Intermachine Variation of Ultrasound Strain Elastographic Measures of the Quadriceps and Patellar Tendons in Healthy Participants: Implications for Clinical Practice

Dickson, Diane M.; Fawole, Henrietta O.; Hendry, Gordon J.; Smith, Stephanie L.

Abstract

Objectives
To evaluate intermachine variation and compare intraoperator and interoperator agreement and repeatability characteristics of 2 ultrasound (US) systems for measurements of quadriceps and patellar tendons by strain elastography (SE).

Methods
Forty tendons from 20 healthy participants were investigated by operators with different experience (operator 1, 12 years of US experience and >50 SE examinations; operator 2, no US experience and 1 day of SE training). Repeated measures were performed on GE Healthcare (Waukesha, WI) and Esaote (Genoa, Italy) US systems. The percentage of agreement, Cohen κ, intraclass correlation coefficient, and correlation tests assessed agreement, repeatability, and associations of SE measures. A paired t test and Wilcoxon signed rank test assessed differences in SE measures.

Results
The study participants included 5 male and 15 female volunteers (mean [range] age, 29.3 [21–39] years). Better agreement and repeatability characteristics were observed for the patellar compared to the quadriceps tendon and the color score (CS) method over the elasticity ratio (ER). Intraoperator agreement was better for the experienced operator. Intraoperator repeatability was achieved in 55% of ER (intraclass correlation coefficient, 0.40–0.91; P  [less than] .05) and 77% to 85% (κ = –0.25–1) of CS measures. Interoperator repeatability was achieved in 35% (t /z , –2.93–7.94; P  [less than] .001–.048) of all ER measures. No significant differences in proximal (z , –0.13– –0.78) and distal patellar (z , –1.52–2.26; P  > .5) patellar ER measures were observed. Seventy‐four percent to 75% mean agreement (κ = 0–0.5) for CS measures comparable across both US systems was observed. Intermachine ER associations were poor (r = –0.39–0.13; P  > .05), whereas greater than 70% agreement (κ = –0.87–0.53) for the CS was achieved.

Conclusions
The reproducibility of knee tendon SE measurements is influenced by the operator experience, US system, and tendon site.

Citation

Dickson, D. M., Fawole, H. O., Hendry, G. J., & Smith, S. L. (2020). Intermachine Variation of Ultrasound Strain Elastographic Measures of the Quadriceps and Patellar Tendons in Healthy Participants: Implications for Clinical Practice. Journal of Ultrasound in Medicine, 39(7), 1343-1353. https://doi.org/10.1002/jum.15228

• Journal Article Type: Article
• Acceptance Date: Jan 7, 2020
• Online Publication Date: Jan 25, 2020
• Publication Date: 2020-07
• Deposit Date: Jun 5, 2020
• Publicly Available Date: Jan 26, 2021
• Journal: Journal of Ultrasound in Medicine
• Print ISSN: 0278-4297
• Electronic ISSN: 1550-9613
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 39
• Issue: 7
• Pages: 1343-1353
• DOI: https://doi.org/10.1002/jum.15228
• Keywords: Radiological and Ultrasound Technology; Radiology Nuclear Medicine and imaging
• Public URL: https://nottingham-repository.worktribe.com/output/4584454
• Publisher URL: https://onlinelibrary.wiley.com/doi/abs/10.1002/jum.15228
• Additional Information: This is the peer reviewed version of the following article: Dickson, D.M., Fawole, H.O., Hendry, G.J. and Smith, S.L. (2020), Intermachine Variation of Ultrasound Strain Elastographic Measures of the Quadriceps and Patellar Tendons in Healthy Participants. J Ultrasound Med., which has been published in final form at https://doi.org/10.1002/jum.15228. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.