Sonography of the achilles tendon in hypercholesterolaemia

Abstract

We conclude that ultrasonography is a sensitive method of detecting xanthomas that reveals the altered tendon structure even in xanthomatous tendons of normal thickness.

The Use of Achilles Tendon Sonography to Distinguish Familial Hypercholesterolemia from Other Genetic Dyslipidemias

“…These gender differences have been observed in other studies 11,14,16,26 and may be explained by the usually higher musculoskeletal development in men. Supporting prior results in control subjects, 26 AT size was related to body weight, a plausible finding given the body support function that AT plays in skeletal physiology.…”

“…Tendon xanthomas are a key feature for the clinical diagnosis of FH, 8,10 but identification by physical examination is subjective and based on clinical experience, and may be difficult in borderline cases. Ultrasonography has been shown to accurately measure AT thickness, which is enlarged when xanthomas are present [11][12][13][14][15][16] and, using state-of-the-art musculoskeletal sonography and a careful technique, it also detects echostructural abnormalities that are diagnostic of xanthoma in tendons not injured previously. 10 -15,22 By using this technique, we observed no sonographic AT xanthomas in either control or non-FH subjects, but detected them in a sizeable proportion of FH subjects (40% and 24% in those with and without DNA diagnosis, respectively).…”

“…In uniformly sized tendons, measurements were taken 2 cm proximally to insertion in the os calcis. We also classified AT echostructure into the following 2 categories: normal, when the fibrillar structure of the tendon was preserved; and xanthoma, when fibrillar structure was lost and/or single, or multiple echolucent areas were detected within [12][13][14][15]22 (see http://atvb.ahajournals.org). We evaluated the interobserver variation for thickness and breadth in 15 subjects and found correlation coefficients of 0.91 and 0.86, respectively.…”

“…Ultrasonography, a simple, affordable, and rapid imaging technique, has been used to reproducibly assess AT thickness and improve on the clinical diagnosis of xanthomas. [11][12][13][14][15][16] However, the ultrasound characteristics of AT in other genetic dyslipidemias disclosing elevated blood cholesterol levels that might easily lead to a suspicion of FH have not been evaluated. The aim of this study was to assess the usefulness of AT sonography to distinguish genetically ascertained FH from clinical FH without a molecular diagnosis and other genetic dyslipidemias in comparison with normolipidemic subjects.…”

Tendinopathy Discrimination by Use of Spatial Frequency Parameters in Ultrasound B-Mode Images

“…Clinically, this can lead to the development of a tendinopathy as evidenced by the presence of pain and functional limitation for periods longer than six weeks, without relief from anti-inflammatory medication. The accompanying disruption of tissue organization results in a more isotropic speckle pattern, with visual analysis suggesting reduced organization of the parallel striations and localized regions of hypoechogenicity [4]- [7]. It has been shown that changes in ultrasound radio-frequency (RF) spectra may be used to indicate damage in equine tendon [8], and discriminate age in human tendon [9].…”