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Updated: Sep 21, 2025
Author Spotlight: Exploring the Complexities of Achilles Tendon Injuries — Research and Future Directions
Published on: October 27, 2023
Validation of High-Resolution peripheral Quantitative Computed Tomography-Derived Achilles Tendon Properties Against
Hugo J W Fung1,2, Angela M Cheung2,3,4,5, Sunita Mathur6,7
1Department of Exercise Science, Faculty of Kinesiology and Physical Education, University of Toronto, Canada.
Objectives:
1) To assess the precision of high resolution peripheral quantitative computed tomography (HR-pQCT)-derived Achilles tendon (AT) cross-sectional area (HR AT-CSA) and density, and 2) to validate HR AT-CSA against ultrasound-derived AT-CSA (US AT-CSA).
Methods:
Women and men (≥50 years) had HR-pQCT (0.082mm isotropic) and US scans (B-mode) performed on the non-dominant ankle. Linear regression and Bland-Altman analyses assessed systematic differences between HR-pQCT and US-derived AT-CSA. Precision measured by % root mean square coefficients of variation (%RMSCV) and agreement by type 2,1 intraclass correlation coefficients (ICC2,1), were determined for test-retest US AT-CSA scans, and analysis-reanalysis of 30 HR-pQCT and US images.
Results:
Among 44 participants, HR and US AT-CSA were strongly correlated (R2=0.84, p<0.01, B=1.05[0.90-1.19]), with no differences between modalities (p=0.37). Bland-Altman analysis revealed minimal systematic bias (-0.7mm2[-10.7-9.3]; 1.3%) between HR-pQCT and US-derived AT-CSA with smaller AT-CSA values showing larger inter-modality differences (R2=0.098, B=-0.137 [-0.268--0.008], p=0.039). US AT-CSA demonstrated excellent test-retest precision (ICC2,1=0.998, %RMSCV=1.04%). Analysis-reanalysis of HR-pQCT AT-density and both HR-pQCT and US AT-CSA displayed ICC2,1 above 0.95 and %RMSCV within 3%.
Conclusion:
HR-pQCT can examine AT-morphometry with acceptable analytical precision. Future studies should explore these metrics' association with functional outcomes and ankle-bone structural and mechanical properties.
