Abstract Background Achilles tendon pathologies are common among athletic and non-athletic individuals. Ultrasound (US) is an accessible and cost-effective modality. Shear wave elastography (SWE) is a promising US technique that offers quantitative assessment of tissue stiffness. The aim of the study was to assess the diagnostic performance of B-mode US and SWE in diagnosing Achilles tendon pathologies using MRI as a reference. Results The study included 47 Achilles pathologies patients (13 males and 34 females, age range: 18–60 years, mean age: 46.49 years) and 47 asymptomatic age- and sex-matched controls. Tendon stiffness was significantly reduced in Achilles pathologies and in Achilles tears. Compared to MRI, B-mode ultrasound showed 83.87% sensitivity, 100% specificity, and 93.59% accuracy in Achilles tendinopathy and 75% sensitivity, 100% specificity, and 91.49% accuracy in Achilles tendon tears. The integration of B-mode and SWE improved diagnostic precision to 100%, reaching equivalence to MRI in both tendinopathy and tears. A SWE cutoff value < 116.7 kPa achieved 100% accuracy in differentiating normal and pathological tendons, and a cutoff < 73.15 kPa achieved 85.87% accuracy in diagnosis of tears. The SWE values significantly negatively correlated with Doppler (Öhberg) score and significantly positively correlated with MRI-derived VIMAT score. Conclusions Ultrasound is reliable in diagnosis of Achilles pathologies. The integration of B-mode and SWE results in an enhanced diagnostic performance in Achilles tendinopathy and tears. The SWE values can be implemented for stratifying Achilles pathology; however, larger multicenter studies are warranted to validate cutoff values and to standardize acquisition protocols.
Ibrahim et al. (2026) studied this question.