Real-time sonoelastography using an external reference material: test–retest reliability of healthy Achilles tendons

Alessandro Schneebeli, Filippo Del Grande, Gabriele Vincenzo, Corrado Cescon, Ron Clijsen, Fulvio Biordi, Marco Barbero

Research output: Contribution to journalArticle


Objective: To establish the test–retest reliability of sonoelastography (SE) on healthy Achilles tendons in contracted and relaxed states using an external reference system. Materials and Methods: Forty-eight Achilles tendons from 24 healthy volunteers were assessed using ultrasound and real-time SE with an external reference material. Tendons were analyzed under relaxed and contracted conditions. Strain ratios between the tendons and the reference material were calculated. The intraclass correlation coefficient (ICC2.k) and Bland–Altman plot were used to assess test–retest reliability. Results: The reliability of SE measurements under relaxed conditions ranged from high to very high, with an ICC2.k of 0.84 (95 % CI: 0.64–0.92) for reference material, 0.91 (95 % CI: 0.83–0.95) for Achilles tendons and 0.95 (95 % CI: 0.91–0.97) for Kager fat pads (KFP). The ICC2.k value for skin was 0.30 (95 % CI: –0.26 to 0.61). Reliability for measurements in the contracted state ranged from high to very high, with an ICC2.k of 0.93 (95 % CI: 0.87–0.96) for reference material, 0.72 (95 % CI: 0.50–0.84) for skin, 0.93 (95 % CI: 0.87–0.96) for Achilles tendons, and 0.81 (95 % CI: 0.66–0.89) for KFP. Reliability of the strain ratio (tendon/reference) under relaxed conditions was high with an ICC2.k of 0.87 (95 % CI: 0.75–0.93), and in the contracted state, it was very high with an ICC2.k of 0.94 (95 % CI: 0.90–0.97). Conclusion: Sonoelastography using an external reference material is a reliable and simple technique for the assessment of the elasticity of healthy Achilles tendons. The use of an external material as a reference, along with strain ratios, could provide a quantitative measure of elasticity.

Original languageEnglish (US)
Pages (from-to)1045-1052
Number of pages8
JournalSkeletal Radiology
Issue number8
Publication statusPublished - Aug 1 2016
Externally publishedYes



  • Achilles tendon
  • Reliability
  • Sonoelastography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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