Ultrasonography diagnosed Achilles tendon thickening in 36.5% versus 21.0% by X-ray in CAD patients, with a 19.4% discordance mainly due to X-ray underdiagnosis.
Does ultrasonography compared to soft X-ray radiography show diagnostic agreement for Achilles tendon thickness measurement in patients with coronary artery disease?
Ultrasonography diagnoses more patients with Achilles tendon thickening compared to soft X-ray radiography, demonstrating a nearly 20% diagnostic discordance despite significant correlation between the modalities.
Absolute Event Rate: 0% vs 0%
Abstract Background Achilles tendon (AT) thickening is a key clinical feature of familial hypercholesterolemia (FH). Although soft X-ray radiography (XR) are widely used for AT thickness (ATT) assessment, the large variation in measurement values due to its low image resolution have been considered a major limitation. In contrast, ultrasonography (US) provides better imaging quality and can more accurately assess ATT. However, data comparing the diagnostic agreement between XR and US for AT thickening are limited. Purpose We aimed to assess the diagnostic agreement between XR and US for AT thickness (ATT) measurement in patients with coronary artery disease (CAD). Methods Patients with CAD undergoing XR and US for ATT measurement between April 2024 and January 2025 at 2 academic centers in Japan were prospectively enrolled (UMIN-ID: 000053786). The cut-off values for AT thickening were defined according to the Japan atherosclerosis society guideline for prevention of atherosclerotic cardiovascular diseases 2022 (XR: ≥ 8 mm in male and ≥ 7.5 mm in female, US: ≥ 6 mm in male and ≥ 5.5 mm in female). The correlation of ATT and concordance rate for AT thickening between XR and US were assessed. Results Among 222 patients, 15 (6.8%) were clinically diagnosed with FH. The median age of the cohort was 75 years and 14.9% of patients were female. Median ATT by XR was greater than by US (7.0 mm IQR 6.3-7.7 vs. 5.6 mm IQR 5.2-6.3, P 0.001). There was a significant correlation between XR and US for ATT measurement (r = 0.635, P 0.001) (Figure 1). AT thickening was confirmed in 21.0% of patients by XR and 36.5% by US. The concordance rate between XR and US for AT thickening was 80.6% (XR+ and US+: 19.4% n=43, XR- and US-: 61.3% n=136). Among 43 (19.4%) patients with discordance, the majority were classified as XR- but US+ (n=38 88.4%). A significant correlation between XR and US for ATT measurement was observed in male and female (male: r = 0.640, P 0.001, female: r = 0.584, P 0.001) (Figure 2). Multivariate logistic regression analysis demonstrated that FH was significantly associated with the diagnostic discordance (OR 4.71, 95% CI 1.53-14.50, P=0.007). Conclusion Although there was a correlation between XR and US for ATT measurement, substantial discordance (i.e. ≈20%) in the diagnosis of AT thickening was observed. Physicians should be aware that US assessment may result in more patients diagnosed with AT thickening than XR. The cut-off values should be tested in the larger population with a reference standard of FH with genetic diagnosis.Figure 1 Figure 2
Itagaki et al. (Sat,) reported a other. Ultrasonography diagnosed Achilles tendon thickening in 36.5% versus 21.0% by X-ray in CAD patients, with a 19.4% discordance mainly due to X-ray underdiagnosis.