Journal of Medical Ultrasonics

, Volume 46, Issue 1, pp 45–49 | Cite as

Virtual touch IQ elastography in evaluation of Achilles tendon in patients with chronic renal failure

  • Emrah CaglarEmail author
  • Ibrahim Ilker Oz
  • Serkan Guneyli
  • Muammer Bilici
  • Fatih Yılmaz
  • Sevil Uygun Ilikhan
  • Ali Borazan
Original Article



To evaluate the sonoelastographic changes in the Achilles tendon in patients with chronic renal failure (CRF) using virtual touch imaging quantification (VTIQ) elastography.


Twenty-six patients undergoing three hemodialysis sessions per week and 26 subjects admitted to our institution between January 2016 and April 2016 were included in this prospective study. The characteristics and body mass index of the patients were noted. Ultrasonography was performed parallel to the long axis of the bilateral Achilles tendons during relaxation of the legs using the Siemens Acuson S3000™ ultrasound device (Siemens HealthCare, Erlangen, Germany). Tendon thickness was reviewed, and tissue stiffness was quantitatively assessed using VTIQ elastography. Independent samples t test and Mann–Whitney U test were used for statistical analyses.


The median values of shear wave velocities of the Achilles tendon in patients with CRF were 7.19 m/s (4.23–9.77 m/s) on the right and 6.98 m/s (4.00–9.82 m/s) on the left, while they were 5.11 m/s (4.09–8.82 m/s) on the right and 5.36 m/s (4.05–8.80 m/s) on the left in controls. The stiffness of the Achilles tendons in patients with CRF was found to be higher than that in controls (right: P < 0.001, left: P = 0.004). There was no statistically significant difference in tendon thickness between the CRF and control groups (P > 0.05).


The thickness and stiffness of tendon can be effectively evaluated with sonoelastography. The thickness of the Achilles tendon did not significantly differ between the patients with CRF and healthy subjects. However, the stiffness of the Achilles tendon measured with VTIQ elastography was demonstrated to be increased in the patients with CRF.


Achilles tendon Elastography Hemodialysis VTIQ 


Compliance with ethical standards

Conflict of interest

Emrah Caglar, Ibrahim Ilker Oz, Serkan Guneyli, Muammer Bilici, Sevil Uygun Ilıkhan, Fatih Yılmaz, and Ali Borazan declare that they have no conflicts of interest.

Ethical statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.


  1. 1.
    Murphy D, McCulloch CE, Lin F, et al. Trends in prevalence of chronic kidney disease in the United States. Ann Intern Med. 2016;165:473–81.CrossRefGoogle Scholar
  2. 2.
    De Franco P, Varghese J, Brown WW, et al. Secondary hyperparathyroidism, and not beta 2-microglobulin amyloid, as a cause of spontaneous tendon rupture in patients on chronic hemodialysis. Am J Kidney Dis. 1994;24:951–5.CrossRefGoogle Scholar
  3. 3.
    Kalantar-Zadeh K, Singh K, Kleiner M, et al. Nontraumatic bilateral rupture of patellar tendons in a diabetic dialysis patient with secondary hyperparathyroidism. Nephrol Dial Transplant. 1997;12:1988–90.CrossRefGoogle Scholar
  4. 4.
    Shiota E, Tsuchiya K, Yamaoka K, et al. Spontaneous major tendon ruptures in patients receiving long-term hemodialysis. Clin Orthop Relat Res. 2002;394:236–42.CrossRefGoogle Scholar
  5. 5.
    Ureten K, Ozturk MA, Ozbek M, et al. Spontaneous and simultaneous rupture of both Achilles tendons and pathological fracture of the femur neck in a patient receiving long-term hemodialysis. Int Urol Nephrol. 2008;40:1103–6.CrossRefGoogle Scholar
  6. 6.
    Basic-Jukic N, Juric I, Racki S, et al. Spontaneous tendon ruptures in patients with end-stage renal disease. Kidney Blood Press Res. 2009;32:32–6.CrossRefGoogle Scholar
  7. 7.
    Jones N, Kjellstrand CM. Spontaneous tendon ruptures in patients on chronic dialysis. Am J Kidney Dis. 1996;28:861–6.CrossRefGoogle Scholar
  8. 8.
    Dams OC, Reininga IHF, Gielen JL, et al. Imaging modalities in the diagnosis and monitoring of Achilles tendon ruptures: a systematic review. Injury. 2017;48:2383–99.CrossRefGoogle Scholar
  9. 9.
    Yuan S, Magarik M, Lex AM, et al. Clinical applications of sonoelastography. Expert Rev Med Devices. 2016;13:1107–17.CrossRefGoogle Scholar
  10. 10.
    Golatta M, Schweitzer-Martin M, Harcos A, et al. Evaluation of virtual touch tissue imaging quantification, a new shear wave velocity imaging method, for breast lesion assessment by ultrasound. Biomed Res Int. 2014;2014:960262.CrossRefGoogle Scholar
  11. 11.
    Yang YP, Xu XH, Bo XW, et al. Comparison of virtual touch tissue imaging and quantification (VTIQ) and virtual touch tissue quantification (VTQ) for diagnosis of thyroid nodules. Clin Hemorheol Microcirc. 2017;65:137–49.CrossRefGoogle Scholar
  12. 12.
    Park JH, Kim SB, Shin HS, et al. Spontaneous and serial rupture of both Achilles tendons associated with secondary hyperparathyroidism in a patient receiving long-term hemodialysis. Int Urol Nephrol. 2013;45:587–90.CrossRefGoogle Scholar
  13. 13.
    Tsourvakas S, Gouvalas K, Gimtsas C, et al. Bilateral and simultaneous rupture of the triceps tendons in chronic renal failure and secondary hyperparathyroidism. Arch Orthop Trauma Surg. 2004;124:278–80.CrossRefGoogle Scholar
  14. 14.
    Palmer S, Birks C, Dunbar J, et al. Simultaneous multiple tendon ruptures complicating a seizure in a haemodialysis patient. Nephrol (Carlton). 2004;9:262–4.CrossRefGoogle Scholar
  15. 15.
    Thaunat M, Gaudin P, Naret C, et al. Role of secondary hyperparathyroidism in spontaneous rupture of the quadriceps tendon complicating chronic renal failure. Rheumatol (Oxf). 2006;45:234–5.CrossRefGoogle Scholar
  16. 16.
    Teber MA, Ogur T, Bozkurt A, et al. Real-time sonoelastography of the quadriceps tendon in patients undergoing chronic hemodialysis. J Ultrasound Med. 2015;34:671–7.CrossRefGoogle Scholar
  17. 17.
    Golatta M, Schweitzer-Martin M, Harcos A, et al. Normal breast tissue stiffness measured by a new ultrasound technique: virtual touch tissue imaging quantification (VTIQ). Eur J Radiol. 2013;82:e676–9.CrossRefGoogle Scholar
  18. 18.
    Ianculescu V, Ciolovan LM, Dunant A, et al. Added value of virtual touch IQ shear wave elastography in the ultrasound assessment of breast lesions. Eur J Radiol. 2014;83:773–7.CrossRefGoogle Scholar
  19. 19.
    Zhang SP, Zeng Z, Liu H, et al. Combination of conventional ultrasonography and virtual touch tissue imaging quantification for differential diagnosis of breast lesions smaller than 10 mm. Clin Hemorheol Microcirc. 2017;67:59–68.CrossRefGoogle Scholar
  20. 20.
    Teke M, Goya C, Teke F, et al. Combination of virtual touch tissue imaging and virtual touch tissue quantification for differential diagnosis of breast lesions. J Ultrasound Med. 2015;34:1201–8.CrossRefGoogle Scholar
  21. 21.
    Zhang Y, Zhao CK, Li XL, et al. Virtual touch tissue imaging and quantification: value in malignancy prediction for complex cystic and solid breast lesions. Sci Rep. 2017;7:7807.CrossRefGoogle Scholar
  22. 22.
    Zhang LN, Wan WB, Wang YX, et al. Evaluation of elastic stiffness in healing achilles tendon after surgical repair of a tendon rupture using in vivo ultrasound shear wave elastography. Med Sci Monit. 2016;22:1186–91.CrossRefGoogle Scholar
  23. 23.
    Helland C, Bojsen-Moller J, Raastad T, et al. Mechanical properties of the patellar tendon in elite volleyball players with and without patellar tendinopathy. Br J Sports Med. 2013;47:862–8.CrossRefGoogle Scholar
  24. 24.
    Dirrichs T, Quack V, Gatz M, et al. Shear wave elastography (SWE) for the evaluation of patients with tendinopathies. Acad Radiol. 2016;23:1204–13.CrossRefGoogle Scholar
  25. 25.
    Lee WC, Zhang ZJ, Masci L, et al. Alterations in mechanical properties of the patellar tendon is associated with pain in athletes with patellar tendinopathy. Eur J Appl Physiol. 2017;117:1039–45.CrossRefGoogle Scholar
  26. 26.
    Couppe C, Kongsgaard M, Aagaard P, et al. Differences in tendon properties in elite badminton players with or without patellar tendinopathy. Scand J Med Sci Sports. 2013;23:e89–95.CrossRefGoogle Scholar
  27. 27.
    Coombes BK, Tucker K, Vicenzino B, et al. Achilles and patellar tendinopathy display opposite changes in elastic properties: a shear wave elastography study. Scand J Med Sci Sports. 2018;28:1201–8.CrossRefGoogle Scholar
  28. 28.
    Zhang ZJ, Ng GY, Lee WC, et al. Changes in morphological and elastic properties of patellar tendon in athletes with unilateral patellar tendinopathy and their relationships with pain and functional disability. PLoS One. 2014;9:e108337.CrossRefGoogle Scholar
  29. 29.
    Chen CM, Chu P, Huang GS, et al. Spontaneous rupture of the patellar and contralateral quadriceps tendons associated with secondary hyperparathyroidism in a patient receiving long-term dialysis. J Formos Med Assoc. 2006;105:941–5.CrossRefGoogle Scholar
  30. 30.
    Terai K, Nara H, Takakura K, et al. Vascular calcification and secondary hyperparathyroidism of severe chronic kidney disease and its relation to serum phosphate and calcium levels. Br J Pharmacol. 2009;156:1267–78.CrossRefGoogle Scholar
  31. 31.
    Johansen KL, Chertow GM, Ng AV, et al. Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney Int. 2000;57:2564–70.CrossRefGoogle Scholar
  32. 32.
    Longenecker JC, Coresh J, Powe NR, et al. Traditional cardiovascular disease risk factors in dialysis patients compared with the general population: the CHOICE Study. J Am Soc Nephrol. 2002;13:1918–27.CrossRefGoogle Scholar
  33. 33.
    Johansen KL, Shubert T, Doyle J, et al. Muscle atrophy in patients receiving hemodialysis: effects on muscle strength, muscle quality, and physical function. Kidney Int. 2003;63:291–7.CrossRefGoogle Scholar
  34. 34.
    Moore GE, Brinker KR, Stray-Gundersen J, et al. Determinants of VO2peak in patients with end-stage renal disease: on and off dialysis. Med Sci Sports Exerc. 1993;25:18–23.CrossRefGoogle Scholar
  35. 35.
    Kettner A, Goldberg A, Hagberg J, et al. Cardiovascular and metabolic responses to submaximal exercise in hemodialysis patients. Kidney Int. 1984;26:66–71.CrossRefGoogle Scholar
  36. 36.
    Lo CY, Li L, Lo WK, et al. Benefits of exercise training in patients on continuous ambulatory peritoneal dialysis. Am J Kidney Dis. 1998;32:1011–8.CrossRefGoogle Scholar
  37. 37.
    Deligiannis A, Kouidi E, Tassoulas E, et al. Cardiac effects of exercise rehabilitation in hemodialysis patients. Int J Cardiol. 1999;70:253–66.CrossRefGoogle Scholar
  38. 38.
    Akiba T, Matsui N, Shinohara S, et al. Effects of recombinant human erythropoietin and exercise training on exercise capacity in hemodialysis patients. Artif Organs. 1995;19:1262–8.CrossRefGoogle Scholar
  39. 39.
    Turan A, Teber MA, Yakut ZI, et al. Sonoelastographic assessment of the age-related changes of the Achilles tendon. Med Ultrason. 2015;17:58–61.CrossRefGoogle Scholar

Copyright information

© The Japan Society of Ultrasonics in Medicine 2018

Authors and Affiliations

  1. 1.Department of Radiology, School of MedicineBülent Ecevit UniversityKozluTurkey
  2. 2.Department of Internal MedicineBulent Ecevit University School of MedicineZonguldakTurkey
  3. 3.Department of NephrologyZonguldak Ataturk State HospitalZonguldakTurkey
  4. 4.Department of NephrologyBulent Ecevit University School of MedicineZonguldakTurkey

Personalised recommendations