MRI in acute muscle tears in athletes: can quantitative T2 and DTI predict return to play better than visual assessment?

Abstract

Objectives To assess the ability of quantitative T2, diffusion tensor imaging (DTI) and radiologist’s scores to detect muscle changes following acute muscle tear in soccer and rugby players. To assess the ability of these parameters to predict return to play times. Methods In this prospective, longitudinal study, 13 male athletes (age 19 to 34 years; mean 25 years) underwent MRI within 1 week of suffering acute muscle tear. Imaging included measurements of T2 and DTI parameters. Images were also assessed using modified Peetrons and British athletics muscle injury classification (BAMIC) scores. Participants returned for a second scan within 1 week of being determined fit to return to play. MRI measurements were compared between visits. Pearson’s correlation between visit 1 measurements and return to play times was assessed. Results There were significant differences between visits in BAMIC scores (Z = − 2.088; p = 0.037), modified Peetrons (Z = − 2.530; p = 0.011) and quantitative MRI measurements; T2, 13.12 ms (95% CI, 4.82 ms, 21.42 ms; p = 0.01); mean diffusivity (0.22 (0.04, 0.39); p = 0.02) and fractional anisotropy (0.07 (0.01, 0.14); p = 0.03). BAMIC scores showed a significant correlation with return to play time (Rs = 0.64; p = 0.02), but modified Peetrons scores and quantitative parameters did not. Conclusions T2 and DTI measurements in muscle can detect changes due to healing following muscle tear. Although BAMIC scores correlated well with return to play times, in this small study, quantitative MRI values did not, suggesting that T2 and DTI measurements are inferior predictors of return to play time compared with visual scoring. Key Points • Muscle changes following acute muscle tear can be measured using T2 and diffusion measurements on MRI. • Measurements of T2 and diffusion using MRI are not as good as a radiologist’s visual report at predicting return to play time after acute muscle tear.

Time to return to full training and recurrence of rectus femoris injuries in elite track and field athletes 2010–2019; a 9‐year study using the British Athletics Muscle Injury Classification

“…29 In hamstring and calf muscle injuries, the BAMIC diagnosis has been associated with TRFT, in both retrospective and prospective studies. 22,[30][31][32][33][34][35][36][37] The aim of this study was to describe and compare TRFT and repeat injury rates in BAMIC classified RF injuries,sustained by elite track, and field athletes on a world class performance program over a 9-year period. It was hypothesized that intratendon tears would have an increased TRFT and higher repeat injury rates in comparison with myofascial and MTJ RF injuries.…”

“…The most unique feature of this system is the structural classification (a, b or c), which may direct a more specific rehabilitation management approach to the specific tissue damage and has been advocated in hamstring injury 29 . In hamstring and calf muscle injuries, the BAMIC diagnosis has been associated with TRFT, in both retrospective and prospective studies 22,30–37 …”

Age Differences in Recovery Rate Following an Aerobic-Based Exercise Protocol Inducing Muscle Damage Among Amateur, Male Athletes

“…Four muscles were chosen to evaluate the anterior (rectus femoris and vastus lateralis) and posterior (biceps femoris and semitendinosus) compartments of the thigh muscles. Muscle integrity was assessed using DTI, a protocol that is sensitive to subclinical signs of muscle injury and changes in the tissue, as we and other have previously shown ( Froeling et al, 2015 ; Oudeman et al, 2016 ; Biglands et al, 2020 ). Data obtained from MRI DTI scans can be used to calculate parameters that are sensitive to tissue changes following EIMD ( Froeling et al, 2015 ), such as fractional anisotropy and mean diffusivity by evaluating the quality and direction of water diffusion in a given voxel, thus providing information about the integrity of the area of skeletal muscle scanned ( Keller et al, 2020 ).…”

Application of diffusion microstructure imaging in musculoskeletal radiology — translation from head to shoulders

“…Elevated diffusivity was described in inflamed muscle, and reduced diffusivity and less anisotropic diffusion were found in muscles with fatty infiltration [13,14]. Moreover, DTI has been applied to assess muscle tears in athletes [15,16].…”