Achillodynia – Radiological Imaging of Acute and Chronic Overuse Injuries of the Achilles Tendon

Abstract

In the past decades the incidence of acute and chronic disorders of the Achilles tendon associated with sport-induced overuse has steadily increased. Besides acute complete or partial ruptures, achillodynia (Achilles tendon pain syndrome), which is often associated with tendon degeneration, represents the most challenging entity regarding clinical diagnostics and therapy. Therefore, the use of imaging techniques to differentiate tendon disorders and even characterize structure alterations is of growing interest. This review article discusses the potential of different imaging techniques with respect to the diagnosis of acute and chronic tendon disorders. In this context, the most commonly used imaging techniques are magnetic resonance imaging (MRI), B-mode ultrasound, and color-coded Doppler ultrasound (US). These modalities allow the detection of acute tendon ruptures and advanced chronic tendon disorders. However, the main disadvantages are still the low capabilities in the detection of early-stage degeneration and difficulties in the assessment of treatment responses during follow-up examinations. Furthermore, differentiation between chronic partial ruptures and degeneration remains challenging. The automatic contour detection and texture analysis may allow a more objective and quantitative interpretation, which might be helpful in the monitoring of tendon diseases during follow-up examinations. Other techniques to quantify tendon-specific MR properties, e. g. based on ultrashort echo time (UTE) sequences, also seem to have great potential with respect to the precise detection of degenerative tendon disorders and their differentiation at a very early stage.

Key Points:

• For radiological imaging in the clinical routine, different clinical presentations of acute or chronic overuse injuries of the Achilles tendon must be considered.

• In addition to qualitative morphological imaging criteria, supplementary quantitative criteria (planimetry/volumetry) of the Achilles tendon seem to be significant with respect to the differentiation between symptomatic and asymptomatic Achilles tendons.

• Other techniques to quantify tendon-specific MR properties, e. g. based on ultrashort echo time (UTE) sequences, seem to have great potential with respect to the precise detection of degenerative tendon disorders and their differentiation at a very early stage.

Citation Format:

• Syha R., Springer F., Ketelsen D. et al. Achillodynia – Radiological Imaging of Acute and Chronic Overuse Injuries of the Achilles Tendon. Fortschr Röntgenstr 2013; 185: 1041 – 1055

Zusammenfassung

Innerhalb der letzten Jahrzehnte hat die Inzidenz von akuten und chronischen Überlastungsschäden der Achillessehne stetig zugenommen. Die deutliche Zunahme in den letzten Dekaden lässt sich in erster Linie durch die erhöhte Freizeitaktivität in der Bevölkerung begründen. Neben den akuten Teil- oder Komplettrupturen der Achillessehne stellt die Achillodynie (Schmerzsyndrom der Achillessehne), welche häufig mit einer Sehnendegeneration einhergeht, eine Herausforderung für Diagnostik und Therapie dar. In diesem Zusammenhang hat der Einsatz von bildgebenden Verfahren zur Diagnostik und Charakterisierung sehnenspezifischer Veränderungen deutlich zugenommen. Im folgenden Übersichtsartikel werden die Möglichkeiten der aktuellen radiologischen Bildgebung bezüglich akuter und chronischer Überlastungsschäden der Achillessehne erörtert. Gängige bildgebende Verfahren stellen hier die Magnetresonanztomografie (MRT) sowie der B-Mode- und farbkodierte Ultraschall (US) dar. Hiermit lassen sich Komplettrupturen und fortgeschrittene degenerative Veränderungen gut detektieren. Schwächen haben die genannten Verfahren in der Diagnostik von Frühstadien der Tendinose und der Verlaufsbeurteilung unter Therapie. Die eindeutige Differenzierung zwischen chronischer Partialruptur und Tendinose kann eine Herausforderung darstellen. Neue automatisierte Konturerkennungsverfahren und Texturanalysen erlauben darüber hinaus auch eine quantitative Beurteilung der Achillessehne, was die objektive Beurteilung von Strukturänderungen im Krankheitsverlauf erleichtern und in seiner Qualität verbessern könnte. Weiterhin scheinen neue Methoden zur quantitativen, MR-tomografischen Charakterisierung des tendinösen Gewebes, z. B. mithilfe ultrakurzer Echozeiten (UTE), ein großes Potenzial zur frühzeitigen Erkennung und Verlaufsbeurteilung von degenerativen Veränderungen der Achillessehne zu haben.

Key words

tendons - MR imaging - ultrasound

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