Movin T, Kristoffersen-Wiberg M, Rolf C, Aspelin P
Department of Orthopedic Surgery, Karolinska Institute, Huddinge University Hospital, Sweden.
Acta Radiol. 1998 Mar;39(2):126-32. doi: 10.1080/02841859809172165.
The primary objective was to compare 4 imaging sequences (T1-weighted, T2-weighted, proton density, and T1-weighted with gadolinium contrast agent enhancement) with regard to intratendinous signal abnormality in patients with achillodynia. The secondary objective was to relate the images to the clinical symptoms and histopathological findings.
Twenty patients (16 men, 4 women, median age 40 years) with chronic achillodynia participated in the study. The symptoms prohibited activity and clinical examination revealed swelling and tenderness 1.5-6 cm proximal to the Achilles tendon insertion. Of the 20 patients: 5 had bilateral achillodynia, 4 had had previous contralateral Achilles tendon disorder, and 11 had never had symptoms in the contralateral tendon region. These 11 tendons served as controls for comparison. MR imaging was performed on a superconductive 1.5 T unit. Both Achilles tendons were examined (n = 40) at the same time, and multiple sagittal and transversal images were obtained. The corresponding sections on these images were visually graded according to both extension and level of MR signal intensity. Tissue was obtained for microscopic examination from the most symptomatic side in all patients (n = 20).
T1-weighted images following gadolinium contrast medium enhancement proved to be the best method by which to visualize intratendinous signal abnormality. This sequence revealed signal abnormality in 24/25 symptomatic tendons and in 1/11 control tendons (p < 0.001). Histopathological examination showed an increased noncollagenous extracellular matrix and altered fiber structure in the lesions corresponding to the contrast-enhanced areas.
Gadolinium enhancement improved the imaging of intratendinous signal abnormality on T1-weighted images. There was a high level of extracellular glycosaminoglycans, which are highly-fixed negatively-charged macromolecules with extreme water-retaining capacity and which may have contributed to the enhancement by the gadolinium contrast agent.
主要目的是比较4种成像序列（T1加权、T2加权、质子密度以及钆对比剂增强的T1加权）在跟腱痛患者中检测肌腱内信号异常的情况。次要目的是将图像与临床症状及组织病理学发现相关联。
20例慢性跟腱痛患者（16例男性，4例女性，中位年龄40岁）参与了本研究。症状导致活动受限，临床检查显示跟腱附着点近端1.5 - 6 cm处肿胀且压痛。20例患者中：5例为双侧跟腱痛，4例既往有对侧跟腱疾病，11例对侧肌腱区域从未有过症状。这11条肌腱作为对照用于比较。在一台1.5 T超导设备上进行磁共振成像。同时检查双侧跟腱（n = 40），获取多个矢状位和横断位图像。根据图像上相应节段的磁共振信号强度范围和程度进行视觉分级。从所有患者（n = 20）症状最明显的一侧获取组织进行显微镜检查。
钆对比剂增强后的T1加权图像被证明是观察肌腱内信号异常的最佳方法。该序列在25条有症状的肌腱中发现24条有信号异常，在11条对照肌腱中发现1条有信号异常（p < 0.001）。组织病理学检查显示，与对比增强区域对应的病变中非胶原细胞外基质增加且纤维结构改变。
钆增强改善了T1加权图像上肌腱内信号异常的成像。细胞外糖胺聚糖含量较高，这些是具有高固定负电荷且保水能力极强的大分子，可能是钆对比剂增强的原因。
