Ultrasound and magnetic resonance imaging are not interchangeable to assess the Achilles tendon cross-sectional-area

PURPOSE: The major aim of this study was to compare ultrasound (US) and magnetic resonance imaging (MRI) measurements of the Achilles tendon cross-sectional area (CSA). Further aims were to conduct reliability analyses and to assess the influence of transducer pressure on the tendon properties in US measurements. METHODS: The Achilles tendon CSA of 15 participants was assessed at two positions with US and MRI by use of a standardized protocol. Method comparison was performed by two-way analysis of variance (ANOVA) and paired t test. Reliability was assessed by coefficients of variation (CV), intraclass correlation (ICC(2,2)), standard error of measurement (SEM), and minimal detectable change (MDC(95)). A paired t test was performed to investigate the effect of probe pressure on tendon CSA and thickness. RESULTS: Mean US measurements provided a ~5.5% smaller CSA compared to MRI measurements. Intra-rater reliability analyses of US demonstrated CV values of 1.5–4.9%, ICC of 0.89–0.97, SEM and MDC(95) values of 0.22–0.77 mm(2) and 0.61–2.16 mm(2) for both raters, whereby CV values for intra-rater reliability of MRI ranged from 1.0 to 3.7%. Inter-rater reliability was lower for both modalities. Pressure applied on the transducer altered Achilles tendon CSA and thickness significantly (p < 0.05). CONCLUSIONS: Our findings show that US and MRI cannot be used interchangeably for Achilles tendon CSA assessments, however, each imaging modality separately is reliable to assess this property. Pressure applied on the transducer during US measurements causes alterations of the tendon’s morphology and should be avoided.