Movin T, Kristoffersen-Wiberg M, Shalabi A, Gad A, Aspelin P, Rolf C
Department of Orthopedic Surgery, Huddinge University Hospital, Sweden.
Foot Ankle Int. 1998 May;19(5):311-7. doi: 10.1177/107110079801900508.
We performed a comparative study of ultrasonography and gadolinium imaging contrast-enhanced T1-weighted magnetic resonance to evaluate tendon pathology in chronic Achilles tendon disorder. Another main issue was to evaluate the structural basis as defined by histopathology from hypoechoic compared with normoechoic areas within the same tendon.
Twenty patients (16 male, 4 females, median age 40 years) with chronic achillodynia participated in the study. Clinical examination revealed swelling and tenderness localized to the midportion of the Achilles tendon. Contrast medium-enhanced magnetic resonance imaging (CME-MRI) was performed in all patients. Ultrasonography-guided core biopsies were taken from regions with a clear widening of the tendon and a pathologic low-echo signal as well as from normoechoic areas. The specimens were analyzed with a standardized protocol giving a total tendon score (0-24), and a stereologic method for quantification of glycosaminoglycan (GAG)-rich areas.
The volume of the intratendinous abnormality was larger in 13 of 20 when imaged by CME-MR (P < 0.05), whereas the shape and enlargement of the tendon per se were similarly imaged by ultrasound (US) and CME-MR. Tendon pathology as imaged by US was graded as severe from hypoechoic regions and moderate from normoechoic regions. The corresponding quantification of GAGs was 0.36 compared with 0.17, respectively (P < 0.001).
CME-MR imaging revealed greater sensitivity in demonstrating intratendinous pathology than the ultrasound; this was documented by the larger size of the corresponding lesion and the fact that the pathology was occurring in areas that were considered normal by ultrasonography. US hypoechoic areas showed a markedly abnormal tendon structure including an increased amount of GAG-rich areas. However, moderate pathology was also found in the neighboring normoechogenous areas within the same tendon, indicating a more generalized disorder than depicted by echogenic properties.
我们对超声检查和钆成像对比增强T1加权磁共振成像进行了一项比较研究，以评估慢性跟腱疾病中的肌腱病变。另一个主要问题是，根据同一肌腱内低回声区与等回声区的组织病理学定义，评估其结构基础。
20例慢性跟腱疼痛患者（16例男性，4例女性，中位年龄40岁）参与了本研究。临床检查发现跟腱中部肿胀和压痛。所有患者均接受了对比剂增强磁共振成像（CME-MRI）检查。在肌腱明显增宽且有病理低回声信号的区域以及等回声区，进行超声引导下的核心活检。标本采用标准化方案进行分析，得出肌腱总评分（0-24分），并采用体视学方法对富含糖胺聚糖（GAG）的区域进行定量分析。
20例患者中，13例通过CME-MR成像时，肌腱内异常区域的体积更大（P<0.05），而肌腱本身的形状和增粗情况在超声（US）和CME-MR成像中相似。超声成像显示，肌腱病变在低回声区为重度，在等回声区为中度。相应的GAG定量分析结果分别为0.36和0.17（P<0.001）。
CME-MR成像在显示肌腱内病变方面比超声更具敏感性；这一点通过相应病变的更大尺寸以及病变发生在超声检查认为正常的区域这一事实得到了证实。超声低回声区显示出明显异常的肌腱结构，包括富含GAG的区域增多。然而，在同一肌腱相邻的等回声区内也发现了中度病变，这表明该疾病比回声特性所显示的更为广泛。
