Achilles Tendon Elasticity Decreases with Intermittent Claudication in Patients by Acoustic Radiation Force Impulse Imaging (ARFI)
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Objective: To investigate the value of Acoustic Radiation Force Impulse elastography and its application in Achilles tendon elasticity of intermittent claudication due to lower extremity arterial ischaemia. Methods: This prospective case-control study was conducted at the Department of Radiology, Faculty of Medicine, Baskent University, Istanbul, Turkey, from October 2015 to January 2016, and comprised bilateral Achilles tendons of patients with intermittent claudication and healthy individuals. Shear-Wave Velocity (SWV) of each tendon was measured using Acoustic Radiation Force Impulse elastography. Arterial Doppler ultrasonography at tibialis posterior artery was performed to establish the diagnosis of occlusive arterial disease, and the degree of obstruction was recorded. SPSS 16 was used for data analysis. Results: Of the 84 subjects, 42(50%) were patients and 42(50%) were controls. The number of bilateral Achilles tendons was 168, i.e. 84(50%) of patients and 84(50%) of controls. SWV of the Achilles tendon were different between the two groups (p<0.05). The mean SWV was 5.24 +/- 0.45 m/s in the relaxed state in the patients and 2.83 +/- 0.56 m/s in the controls. No monophasic flow pattern was observed in 23(54.8%) posterior tibial artery and SWV was 4.94 +/- 0.40 m/s in the relaxed state Achilles tendon in patients. Monophasic flow pattern was observed in 61(72.6%) posterior tibial artery and SWV was 5.35 +/- 0.42 m/s in the relaxed state Achilles tendon in patients. SWV values were higher in monophasic flow patterns in the posterior tibial artery than in those without monophasic flow patterns in patients group (p<0.01). Conclusion: The elasticity of healthy tendon decreased with intermittent claudication in patients.