Tam Kwok Fai, Lui Tun Hing
Department of Radiology, North District Hospital, Hong Kong.
Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong.
Open Orthop J. 2017 Jul 31;11:697-703. doi: 10.2174/1874325001711010697. eCollection 2017.
Achilles tendon tear is common and increasingly frequent. Magnetic resonance imaging (MRI) is the modality of choice for radiological evaluation. It is accurate to assess the status and integrity of the tendon with well documented features. In this article, the MR findings of a normal Achilles tendon as well as common diseases like insertional and noninsertional tendinosis, chronic tendinosis with marked lengthening, tendon rupture are illustrated. After a torn Achilles tendon receives surgical repair, it undergoes different stages of healing process including inflammatory, reparative and remodeling phases. Acute scar tissue in the surgical bed may share similar MR features of tendon re-rupture especially in the early healing phase because both are T2W hyperintense. The size of the gap may even appear larger than expected on T2W images possibly due to tendon remodeling. Understanding of the healing process in post-operative period may prevent overestimation of tendon gap and misdiagnosis of re-tear. We describe the MR features of the post-operative changes with serial studies in different months after surgery. The MR findings with the highlights of the expected sequential changes in normal healing process are illustrated in different cases. A case with surgical repair on a partial tear of Achilles tendon is also included.
跟腱撕裂很常见且愈发频发。磁共振成像（MRI）是放射学评估的首选方式。它能够准确评估肌腱的状态和完整性，且具有充分记录的特征。在本文中，展示了正常跟腱的磁共振成像表现以及诸如附着点和非附着点肌腱病、伴有明显延长的慢性肌腱病、肌腱断裂等常见疾病的表现。跟腱撕裂接受手术修复后，会经历不同的愈合阶段，包括炎症期、修复期和重塑期。手术部位的急性瘢痕组织可能具有与肌腱再次断裂相似的磁共振成像特征，尤其是在愈合早期，因为二者在T2加权像上均呈高信号。在T2加权像上，间隙大小甚至可能看起来比预期更大，这可能是由于肌腱重塑所致。了解术后愈合过程可避免对肌腱间隙的高估以及对再次撕裂的误诊。我们通过对术后不同月份的系列研究来描述术后改变的磁共振成像特征。在不同病例中展示了磁共振成像表现以及正常愈合过程中预期的连续变化要点。还纳入了一例跟腱部分撕裂手术修复的病例。
