Magnetic resonance imaging for assessing hamstring injuries: clinical benefits and pitfalls &amp;ndash; a review of the current literature

Greenky, Max; Cohen, Steven B.

doi:10.2147/oajsm.s113007

Cited by 13 publications

(8 citation statements)

References 24 publications

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“…Although considerable progress has been made, effective treatment and rehabilitation of muscle injury, particularly those affecting leg muscles, remain challenging as demonstrated by the high recurrence incidence after acute hamstring injury [2,3]. For diagnostic purposes, conventional T2-weighted fat-suppressed MRI is commonly used [4]. Unfortunately, a major drawback is that hyperintensity-a characteristic of the injury-remains visible in these images long after all clinical symptoms have cleared and the athlete has resumed sports activity [5].…”

Section: Introductionmentioning

confidence: 99%

The repeatability of bilateral diffusion tensor imaging (DTI) in the upper leg muscles of healthy adults

et al. 2019

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Objectives Assessment of the repeatability of diffusion parameter estimations in the upper leg muscles of healthy adults over the time course of 2 weeks, from a simultaneous bilateral upper leg DTI measurement. Methods SE-EPI DTI datasets were acquired at 3 T in the upper legs of 15 active adults at a time interval of 2 weeks. ROIs were manually drawn for four quadriceps and three hamstring muscles of both legs. The following DTI parameters were analyzed: 1st, 2nd, and 3rd eigenvalue (λ 1 , λ 2 , and λ 3), mean diffusivity (MD), and fractional anisotropy (FA). DTI parameters per muscle were calculated with and without intravoxel incoherent motion (IVIM) correction together with SNR levels per muscle. Bland-Altman plots and within-subject coefficient of variation (wsCV) were calculated. Left-right differences between muscles were assessed. Results The Bland-Altman analysis showed good repeatability of all DTI parameters except FA for both the IVIM-corrected and standard data. wsCV values show that MD has the highest repeatability (4.5% IVIM; 5.6% standard), followed by λ 2 (4.9% IVIM; 5.5% standard), λ 1 (5.3% IVIM; 7.5% standard), and λ 3 (5.7% IVIM; 5.7% standard). wsCV values of FA were 15.2% for the IVIM-corrected data and 13.9% for the standard analysis. The SNR (41.8 ± 16.0 right leg, 41.7 ± 17.1 left leg) and wsCV values were similar for the left and right leg and no left-right bias was detected. Conclusions Repeatability was good for standard DTI data and slightly better for IVIM-corrected DTI data. Our protocol is suitable for DTI of the upper legs with overall good SNR. Key Points • The presented DTI protocol is repeatable and therefore suitable for bilateral DT imaging of the upper legs. • Additional B1 + calibrations improve SNR and repeatability. • Correcting for perfusion effects improves repeatability. Keywords Diffusion tensor imaging. Magnetic resonance imaging. Hamstring muscles. Quadriceps muscle Abbreviations BFL Left biceps femoris long head BFR Right biceps femoris long head IVIM Intravoxel incoherent motion MD Mean diffusivity RFL Left rectus femoris RFR Right rectus femoris ROI Region of interest SML Left semimembranosus SMR Right semimembranosus SNR Signal-to-noise ratio STL Left semitendinosus STR Right semitendinosus VIL Left vastus intermedius VIR Right vastus intermedius Electronic supplementary material The online version of this article (

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Section: Introductionmentioning

confidence: 99%

The repeatability of bilateral diffusion tensor imaging (DTI) in the upper leg muscles of healthy adults

et al. 2019

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“…4,5 These MRI findings include but are not limited to: radiological grade, 11 radiological size, 6,7,8 , absence of hyperintensity 6,8,9 and radiological location and tendon involvement. 7,10 It was shown that the majority of the correlations were found by univariate analysis, had a high risk of bias and were often conflicting. 4,5 A potentially relevant MRI feature that has not yet been investigated is the signal intensity on fluid sensitive sequences and their changes over time.…”

Section: Introductionmentioning

confidence: 99%

“…The use of fluid sensitive sequences is not new in HSI research. 10,12 Some lesions may appear brighter white to clinicians than other lesions, the brightness (i.e. signal intensity) can be measured on fluid sensitive sequences.…”

Section: Introductionmentioning

confidence: 99%

The value of MRI STIR signal intensity on return to play prognosis and reinjury risk estimation in athletes with acute hamstring injuries

Horst

Tol

Weir

et al. 2021

Journal of Science and Medicine in Sport

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Objectives: Previous studies have shown low to moderate evidence for a variety of magnetic resonance imaging (MRI) features as prognostic factors in athletes with hamstring injuries. Short-tau inversion recovery (STIR) signal intensity has not yet been investigated for assessing the prognosis of acute muscle injuries. Our aim was to explore the relationship between MRI STIR signal intensity and time to return to play (RTP) and to investigate the association between MRI STIR and reinjury risk in athletes with acute hamstring injuries. Study design: Case-control study. Methods: We used MRI STIR to measure intramuscular signal intensity in patients with clinically diagnosed hamstring injuries at two time points: at injury and RTP. At injury, we calculated the association of MRI STIR signal intensity with the time to RTP and reinjury risk. At RTP, the association of MRI STIR signal intensity and reinjury risk and the change in MRI STIR signal intensity over time on reinjury risk was evaluated. Results: 51 patients were included. We found increased MRI STIR signal intensity: (1) at time of injury not to be associated with time to RTP, (2) at time of injury to be associated with a slightly lower risk for reinjury: odds 0.986 (0.975-0.998, p = 0.02) and (3) at RTP not to be associated with reinjury risk. (4) We found no association between the change in MRI STIR signal intensity over time and reinjury risk. Conclusion: Increased MRI STIR signal intensity at injury has no value in time to RTP prognosis, but is associated with a reduced reinjury risk.

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“…While there are a range of injury classification or grading systems, HSIs are often classified using three grades of severity, where; grade 1 injury involves a minor tear of a few muscles fibres with minimal loss of function; grade 2 injury involves more severe partial tears of the muscle-tendon unit and some loss of function; and grade 3 injury involves a complete rupture of the muscle-tendon unit and severe loss of function (Agre, 1985). HSIs are usually confirmed via a clinical diagnosis, however, magnetic resonance imaging (MRI) has increasingly been utilized in professional sport to confirm the specific details of the injury (Greenky & Cohen, 2017). MRI scans allow the clinician to determine the specific muscle involved, the location of the injury and the size and extent of the injury (muscle or tendon) (Greenky & Cohen, 2017).…”

Section: Definition Of Hamstring Strain Injurymentioning

confidence: 99%

“…HSIs are usually confirmed via a clinical diagnosis, however, magnetic resonance imaging (MRI) has increasingly been utilized in professional sport to confirm the specific details of the injury (Greenky & Cohen, 2017). MRI scans allow the clinician to determine the specific muscle involved, the location of the injury and the size and extent of the injury (muscle or tendon) (Greenky & Cohen, 2017).…”

Section: Definition Of Hamstring Strain Injurymentioning

confidence: 99%

ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION & THE HAMSTRINGS Implications for injury prevention & rehabilitation

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Magnetic resonance imaging for assessing hamstring injuries: clinical benefits and pitfalls – a review of the current literature

Cited by 13 publications

References 24 publications

The repeatability of bilateral diffusion tensor imaging (DTI) in the upper leg muscles of healthy adults

The repeatability of bilateral diffusion tensor imaging (DTI) in the upper leg muscles of healthy adults

The value of MRI STIR signal intensity on return to play prognosis and reinjury risk estimation in athletes with acute hamstring injuries

ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION & THE HAMSTRINGS Implications for injury prevention & rehabilitation

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