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Musculoskeletal Imaging |
1 From the Departments of Radiology (M.Z., J.H.) and Orthopedic Surgery (A.M., P.V.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; private practice (H.P.K., H.Z.); and Institute of Biostatistics, University of Zurich, Switzerland (B.S.). Received December 19, 2001; revision requested January 25, 2002; final revision received August 7; accepted August 22. Address correspondence to M.Z. (e-mail: marco.zanetti@balgrist.ch).
PURPOSE: To evaluate the clinical relevance of neovascularization diagnosed with power Doppler ultrasonography (US) in Achilles tendons in patients with chronic achillodynia.
MATERIALS AND METHODS: Forty consecutive patients (mean age, 52 years; age range, 30–72 years) were examined. US was performed bilaterally and repeated after 3 months. Shape and echogenicity were assessed with gray-scale US and vascularization with power Doppler US. All patients were treated conservatively. Clinical assessment was performed after 0, 3, and 6 months by using visual analogue scale (VAS) scores (0, no pain; 100, unbearable pain). The VAS scores were compared with the initial US findings, and analysis of variance was used for repeated measurements.
RESULTS: Neovascularization was present in 30 of 55 painful tendons and in one of 25 asymptomatic tendons. The mean VAS scores at 0, 3, and 6 months, respectively, for tendons with neovascularization were 52, 26, and 20; those for tendons without neovascularization were 39, 19, and 18 (P = .15). Forty-eight painful and nine asymptomatic tendons were spindle shaped. The mean VAS scores at 0, 3, and 6 months, respectively, for the spindle-shaped tendons were 48, 25, and 20; those for normally shaped tendons were 33, 10, and 16 (P = .17). Thirty-five painful and four asymptomatic tendons were inhomogeneous. The mean VAS scores at 0, 3, and 6 months, respectively, for symptomatic inhomogeneous tendons were 54, 29, and 25; those for symptomatic homogeneous tendons were 32, 12, and 9 (P < .001).
CONCLUSION: Although neovascularization is a specific sign for pain, it does not indicate an unfavorable outcome. Conversely, tendon inhomogeneity seems to be associated with an unfavorable outcome.
© RSNA, 2003
Index terms: Extremities, US, 463.12984 • Tendinitis, 456.253 • Tendons, US, 456.253 • Ultrasound (US), power Doppler studies, 463.12984
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