title: Dynamic contrast enhanced magnetic resonance imaging in chronic Achilles tendinosis.
abstract: BACKGROUND
  Chronic Achilles tendinosis is a common problem. When evaluating and comparing different therapies there is a need for reliable imaging methods. Our aim was to evaluate if chronic Achilles tendinosis affects the dynamic contrast-enhancement in the tendon and its surroundings and if short-term eccentric calf-muscle training normalizes the dynamic contrast-enhancement.
  
  
  METHODS
  20 patients with chronic Achilles tendinopathy were included. Median duration of symptoms was 31 months (range 6 to 120 months). Both Achilles tendons were examined with dynamic contrast enhanced MRI before and after a 12- week exercise programme of eccentric calf-muscle training. The dynamic MRI was evaluated in tendon, vessel and in fat ventrally of tendon. Area under the curve (AUC), time to peak of signal, signal increase per second (SI/s) and increase in signal between start and peak as a percentage (SI%) was calculated. Pain and performance were evaluated using a questionnaire.
  
  
  RESULTS
  In the fat ventrally of the tendon, dynamic contrast enhancement was significantly higher in the symptomatic leg compared to the contralateral non-symptomatic leg before but not after treatment. Despite decreased pain and improved performance there was no significant change of dynamic contrast enhancement in symptomatic tendons after treatment.
  
  
  CONCLUSIONS
  In Achilles tendinosis there is an increased contrast enhancement in the fat ventrally of the tendon. The lack of correlation with symptoms and the lack of significant changes in tendon contrast enhancement parameters do however indicate that dynamic enhanced MRI is currently not a useful method to evaluate chronic Achilles tendinosis.
authors.affiliation: Department of Clinical Science, Division of Medical Imaging and Technology, Intervention and Technology at Karolinska Institutet, Stockholm SE-141-86, Sweden. anna.gardin@karolinska.se.
authors.forename: Anna
authors.initials: A
authors.lastname: Gärdin
authors.forename: Torkel B
authors.initials: TB
authors.lastname: Brismar
authors.forename: Tomas
authors.initials: T
authors.lastname: Movin
authors.forename: Adel
authors.initials: A
authors.lastname: Shalabi
mesh_terms: D000125:Achilles Tendon / Q000473:pathology*; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003287:Contrast Media; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010147:Pain Measurement; D052256:Tendinopathy / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy
chemical_list: D003287:Contrast Media