Reliability of evaluating Achilles tendon blood flow assessed with Doppler Ultrasound Advanced Dynamic Flow
Main Article Content
Abstract
Reliability of quantifying intratendinous blood flow (IBF) assessed with the high-sensitive Doppler ultrasound Advanced dynamic flow (ADF) has not been examined, yet. Therefore, this study aimed to investigate intra- and inter-observer reliability of evaluating Achilles tendon IBF assessed with ADF using established scoring systems. Three investigators evaluated IBF in 67 recordings in a test-retest design applying the Ohberg score (OS), a modified Ohberg score (MOS), and a counting score (CS). Intra-and inter-observer agreement for OS and MOS was analysed with Cohen’s Kappa and Fleiss Kappa (absolute), Kendall’s tau b and Kendall’s Coefficient of Concordance (Kendall’s W) (relative). Reliability of CS was analysed with ICC 2.1 and 3.1, standard error of measurement (SEM) and Bland-Altman analysis (bias and limits of agreement (LoA)). Intra- and inter-observer agreement (absolute/relative) ranged from 0.61-0.87/0.87-0.95 and 0.11-0.66/0.76-0.89 for OS, and from 0.81-0.87/0.92-0.95 and 0.64-0.80/0.88-0.93 for MOS, respectively. CS revealed an intra-observer ICC of 0.94-0.97, SEM 1.0-1.5, and bias -1, LoA 3-4 vessels. Inter-observer ICC for CS ranged from 0.91-0.98, SEM 1.0-1.9, and bias 0, LoA 3-5 vessels. MOS and CS showed excellent reliability and seem convenient for research and clinical practice. OS revealed decent intra- but unexpected low inter-observer reliability and therefore cannot be recommended.
Article Details
How to Cite
RISCH, Lucie et al.
Reliability of evaluating Achilles tendon blood flow assessed with Doppler Ultrasound Advanced Dynamic Flow.
Medical Research Archives, [S.l.], v. 3, n. 5, oct. 2017.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/479>. Date accessed: 25 apr. 2024.
doi: https://doi.org/10.18103/mra.v3i5.479.
Keywords
Reliability, Intratendinous blood flow, Advanced dynamic flow
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1 Tol JL, Spiezia F, Maffulli N. Neovascularization in Achilles tendinopathy: have we been chasing a red herring? Knee Surg Sports Traumatol Arthrosc 2012; 20: 1891–1894
2 Boesen AP, Boesen MI, Torp-Pedersen S, Christensen R, Boesen L, Hölmich P, Nielsen MB, Koenig MJ, Hartkopp A, Ellegaard K, Bliddal H, Langberg H. Associations between abnormal ultrasound color Doppler measures and tendon pain symptoms in badminton players during a season: a prospective cohort study. Am J Sports Med 2012; 40: 548–555
3 Hirschmüller A, Frey V, Deibert P, Konstantinidis L, Mayer F, Südkamp N, Helwig P. [Achilles tendon power Doppler sonography in 953 long distance runners - a cross sectional study]. Ultraschall Med 2010; 31: 387–393
4 Cassel M, Baur H, Hirschmüller A, Carlsohn A, Fröhlich K, Mayer F. Prevalence of Achilles and patellar tendinopathy and their association to intratendinous changes in adolescent athletes. Scand J Med Sci Sports 2014; 1–9
5 Boesen MI, Koenig MJ, Torp-Pedersen S, Bliddal H, Langberg H. Tendinopathy and Doppler activity: the vascular response of the Achilles tendon to exercise. Scand J Med Sci Sports 2006; 16: 463–469
6 Boesen MI, Boesen A, Koenig MJ, Bliddal H, Torp-Pedersen S. Ultrasonographic investigation of the Achilles tendon in elite badminton players using color Doppler. Am J Sports Med 2006; 34: 2013–2021
7 Malliaras P, Richards PJ, Garau G, Maffulli N. Achilles tendon Doppler flow may be associated with mechanical loading among active athletes. Am J Sports Med 2008; 36: 2210–2215
8 Hirschmüller A, Frey V, Konstantinidis L, Baur H, Dickhuth H-H, Südkamp NP, Helwig P. Prognostic value of Achilles tendon Doppler sonography in asymptomatic runners. Med Sci Sports Exerc 2012; 44: 199–205
9 Ohberg L, Lorentzon R, Alfredson H. Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. Knee Surg Sports Traumatol Arthrosc 2001; 9: 233–238
10 Alfredson H, Ohberg L, Forsgren S. Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Knee Surg Sports Traumatol Arthrosc 2003; 11: 334–338
11 de Vos R-J, Weir A, Cobben LPJ, Tol JL. The value of power Doppler ultrasonography in Achilles tendinopathy: a prospective study. Am J Sports Med 2007; 35: 1696–1701
12 Yang X, Pugh ND, Coleman DP, Nokes LDM. Are Doppler studies a useful method of assessing neovascularization in human Achilles tendinopathy? A systematic review and suggestions for optimizing machine settings. J Med Eng Technol 2010; 34: 365–372
13 Cook JL, Ptazsnik R, Kiss ZS, Malliaras P, Morris ME, De Luca J. High reproducibility of patellar tendon vascularity assessed by colour Doppler ultrasonography: a reliable measurement tool for quantifying tendon pathology. Br J Sports Med 2005; 39: 700–703
14 Ohberg L, Alfredson H. Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med 2002; 36: 173–175; discussion 176–177
15 Sengkerij PM, de Vos R-J, Weir A, van Weelde BJG, Tol JL. Interobserver reliability of neovascularization score using power Doppler ultrasonography in midportion achilles tendinopathy. Am J Sports Med 2009; 37: 1627–1631
16 Sunding K, Fahlström M, Werner S, Forssblad M, Willberg L. Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler: using a four-grade scale. Knee Surgery, Sport Traumatol Arthrosc 2014
17 Weidekamm C, Köller M, Weber M, Kainberger F. Diagnostic value of high-resolution B-mode and Doppler sonography for imaging of hand and finger joints in rheumatoid arthritis. Arthritis Rheum 2003; 48: 325–333
18 Richards PJ, Win T, Jones PW. The distribution of microvascular response in Achilles tendonopathy assessed by colour and power Doppler. Skeletal Radiol 2005; 34: 336–342
19 Malliaras P, Chan O, Simran G, Martinez de Albornoz P, Morrissey D, Maffulli N. Doppler ultrasound signal in Achilles tendinopathy reduces immediately after activity. Int J Sports Med 2012; 33: 480–484
20 Beyer R, Kongsgaard M, Hougs Kjaer B, Ohlenschlaeger T, Kjaer M, Magnusson SP. Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial. Am J Sports Med 2015; 43: 1704–1711
21 Heling KS, Chaoui R, Bollmann R. Advanced dynamic flow -- a new method of vascular imaging in prenatal medicine. A pilot study of its applicability. Ultraschall Med 2004; 25: 280–284
22 Fittschen M, Reinhard I, Wellek S, Friedrichs S, Bahlmann F. Advanced dynamic Doppler flow of the pulmonary artery in a normal population: reference values from 18 to 41 weeks of gestation calculated by automatic Doppler waveform analysis. Arch Gynecol Obstet 2014; 289: 973–980
23 Risch L, Cassel M, Messerschmidt J, Intziegianni K, Fröhlich K, Kopinski S, Mayer F. Is Sonographic Assessment of Intratendinous Blood Flow in Achilles Tendinopathy Patients Reliable? Ultrasound Int Open 2016; epub ahead
24 Robinson JM, Cook JL, Purdam C, Visentini PJ, Ross J, Maffulli N, Taunton JE, Khan KM. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 2001; 35: 335–341
25 Bortz J, Lienert GA. Kurzgefasste Statistik für die klinische Forschung: Leitfaden für die verteilungsfreie Analyse kleiner Stichproben. 3rd ed. Heidelberg: Springer, 2008
26 Atkinson G, Nevill AM. Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Med 1998; 26: 217–238
27 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174
28 Cook JL, Malliaras P, De Luca J, Ptasznik R, Morris M. Vascularity and pain in the patellar tendon of adult jumping athletes: a 5 month longitudinal study. Br J Sports Med 2005; 39: 458–461; discussion 458–461
2 Boesen AP, Boesen MI, Torp-Pedersen S, Christensen R, Boesen L, Hölmich P, Nielsen MB, Koenig MJ, Hartkopp A, Ellegaard K, Bliddal H, Langberg H. Associations between abnormal ultrasound color Doppler measures and tendon pain symptoms in badminton players during a season: a prospective cohort study. Am J Sports Med 2012; 40: 548–555
3 Hirschmüller A, Frey V, Deibert P, Konstantinidis L, Mayer F, Südkamp N, Helwig P. [Achilles tendon power Doppler sonography in 953 long distance runners - a cross sectional study]. Ultraschall Med 2010; 31: 387–393
4 Cassel M, Baur H, Hirschmüller A, Carlsohn A, Fröhlich K, Mayer F. Prevalence of Achilles and patellar tendinopathy and their association to intratendinous changes in adolescent athletes. Scand J Med Sci Sports 2014; 1–9
5 Boesen MI, Koenig MJ, Torp-Pedersen S, Bliddal H, Langberg H. Tendinopathy and Doppler activity: the vascular response of the Achilles tendon to exercise. Scand J Med Sci Sports 2006; 16: 463–469
6 Boesen MI, Boesen A, Koenig MJ, Bliddal H, Torp-Pedersen S. Ultrasonographic investigation of the Achilles tendon in elite badminton players using color Doppler. Am J Sports Med 2006; 34: 2013–2021
7 Malliaras P, Richards PJ, Garau G, Maffulli N. Achilles tendon Doppler flow may be associated with mechanical loading among active athletes. Am J Sports Med 2008; 36: 2210–2215
8 Hirschmüller A, Frey V, Konstantinidis L, Baur H, Dickhuth H-H, Südkamp NP, Helwig P. Prognostic value of Achilles tendon Doppler sonography in asymptomatic runners. Med Sci Sports Exerc 2012; 44: 199–205
9 Ohberg L, Lorentzon R, Alfredson H. Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation. Knee Surg Sports Traumatol Arthrosc 2001; 9: 233–238
10 Alfredson H, Ohberg L, Forsgren S. Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Knee Surg Sports Traumatol Arthrosc 2003; 11: 334–338
11 de Vos R-J, Weir A, Cobben LPJ, Tol JL. The value of power Doppler ultrasonography in Achilles tendinopathy: a prospective study. Am J Sports Med 2007; 35: 1696–1701
12 Yang X, Pugh ND, Coleman DP, Nokes LDM. Are Doppler studies a useful method of assessing neovascularization in human Achilles tendinopathy? A systematic review and suggestions for optimizing machine settings. J Med Eng Technol 2010; 34: 365–372
13 Cook JL, Ptazsnik R, Kiss ZS, Malliaras P, Morris ME, De Luca J. High reproducibility of patellar tendon vascularity assessed by colour Doppler ultrasonography: a reliable measurement tool for quantifying tendon pathology. Br J Sports Med 2005; 39: 700–703
14 Ohberg L, Alfredson H. Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med 2002; 36: 173–175; discussion 176–177
15 Sengkerij PM, de Vos R-J, Weir A, van Weelde BJG, Tol JL. Interobserver reliability of neovascularization score using power Doppler ultrasonography in midportion achilles tendinopathy. Am J Sports Med 2009; 37: 1627–1631
16 Sunding K, Fahlström M, Werner S, Forssblad M, Willberg L. Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler: using a four-grade scale. Knee Surgery, Sport Traumatol Arthrosc 2014
17 Weidekamm C, Köller M, Weber M, Kainberger F. Diagnostic value of high-resolution B-mode and Doppler sonography for imaging of hand and finger joints in rheumatoid arthritis. Arthritis Rheum 2003; 48: 325–333
18 Richards PJ, Win T, Jones PW. The distribution of microvascular response in Achilles tendonopathy assessed by colour and power Doppler. Skeletal Radiol 2005; 34: 336–342
19 Malliaras P, Chan O, Simran G, Martinez de Albornoz P, Morrissey D, Maffulli N. Doppler ultrasound signal in Achilles tendinopathy reduces immediately after activity. Int J Sports Med 2012; 33: 480–484
20 Beyer R, Kongsgaard M, Hougs Kjaer B, Ohlenschlaeger T, Kjaer M, Magnusson SP. Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial. Am J Sports Med 2015; 43: 1704–1711
21 Heling KS, Chaoui R, Bollmann R. Advanced dynamic flow -- a new method of vascular imaging in prenatal medicine. A pilot study of its applicability. Ultraschall Med 2004; 25: 280–284
22 Fittschen M, Reinhard I, Wellek S, Friedrichs S, Bahlmann F. Advanced dynamic Doppler flow of the pulmonary artery in a normal population: reference values from 18 to 41 weeks of gestation calculated by automatic Doppler waveform analysis. Arch Gynecol Obstet 2014; 289: 973–980
23 Risch L, Cassel M, Messerschmidt J, Intziegianni K, Fröhlich K, Kopinski S, Mayer F. Is Sonographic Assessment of Intratendinous Blood Flow in Achilles Tendinopathy Patients Reliable? Ultrasound Int Open 2016; epub ahead
24 Robinson JM, Cook JL, Purdam C, Visentini PJ, Ross J, Maffulli N, Taunton JE, Khan KM. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 2001; 35: 335–341
25 Bortz J, Lienert GA. Kurzgefasste Statistik für die klinische Forschung: Leitfaden für die verteilungsfreie Analyse kleiner Stichproben. 3rd ed. Heidelberg: Springer, 2008
26 Atkinson G, Nevill AM. Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Med 1998; 26: 217–238
27 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174
28 Cook JL, Malliaras P, De Luca J, Ptasznik R, Morris M. Vascularity and pain in the patellar tendon of adult jumping athletes: a 5 month longitudinal study. Br J Sports Med 2005; 39: 458–461; discussion 458–461