Doppler and Contrast-Enhanced Ultrasound to Detect Neovascularisation in Achilles Tendinopathy: A Systematic Review

Objective: To compare the detection capability and reported diagnostic indicators of Doppler ultrasonography (DUS) and contrast-enhanced ultrasound (CEUS) to detect neovascularisation in Achilles tendinopathy, as well as assess the diagnostic relevance in relation to symptoms and treatment outcomes. Materials and Methods: A systematic literature search was conducted using the EBSCO host databases for studies published between 2004 and 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies involving adults with Achilles tendinopathy assessed with DUS and/or CEUS were included. Data extraction was performed using a structured form, and study quality was evaluated using the Critical Appraisal Skills Programme (CASP) tool. Due to methodological heterogeneity, a narrative synthesis was executed. Results: Eight studies met the inclusion criteria, all using DUS, with two additionally incorporating CEUS. The CEUS appeared to demonstrate greater detection capability for microvascular flow compared to DUS, particularly in complex clinical cases. The DUS remained more accessible and clinically feasible. Evidence linking neovascularisation with symptom severity was inconsistent, although some studies reported vascular changes following treatment. Conclusion: Both DUS and CEUS have been shown to detect neovascularisation in Achilles tendinopathy. Based on published evidence, CEUS provides enhanced microvascular assessment, while DUS remains a practical primary diagnostic tool. The diagnostic role of neovascularisation as a clinical biomarker remains uncertain.