Zeynep İlerisoy YAKUT, Törel OĞUR, Şükran ERTEN, Deniz DELİBAŞ, Meltem YILDIRIM, Halil ARSLAN, Mehmet GÜMÜŞ

Tendon patolojilerinin sonoelastografi ile erken tanısı

AMAÇ: Sonoelastografi (SE) dokunun elastikiyeti ve sertliği hakkında bilgi veren yeni bir ultrason yöntemidir. En sık kullanılan gerilim sonoelastografi (GSE) olup dokunun gerçek zamanlı incelenmesine imkan sağlar. Bu çalışmamızda Ailesel Akdeniz Ateşli (AAA) topuk ağrılı olgularda sonoelastografinin aşil tendon patolojilerini göstermede etkinliğini araştırdık. METOD: Tek taraflı topuk ve ayak bileği ağrısı olan, direkt grafide herhangi bir anomali saptanmayan 18 olgunun aşil tendonu sonoelastografi ile değerlendirildi. Ağrılı taraftaki aşil tendonu, simetriğindeki asemptomatik (ağrısız) tendonla karşılaştırıldı. Tendonlar proksimal, orta kesim, distal segmentlere ayrıldı. B-mod US incelemede, tendonların eko yapısı ve kalınlığına bakıldı. Sonoelastografi ile tendonlar renk modunda incelendi. Normal tendonlar mavi-yeşil kodlanırken (tip 1) sarı alanlar içerenler tip 2 ve kırmızı alanlar içerenler tip 3 olarak sınıflandı. Tip 2 ve tip 3 kodlamalar patolojik kabul edildi. BULGULAR: Aşil tendon kalınlıkları 3 segmentten yapılan ölçümlerde ağrısız ve ağrılı tarafta istatistiksel olarak farklı değildi. Aşil tendonu proksimalinden ölçülen elastikiyet değerlerinde ağrılı ve ağrısız gruplar arasında istatistiksel olarak anlamlı farklılık yoktu ( p=0.310). Aşil tendonu orta kesiminden ölçülen elastikiyet değerlerinde ağrılı ve ağrısız gruplar arasında istatistiksel olarak anlamlı farklılık bulunmakta idi ( p=0.005). Aşil tendonu distalinden ölçülen elastikiyet değerlerinde ağrılı ve ağrısız gruplar arasında istatistiksel olarak anlamlı farklılık bulunmakta idi ( p

[Early diagnosis of tendon pathologies with sonoelastography]

AIM : Sonoelastography (SE) is a new ultrasound-based imaging technique that provides information on tissue elasticity and stiffness. Strain sonoelastography is the most commonly used technique that allows real-time visualisation of the tissue. In this study, we searched the efficacy of SE for assessing Achilles tendon abnormalities in patients with familial mediterranean fever (FMF) suffering from talalgia. METHODS: Achilles tendons of 18 FMF patients suffering from unilateral talalagia with normal X-ray were evaluated by SE. Achilles tendon of symptomatic side is compared with normal (painless) side. Tendons were divided into proximal, middle, and distal segments. In B-mode examination, tendon thicknesses and echotextures were evaluated. Color-coded images of tendons were obtained by SE. Normal consistent tendon structures were coded as blue or green (type 1). Tendons including yellow areas and red areas were classified as type 2 and type 3 respectively. Moderately (yellow) or severely (red) coded areas were considered pathological. RESULTS: Achilles tendon thicknesses measured at three segments (proximal, middle ,distal). did not show any statistically significant difference in both painless and symptomatic side. Proximal part of achilles tendon's elasticity did not show any difference in both side (p=0.31). In middle and distal segment , the elasticity was statistically different in symptomatic side than normal side p=0.005 and p=0.001 respectively). CONCLUSION: Sonoelastographic examination of Achilles tendons in patients with FMF suffering from talalgia may be useful for determining early dejenerative changes in tendons either in the absence of Bmode ultrasound findings.

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