Achilles Tendon Novel UonU ltrasound Measures to Inform Clinical Care- MHSRS 2024
Persinger j, mincey c, gabler g, rossi r, grogan s, hager n, schroeder j, metzger e, isaacson b, wagner l, pasquina p
Abstract accepted for poster presentation at the 2024 Military Health System Research Symposium
Musculoskeletal injuries are commonly found in active-duty service members and military recruits. The use of new non-invasive ultrasound technologies, such as microvascular flow (MVF) and shear wave elastography (SWE), may prove to be appropriate and cost effective in the early diagnosis of these injuries. The Geneva Foundation in conjunction with Uniformed Services University of the Health Sciences, and the Madigan Army Medical Center is conducting a research study to establish normative values for thickness, MVF, Power Doppler (PD), and Young’s modulii in the posterior lower leg.
Ultrasound evaluations are conducted utilizing a Samsung RS-85 Prestige with shear wave elastography and microvascular flow capabilities. The TeleRay Remote cloud-based platform is utilized for secure storage and ultrasound image review with the additional capacity to allow remote observation. By study completion, 206 ultrasound examinations will be conducted on asymptomatic participants by a Registered Musculoskeletal Sonographer (RMSKS) credentialed provider. Image acquisition is standardized using EZ Exam. Imaging is obtained from the Achilles insertion to the gastroc-soleus complex with stop points at the calcaneal insertion, avascular zone, gastroc-soleus junction, gastrocnemius, and soleus. Measurements are obtained in orthogonal planes to obtain the width and height at each of the sites. Using a system preset optimized for low-flow states Power Doppler and MVF evaluation is conducted at each point with comments noting the number vessels in the region of interest. SWE interrogation is conducted utilizing a system preset optimized for tendon elastography.
MVF has been shown to be more sensitive than PD (19 instances of flow vs 3). Further evaluation with SWE will continue to provide the normal range of values in this application.