RESUMO
Objectives: This study aims to compare the efficacy of the eccentric exercise (EE) and extracorporeal shock wave therapy (ESWT) on chronic midportion Achilles tendinopathy and evaluate the efficacy of these treatment modalities on tendon thickness, vascularity, and elasticity. Patients and methods: In this randomized controlled trial, a total of 63 patients (40 females, 23 males; mean age: 37.3±12.2; range, 18 to 55 years) with chronic midportion Achilles tendinopathy were enrolled between April 2017 and December 2019. The patients were allocated randomly to two groups: the first group was treated with EE every day for three months with the Alfredson protocol, and the second group received four sessions of ESWT at weekly intervals. The study was terminated at the end of three months. Visual Analog Scales (VAS), Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaires, and ultrasonography measurements were assessed before and after treatment. Patient pain was evaluated at the two-year follow-up. Results: At the three-month follow up, VAS scores decreased, and VISA-A scores increased in both groups (p<0.001). At the two-year-follow-up, VAS scores significantly decreased in the EE group (p<0.001), but the difference was statistically insignificant in the ESWT group (p=0.095). Tendon thickness and stiffness increased in the EE group (p=0.003 and p=0.03, respectively) while the difference was statistically insignificant in the ESWT group after treatment (p=0.173 and p=0.702, respectively). Conclusion: Eccentric exercise and ESWT are efficient in the short term, whereas EE is efficient on tendon pain in the long term. While EE increases tendon thickness and stiffness, ESWT has no effect on these measures.
RESUMO
OBJECTIVES: American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) category 4A lesions can be distinguished from BI-RADS 3 lesions with main ultrasound (US) findings such as a well-defined contour, round/oval shape, and parallel orientation with a homogeneous echo pattern. Breast Imaging Reporting and Data System 4A solid masses might be diagnosed as simple fibroadenomas (SFAs), complex fibroadenomas (CFAs), or benign phyllodes tumors (BPTs). Complex fibroadenomas have an increased risk of invasive cancer development than SFAs, and BPTs have a risk of borderline-malignant phyllodes tumor transformation; both of them are surgically treated, whereas follow-up procedures are applied in SFAs. It is essential to differentiate SFAs from CFAs and BPTs. Grayscale features of these lesions include a prominent overlap. Texture analyses in breast lesions have contributions in benign-malignant lesion differentiation. In this study, we aimed to use texture analysis of US images to differentiate these benign lesions. METHODS: Grayscale US features of lesions (32 SFAs, 31 CFAs, and 32 BPTs) were classified according to the BI-RADS. Texture analysis of US images with LIFEx software (http://www.lifexsoft.org) was performed retrospectively. First- and second-order histogram parameters were evaluated. RESULTS: In grayscale US, the shape, orientation, and posterior acoustic characteristics had statistical significance (P < .05). In the statistical analysis, skewness, kurtosis, excess kurtosis, gray-level co-occurrence matrix (GLCM)-energy, GLCM-entropy log 2, and GLCM-entropy log 10 revealed significant differences among all 3 groups (P < .05). CONCLUSIONS: As grayscale US features show prominent intersections, and treatment options differ, correct diagnosis is essential in SFAs, CFAs, and BPTs. In this study, we concluded that texture analysis of US images can discriminate SFAs from CFAs and BPTs. Texture analyses of US images is a potential candidate diagnostic tool for these lesions, and accurate diagnoses will preclude patients from undergoing unnecessary biopsies.
