Are Ultrasound Measurements of Achilles Tendon Size Reliable? A Systematic Review of Rater Reliability.

Ultrasound measurements of Achilles tendon size are used to assess the tendon's response to exercise, aging, rehabilitation, tendon loading and healing. It is important to understand and minimise the measurement error that occurs with these measurements. This review identified and synthesised studies reporting on intra- and inter-rater reliability of ultrasound measurements of Achilles tendon size. Analysis of 21 studies revealed that good to excellent intra- and inter-rater reliability can be achieved for ultrasound measurements of Achilles tendon size. Reliability can be optimised by using one experienced operator, standardising transducer pressure and orientation and averaging two or three measurements. There was a high risk of methodological bias across the included studies. Reporting of reliability studies needs to be improved by the use of existing reporting guidelines and expansion of these guidelines to include important elements of ultrasound imaging.

The acute effects of exercise on tendon dimensions and vascularity. An exploratory study using diagnostic ultrasound of the male Achilles tendon.

OBJECTIVES: This study examines the acute morphological changes (up to three days) in the normal, asymptomatic Achilles tendon (AT) in response to a single bout of exercise in relation to tendon dimensions and vascularity. DESIGN: Within-subject pre-post design. METHODS: Participants conducted a 7.7km pack march on a sealed road in a time of 1h 16min (approximately 6kmh-1). The longitudinal image of the sagittal diameter, transverse image of the area and vascularity at 20mm proximal to the superior aspect of the calcaneus and longitudinal image of the sagittal diameter at the insertion was measured the day before the pack march, immediately afterwards and then three days later. RESULTS: The tendon showed no significant change in sagittal diameter and cross-sectional area at 20mm proximal to the calcaneus and at the insertion immediately post-exercise. Tendon vascularity increased significantly in 91% of the left ATs and 87% of the right ATs in response to the pack march. Three days after the pack march an increase in sagittal diameter at the insertion and 20mm proximal to the calcaneus was observed and increased vascularity was still present in 22% of the ATs. CONCLUSIONS: This study highlighted the tendon's response to exercise and has shown that at three days post-exercise that the tendon had not recovered to pre-exercise levels with respect to tendon dimensions and vascularity.

Ultrasound measurements of the liver: an intra and inter-rater reliability study.

Introduction: Ultrasound is an easy and inexpensive method to rapidly assess the size of the adult liver. The literature addressing reliability of liver measurements using ultrasound is poorly reported and inadequate. In this study, intra and inter-rater reliability of multiple measurements of the right lobe, left lobe and entire adult liver were assessed. Methods: Two examiners acquired ultrasound images of the liver in multiple positions. Fifteen measurements were taken from each set of images by each examiner. One examiner repeated the images and measurements. Results: Results demonstrated high intra-rater reliability for all measurements (ICC's 0.67-0.97). Inter-rater reliability also demonstrated high reliability (ICC's 0.71-0.94) for nine of the fifteen measurements (six representing the right lobe, one representing the left lobe and two representing the entire liver. Further analysis using paired samples t-tests and Bland Altman plots were performed on these nine measurements. Conclusion: From this study, the most reliable measurements are suggested to be MCL Dome to tip and MCL Max AP for the right lobe and Midline Max AP for the left lobe. The only measurement to truly encompass both lobes (Max Trans) was not shown to be reliable.

Ultrasound is a reliable measure of muscle thickness in acute stroke patients, for some, but not all anatomical sites: a study of the intra-rater reliability of muscle thickness measures in acute stroke patients.

This prospective, blinded study investigates the test retest reliability of measures of muscle thickness made by one sonographer across two cohort groups (n = 29) of people hospitalised with acute stroke. Reliability was assessed in cohort one (n = 14) for measurements made bilaterally at the anterior and posterior upper arms, the anterior and posterior thighs (total of eight measurements) and in cohort two (n = 15), for measurements made bilaterally at the lateral forearms, the anterior abdominal wall and the anterior and lower legs (total of eight measurements). Reliability estimates varied between measurement sites; intraclass correlation coefficients (ICCs) ranged from -0.26 (lateral forearm, paretic side) to 0.95 (anterior thigh, nonparetic side), percent mean differences ranged from 0.42% (posterior upper arm, nonparetic side) to 14.68% (anterior lower limb, nonparetic side) and method error ranged from 1.08 (abdomen, nonparetic side) to 9.69 mm (posterior lower limb, nonparetic side). Only four measurement sites (anterior upper arm, posterior upper arm, abdomen and anterior thigh) were within the acceptable ranges (ICC 0.60 to 1.00, mean percent difference range 0%-5% and method error range 0-5 mm) and considered reliable to use for measures of muscle thickness in people hospitalised with acute stroke.