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Diagnostic Performance of Superb Microvascular Imaging and Other Sonographic Modalities in the Assessment of Lateral Epicondylosis
Author(s) -
Arslan Serdar,
Karahan Ali Yavuz,
Oncu Fatih,
Bakdik Suleyman,
Durmaz Mehmet Sedat,
Tolu Ismet
Publication year - 2018
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.1002/jum.14369
Subject(s) - medicine , cutoff , asymptomatic , power doppler , doppler imaging , elastography , doppler effect , radiology , nuclear medicine , color doppler , ultrasonography , ultrasound , surgery , physics , quantum mechanics , astronomy , blood pressure , diastole
Objectives The aim of this study was to compare the diagnostic performance of different sonographic modalities for diagnosing lateral epicondylosis. Methods A total of 50 symptomatic and 50 asymptomatic common extensor tendons in 44 patients with lateral epicondylosis, and 25 healthy participants were prospectively examined by B‐mode sonography, color Doppler imaging, power Doppler imaging, Superb Microvascular Imaging (SMI; Toshiba Medical Systems Corporation, Tokyo, Japan), and strain elastography. We evaluated blood flow in common extensor tendons by using a grading system with color Doppler imaging, power Doppler imaging, and SMI. The diagnostic performance of the modalities was compared. Results When a cutoff value of hypoechogenicity was used for the mean strain ratio, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rates were 92.0%, 94%.0, 93.9%, 92.2%, and 93.0%, respectively. When a cutoff point of grade 1 was used, the sensitivity, specificity, PPV, NPV, and accuracy rates were 26.0%, 10.0%, 10.0%, 57.5%, and 63.0, for color Doppler imaging; 40.0%, 10.0%, 10.0%, 62.5%, and 70.0% for power Doppler imaging; and 84.0%, 94.0%, 93.0%, 85.5%, and 89.0% for SMI. When a cutoff value of 3.94 was used for the mean strain ratio, the sensitivity, specificity, PPV, NPV, and accuracy rates were 78.0%, 92.0%, 90.7%, 80.7%, and 85.0%, respectively. A statistically significant correlation was detected between SMI, strain elastography, and visual analog scale scores ( P < .001). Conclusions The combination of SMI and B‐mode sonography was found to have excellent diagnostic performance for lateral epicondylosis. Neovascularzation in patients' tendons with lateral epicondylosis was identified much better with SMI compared to color or power Doppler imaging.