of High-Resolution peripheral Quantitative Computed Tomography-Derived Achilles Tendon Properties Against Diagnostic Ultrasound

J Musculoskelet Neuronal Interact. 2022 Jun 1;22(2):203-211.

Authors

Hugo J W Fung^{1

2}, Angela M Cheung^{2

3

4

5}, Sunita Mathur^{6

7}, Eva Szabo^{2

5}, Andy K O Wong^{2

4

7

8

5}

Affiliations

¹ Department of Exercise Science, Faculty of Kinesiology and Physical Education, University of Toronto, Canada.
² Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, ON, Canada.
³ Department of Medicine, University Health Network, Canada.
⁴ Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
⁵ Osteoporosis Program, Schroeder's Arthritis Institute, University Health Network.
⁶ Department of Physical Therapy, Faculty of Medicine, University of Toronto, Canada.
⁷ Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada.
⁸ Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Canada.

PMID: 35642700
PMCID: PMC9186460

Abstract

Objectives: 1) To assess the precision of high resolution peripheral quantitative computed tomography (HR-pQCT)-derived Achilles tendon (AT) cross-sectional area (HR AT-CSA) and density, and 2) to validate HR AT-CSA against ultrasound-derived AT-CSA (US AT-CSA).

Methods: Women and men (≥50 years) had HR-pQCT (0.082mm isotropic) and US scans (B-mode) performed on the non-dominant ankle. Linear regression and Bland-Altman analyses assessed systematic differences between HR-pQCT and US-derived AT-CSA. Precision measured by % root mean square coefficients of variation (%RMSCV) and agreement by type 2,1 intraclass correlation coefficients (ICC_2,1), were determined for test-retest US AT-CSA scans, and analysis-reanalysis of 30 HR-pQCT and US images.

Results: Among 44 participants, HR and US AT-CSA were strongly correlated (R²=0.84, p<0.01, B=1.05[0.90-1.19]), with no differences between modalities (p=0.37). Bland-Altman analysis revealed minimal systematic bias (-0.7mm²[-10.7-9.3]; 1.3%) between HR-pQCT and US-derived AT-CSA with smaller AT-CSA values showing larger inter-modality differences (R²=0.098, B=-0.137 [-0.268--0.008], p=0.039). US AT-CSA demonstrated excellent test-retest precision (ICC_2,1=0.998, %RMSCV=1.04%). Analysis-reanalysis of HR-pQCT AT-density and both HR-pQCT and US AT-CSA displayed ICC_2,1 above 0.95 and %RMSCV within 3%.

Conclusion: HR-pQCT can examine AT-morphometry with acceptable analytical precision. Future studies should explore these metrics' association with functional outcomes and ankle-bone structural and mechanical properties.

Keywords: Achilles Tendon; HR-pQCT; Tendon Cross-Sectional Area; Tendon Density; Ultrasound.

MeSH terms

Achilles Tendon* / diagnostic imaging
Ankle
Female
Humans
Male
Tomography, X-Ray Computed / methods
Ultrasonography