Haims A H, Schweitzer M E, Patel R S, Hecht P, Wapner K L
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Skeletal Radiol. 2000 Nov;29(11):640-5. doi: 10.1007/s002560000273.
To differentiate MR imaging characteristics of symptomatic as compared with asymptomatic Achilles tendons.
1.5 T MR images of 94 feet (88 patients) with "abnormal" MR examinations were retrospectively evaluated and clinically correlated. Two masked, independent observers systematically evaluated for intratendon T2 signal, tendon thickness, presence of peritendonitis, retrocalcaneal bursal fluid volume, pre-Achilles edema, bone marrow edema at the Achilles insertion, and tears (interstitial, partial, complete). These findings were correlated with symptoms (onset and duration) and physical examination results (tenderness, palpable defects, increased angle of resting dorsiflexion).
Of the 94 ankles, 64 ankles (32 females, 29 males) were clinically symptomatic. No relationship between Achilles tendon disorders and age or gender was identified. Asymptomatic Achilles tendons frequently demonstrated mild increased intratendon signal (21/30), 0.747 cm average tendon thickness, peritendonitis (11/30), pre-Achilles edema (12/30), and 0.104 ml average retrocalcaneal bursal fluid volume. Symptomatic patients had thicker tendons (0.877 cm), greater retrocalcaneal fluid volume (0.278 ml), more frequent tears (23/64), a similar frequency of peritendonitis (22/64) but less frequent pre-Achilles edema (18/64). Sixty-four percent of the Achilles tendon tears were interstitial. Except for two interstitial tears in control patients, the majority of Achilles tears were in symptomatic patients (14/16). Only symptomatic tendons demonstrated partial or complete tendon tears. In addition, calcaneal edema was found almost exclusively in actively symptomatic patients. Thicker tendons were associated more often with chronic symptoms and with tears. When present in symptomatic patients, peritendonitis was usually associated with acute symptoms. The presence of pre-Achilles edema, however, did not distinguish acute from chronic disorders.
There is significant overlap of MR findings in symptomatic and asymptomatic Achilles tendons. Furthermore, there is apparently a spectrum of disease in symptomatic tendons ranging from subtle intratendinous and peritendinous signal to partial and complete tendon tear.
比较有症状和无症状跟腱的磁共振成像（MR）特征。
对94只足（88例患者）进行的1.5T MR图像进行回顾性评估，并与临床情况相关联。两名独立的盲法观察者系统评估肌腱内T2信号、肌腱厚度、腱周炎症、跟腱后滑囊液量、跟腱前水肿、跟腱附着处骨髓水肿以及撕裂情况（间质撕裂、部分撕裂、完全撕裂）。这些发现与症状（起病和持续时间）及体格检查结果（压痛、可触及缺损、静息背屈角度增加）相关。
94个踝关节中，64个踝关节（32名女性，29名男性）有临床症状。未发现跟腱疾病与年龄或性别之间存在关联。无症状跟腱常表现为肌腱内信号轻度增高（21/30）、平均肌腱厚度0.747cm、腱周炎症（11/30）、跟腱前水肿（12/30）以及平均跟腱后滑囊液量0.104ml。有症状患者的肌腱更厚（0.877cm）、跟腱后液量更大（0.278ml）、撕裂更常见（23/64）、腱周炎症频率相似（22/64）但跟腱前水肿频率更低（18/64）。64%的跟腱撕裂为间质撕裂。除了对照患者中的两例间质撕裂外，大多数跟腱撕裂发生在有症状患者中（14/16）。只有有症状的肌腱出现部分或完全肌腱撕裂。此外，跟骨水肿几乎仅见于有明显症状的患者。较厚的肌腱更常与慢性症状及撕裂相关。在有症状患者中，腱周炎症通常与急性症状相关。然而，跟腱前水肿的存在并不能区分急性和慢性疾病。
有症状和无症状跟腱的MR表现存在显著重叠。此外，有症状的肌腱显然存在一系列疾病，从细微的肌腱内和腱周信号到部分和完全肌腱撕裂。
