Infrared Thermography, Intratendon Vascular Resistance, and Echotexture in Athletes with Patellar Tendinopathy: A Cross-Sectional Study.

Ultrasonographic signs of tendinopathies are an increase in thickness, loss of alignment in collagen fibers and the presence of neovascularization. Nevertheless, analysis of intratendinous vascular resistance (IVR) can be more useful for understanding the physiological state of the tissue. To show thermal, echotextural, and Doppler signal differences in athletes with patellar tendinopathy and controls. Twenty-six athletes with patellar tendinopathy (PT) participants (30.1 years; SD = 9.0 years) and 27 asymptomatic athletes (23.3 years; SD = 5.38 years) were evaluated with thermographic and Doppler ultrasonography (DS). Area of Doppler signals (DS), echotextural parameters (echointensity and echovariation) and IVR were determined by image analysis. The statistical analysis was performed by Bayesian methods and the results were showed by Bayes Factor (BF10: probability of alternative hypothesis over null hypothesis), and Credibility intervals (CrI) of the effect. The absolute differences of temperature (TD) were clearly greater (BF10 = 19) in the tendinopathy group (patients) than in controls. Regarding temperature differences between the affected and healthy limb, strong evidence was found (BF10 = 14) for a higher temperature (effect = 0.53°C; 95% CrI = 0.15°C-0.95°C) and very strong for reduced IVR compared (BF10 = 71) (effect = -0.67; 95% CrI = -1.10 to 0.25). The differences in area of DS (BF10 = 266) and EV (BF10 = 266) were higher in tendinopathy group. TD showed a moderate positive correlation with VISA-P scores (tau-B = .29; 95% CrI = .04-.51) and strong correlation with IVR (r = -.553; 95%CrI = -.75 to .18). Athletes with patellar tendinopathy showed a more pronounced thermal difference, a larger area of Doppler signal, a lower IVR and a moderately higher echovariaton than controls. The correlation between temperature changes and IVR might be related with the coexistence of degenerative and inflammatory process in PT.

Reliability of a New Semi-automatic Image Analysis Method for Evaluating the Doppler Signal and Intratendinous Vascular Resistance in Patellar Tendinopathy.

The aim of this study was to determine the intra- and inter-rater reliability of a new semi-automatic image analysis method for quantification of the shape of the Doppler signal and the intratendinous vascular resistance in patellar tendinopathy. Thirty athletes (27.4 y, standard deviation = 8.57 y) with patellar intratendinous vascularity were included in a cross-sectional study (42 tendons analyzed). The intratendinous blood flow was assessed with power Doppler and ImageJ (Version 1.50b, National Institutes of Health, Bethesda, MD, USA) quantification software over a manually selected region of interest. Two blinded observers performed the analysis of the Doppler signal (vascular resistance) and shape descriptors (number of signals, pixel intensity, area, perimeter, major diameter, minor diameter, circularity and solidity). The intraclass correlation coefficient (ICC) was calculated, and the Bland-Altman mean of differences (MoD) and 95% limits of agreement (LoA) were determined. Also, small real differences (SRDs) and the standard error of measurement (SEM) were calculated. Intra-rater reliability was at a maximum for area (ICC = 0.999, 95% confidence interval [CI] = 0.998-0.999) and at a minimum for solidity (ICC = 0.782, 95% CI: 0.682-0.853). The MoD and 95% LoA were very low, and the relative SRD and SEM were below 5.3% and 2%, respectively. The inter-rater reliability was the maximum for area (ICC = 0.993, 95% CI = 0.989-0.996) and the minimum for circularity (ICC = 0.73; 95% CI=0.611-0.817). The MoD and 95% LoA were low, with the SRD and SEM below 6% and 2.2%. The proposed quantitative method for studying the intratendinous Doppler signal in the patellar tendon is reliable and reproducible.

Quantitative neuromuscular ultrasound analysis as biomarkers in amyotrophic lateral sclerosis.

OBJECTIVES: To assess the differences in morphological and texture parameters of median nerve (MN) and abductor pollicis brevis (APB) between amyotrophic lateral sclerosis (ALS) patients and controls. METHODS: The cross-sectional area (CSA) of the MN and the muscle thickness (MTh) of APB were measured bilaterally in 59 recently diagnosed ALS patients and 20 matched healthy controls. Echointensity (EI), echovariation (EV) and grey-level co-occurrence matrix (GLCM) texture features of both structures were also analysed. Correlations between these parameters and clinical variables (muscle strength and disability) were analysed. RESULTS: The CSA of MN was significantly lower in ALS patients (MD = - 1.83 mm2 [95% CI = 2.89; - 0.77 mm2]; p = 0.01). ALS patients showed significantly lower MTh (- 2.23 mm [3.16; - 1.30 mm]; p < 0.001) and EV (- 7.40 [11.5; - 3.33]; p = 0.004) and higher EI (21.2 [11.9; 30.6]; p < 0.001) in the APB muscle. No relevant differences were detected in GLCM features for this muscle. The model including all parameters (CSA for MN and MTh, EI and EV for APB) showed an AUC of 82% (sensitivity 87%; specificity 42%). Muscle strength and disability correlated with APB muscle ultrasound parameters but not with those of the MN. CONCLUSIONS: APB muscle ultrasound biomarkers (especially MTh and EI) showed better discrimination capacity and correlation with clinical variables than MN biomarkers. However, the combination of both biomarkers increased their ability to detect LMN impairment, suggesting that both biomarkers could be used in a complementary manner for the diagnosis and progression monitoring in ALS. KEY POINTS: • Abductor pollicis brevis muscle and median nerve impairment is detectable by ultrasound in amyotrophic lateral sclerosis patients, even in those without clinical impairment. • Muscle ultrasound biomarkers show better discrimination capacity than nerve biomarkers in amyotrophic lateral sclerosis. • Quantitative neuromuscular ultrasound biomarkers could be useful in a general amyotrophic lateral sclerosis population early on the disease.

Sonoelastography for the Assessment of Muscle Changes in Amyotrophic Lateral Sclerosis: Results of a Pilot Study.

The purpose of this study was to assess the sonoelastographic features of four different muscles in patients with amyotrophic lateral sclerosis compared with healthy controls and to evaluate the relationship of these features to muscle strength and other ultrasonographic variables. Fourteen patients with amyotrophic lateral sclerosis and 20 controls were examined using strain sonoelastography scanning. The RGB channel fraction ratio was analyzed with ImageJ software (Version 1.48). Two main sonoelastographic patterns could be distinguished in the controls: a clear predominance of the blue channel (hard areas) and a more heterogeneous pattern with predominance of the green channel (intermediate stiffness). These patterns were also observed in patients, although a higher green channel score was observed in mildly impaired muscles, whereas a higher blue channel score was observed in the most severely impaired muscle. Sonoelastography may be a good complementary biomarker in the detection and monitoring of muscle changes in amyotrophic lateral sclerosis.

Monitoring Progression of Amyotrophic Lateral Sclerosis Using Ultrasound Morpho-Textural Muscle Biomarkers: A Pilot Study.

The need is increasing for progression biomarkers that allow the loss of motor neurons in amyotrophic lateral sclerosis (ALS) to be monitored in clinical trials. In this prospective longitudinal study, muscle thickness, echointensity, echovariation and gray level co-occurrence matrix textural features are examined as possible progression ultrasound biomarkers in ALS patients during a 5-mo follow-up period. We subjected 13 patients to 3 measurements for 20 wk. They showed a significant loss of muscle, an evident tendency to loss of thickness and increased echointensity and echovariation. In regard to textural parameters, muscle heterogeneity tended to increase as a result of the neoformation of non-contractile tissue through denervation. Considering some limitations of the study, the quantitative muscle ultrasound biomarkers evaluated showed a promising ability to monitor patients affected by ALS.

Muscular Echovariation: A New Biomarker in Amyotrophic Lateral Sclerosis.

The purpose of the work described here was to assess the characteristics of echovariation in amyotrophic lateral sclerosis (ALS) compared with other muscle ultrasonography parameters. Twenty-six ALS patients (8 women, mean age 58.9 y, standard deviation 12.02 y) and 26 healthy controls (17 women, mean age 59.6 y, standard deviation 6.41 y) were included in this observational study. They underwent bilateral and transverse ultrasound of the biceps/brachialis, forearm flexor group, quadriceps femoris and tibialis anterior. Muscular thickness, echo-intensity and echovariation were analyzed. Muscles affected by ALS had increased echo-intensity, decreased thickness and decreased echovariation. Echovariation in all muscles except the quadriceps femoris strongly correlated with muscle strength (explained variance between 21.8% in the biceps/brachialis and 37.5% in the tibialis anterior) and the ALS Functional Rating Scale Revised score (explained variance between 26% in the biceps/brachialis and 36.7% in the forearm flexor group). Echovariation is an easy-to-obtain quantitative muscle ultrasonography parameter that could distinguish ALS patients from healthy controls more accurately than previous described biomarkers.

Sonoelastography of Plantar Fascia: Reproducibility and Pattern Description in Healthy Subjects and Symptomatic Subjects.

The purpose of the work reported here was to describe the sonoelastographic appearance of the plantar fascia of healthy volunteers and patients with fasciitis. Twenty-three healthy subjects and 21 patients with plantar fasciitis were examined using B-mode and real-time sonoelastography (RTSR) scanning. B-Mode examination included fascia thickness and echotexture. Echogenicity and echovariation of the color histogram were analyzed. Fasciae were classified into type 1, blue (more elastic); type 2, blue/green (intermediate); or type 3, green (less elastic). RTSE revealed 72.7% of fasciae as type 2, with no significant association with fasciitis (χ(2) = 3.6, df = 2, p = 0.17). Quantitative analysis of the color histogram revealed a significantly greater intensity of green (mean = 77.8, 95% confidence interval [CI] = 71.9-83.6) and blue (mean = 74.2, 95% CI = 69.7-78.8) in healthy subjects. Echovariation of the color red was 33.4% higher in the fasciitis group than in the healthy group (95% CI = 16.7-50.1). Sonoelastography with quantitative analysis of echovariation can be a useful tool for evaluation of plantar fascia pathology.

Fiabilidad y reproducibilidad de un nuevo método de análisis morfotextural de imágenes ecográficas del tendón rotuliano / Reliability and reproducibility of a morpho-textural image analysis method over a patellar ligament ultrasonography

Objetivos. La aplicación de ecografía cuantitativa sobre el tejido tendinoso puede resultar de utilidad pero es necesario conocer la fiabilidad tanto del proceso de la toma ecográfica como de la selección de las regiones para el análisis. Los objetivos del trabajo fueron calcular la fiabilidad y reproducibilidad del método de análisis morfotextural intra-ecografía e interecografía del tendón rotuliano. Material y métodos. Estudio de concordancia del tipo testretest sobre 120 ecografías transversales del tendón rotuliano a 1cm del pico de la rótula, con un ecógrafo Sonosite Titan y sonda L-38 (5–10MHz) y el software de análisis Image J v1.40. Se calcularon variables morfométricas: perímetro, área, anchura, grosor y ecogenicidad media; y texturales: uniformidad, homogeneidad y entropía. Se calculó el coeficiente de correlación intraclase (CCI) junto con las representaciones gráficas de Bland con un IC del 95%. Resultados. Se encontraron coeficientes de correlación intraclase con valores superiores a 0,70, con fuerza de la concordancia entre buena y muy buena en todas las variables y tanto en el estudio intraecografía como en el estudio interecografía. Conclusión. La fiabilidad del método fue buena por lo que la variabilidad introducida por los exploradores no es significativa y el método es potencialmente válido para el estudio y cuantificación ecográfica del tejido tendinoso (AU)

Objective. Image analysis techniques over ultrasonograms may be useful to extract quantitative information. Because ecography and the selection of the area of interest are technician-dependent, the objective of this work was to calculate the reliability and the reproducibility of the analysis method. Material and methods. Test-retest reliability study on 60 cross-sectional patellar ligament ultrasonograms on 1cm of patella were carried out. Sonosite Titan L-38 (5–10MHz) and the Image analysis software J v1.40 were used. Morphometric variables were: perimeter, area, width, thickness, and mean echogenity; textural variables were: uniformity, homogeneity and entropy. The intraclass correlation coefficient (ICC) was calculated with a confidence interval of 95%. Results. Intraclass correlation coefficients over 0,70 were found, with an agreement ranging from good to very good in all of the variables both for the intra ecography and inter ecography studies. Conclusion. Very good levels of reliability and internal consistency were seen, demonstrating that from the statistical point of view, the variability introduced by the technician is not significant. This method can be taken as a reference to analyze the reliability between several ultrasonographers (AU)

[Reliability and reproducibility of a morpho-textural image analysis method over a patellar ligament ultrasonography]. / Fiabilidad y reproducibilidad de un nuevo método de análisis morfotextural de imágenes ecográficas del tendón rotuliano.

OBJECTIVE: Image analysis techniques over ultrasonograms may be useful to extract quantitative information. Because ecography and the selection of the area of interest are technician-dependent, the objective of this work was to calculate the reliability and the reproducibility of the analysis method. MATERIAL AND METHODS: Test-retest reliability study on 60 cross-sectional patellar ligament ultrasonograms on 1cm of patella were carried out. Sonosite Titan L-38 (5-10 MHz) and the Image analysis software J v1.40 were used. Morphometric variables were: perimeter, area, width, thickness, and mean echogenity; textural variables were: uniformity, homogeneity and entropy. The intraclass correlation coefficient (ICC) was calculated with a confidence interval of 95%. RESULTS: Intraclass correlation coefficients over 0.70 were found, with an agreement ranging from good to very good in all of the variables both for the intra ecography and inter ecography studies. CONCLUSION: Very good levels of reliability and internal consistency were seen, demonstrating that from the statistical point of view, the variability introduced by the technician is not significant. This method can be taken as a reference to analyze the reliability between several ultrasonographers.