Related Experiment Video
Updated: Mar 16, 2026
Ultrasound Tissue Characterization of Human Achilles Tendon by Stability Quantification of Echo Patterns
Published on: September 5, 2025
Quantitative ultrasound imaging of Achilles tendon integrity in symptomatic and asymptomatic individuals: reliability
Marie-Josée Nadeau1, Amélie Desrochers2, Martin Lamontagne3
1Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; School of Rehabilitation, Université de Montréal, Pavillon 7077 Avenue du Parc, Station Centre-Ville, P.O. Box 6128, Montreal, Quebec H3C 3J7 Canada.
Background:
Quantifying the integrity of the Achilles tendon (AT) is a rehabilitation challenge. Adopting quantitative ultrasound measurements (QUS measurements) of the AT could fill this gap by 1) evaluating the test-retest reliability and accuracy of QUS measurements of the AT; 2) determining the best protocol for collecting QUS measurements in clinical practice.
Methods:
A total of 23 ATs with symptoms of Achilles tendinopathy and 63 asymptomatic ATs were evaluated. Eight images were recorded for each AT (2 visits × 2 evaluators × 2 images). Multiple sets of QUS measurements were taken: geometric (thickness, width, area), first-order statistics (computed from a grayscale histogram distribution: echogenicity, variance, skewness, kurtosis, entropy) and texture features (computed from co-occurrence matrices: contrast, energy, homogeneity). A generalizability study quantified the reliability and standard error of measurement (accuracy) of each QUS measurement, and a decision study identified the best measurement taking protocols.
Results:
Geometric QUS measurements demonstrated excellent accuracy and reliability. QUS measurements computed from the grayscale histogram distribution revealed poor accuracy and reliability. QUS measurements derived from co-occurrence matrices showed variable accuracy and moderate to excellent reliability. In clinical practice, using an average of the results of three images collected by a single evaluator during a single visit is recommended.
Conclusions:
The use of geometric QUS measurements enables quantification of AT integrity in clinical practice and research settings. More studies on QUS measurements derived from co-occurrence matrices are warranted.
