Figure 3: Magnetic resonance and ultrasound

images of tendon disease showing the relative sensitivity of each modality. (a) MRI shows subtle thickening of the mid portion of the tendon

(b) ultrasound shows more obvious thickening and tendonopathy of the tendon.

Figure 4: Sagittal MRI scan of the knee of a young patient showing an avulsion fracture of the anterior cruciate ligament (arrowed) associated with a large lipohaemarthrosis (asterisk).

2. Anderson I(J), Read JW, Steinweg J. Atlas of Imaging in Sports Medicine. McGraw Hill 1998. ISBN 0074715844 (£147.24 – 2008). To order http://bit.ly/ImagingAtlas

CAN BE DETRIMENTAL TO AN ATHLETE’S HEALTH AND TO HIS OR HER CAREER

TREATMENT BASED ON IMAGING FINDINGS ALONE

is exquisitely sensitive to oedema (1,9,13). Figure 3 shows the relative sensitivity of MRI compared to ultrasound. Each has its own strengths and weakness and both approaches complement each other, so the most effective strategy harnesses the benefits of each modality. The main limitations of MRI are the long scanning times (anywhere between 15 minutes and 1 hour), its tendency to cause claustrophobia (a problem in up to 1% of patients) and the fact that it is contraindicated in patients who have metallic foreign bodies (e.g. a pacemaker). More recently there have been concerns raised about the effects of MRI contrast medium on the kidneys (1–3,9,13,14).

CONCLUSION There are many imaging techniques currently available that enhance your ability to diagnose and deliver treatment to the athletes in your care. In this article we have reviewed these modalities used for imaging sports injuries. In the next part [ref to next issue] we will discuss the application of each of these modalities, and will help you determine how appropriate each investigation is for different injuries, for both aiding diagnosis and delivering image-guided therapies.

References 1. Orchard JW, Read JW, Anderson I(J). The use of diagnostic imaging in sports medicine. Medical Journal of Australia 2005;183:482–486

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3. Forster B, Rampure J, Kiss Z, Anderson I(J). Principles of diagnosis: Investigations including imaging. In: Brukner P, Khan K (eds) Clinical Sports Medicine, 3rd edn. McGraw-Hill 2007. ISBN 0070278997. (£48.49 – 2009) To order http://bit.ly/ BruknerKhan

4. Anderson MW, Greenspan A. Stress fractures. Radiology 1996;199:1–12 5. Brittenden J, Robinson P. Imaging of pelvic injuries in athletes. British Journal of Radiology 2005;78:457–468 6. Royal College of Radiologists. Making the best use of clinical radiology services, 6th edn. London: Royal College of Radiologists, 2007. ISBN 1905034245 7. United States Food and Drug Administration. Centre for Devices and Radiological Health. What are the radiation risks from CT? Available at: http://bit.ly/4TKOmq 8. Hart D, Wall BF. Radiation exposure of the UK population from medical and dental X-ray examinations. Didcot: National Radiological Protection Board, 2002 9. Grassi W, Filippucci E. Imaging modalities for identifying the origin of regional musculoskeletal pain. Best Practice and Research in Clinical Rheumatology 2003;17(1):17–32 10. Kanstrup L. Bone scintigraphy in sports medicine: A review. Scandinavian Journal of Medicine and Science in Sports 2007;7(6):322–330 11. Jacobson JA. Ultrasound in sports medicine. Radiology Clinics of North America 2002;40(2):363–386 12. Winter TC, Teefey SA, Middleton WD. Musculoskeletal ultrasound: An update. Radiology Clinics of North America 2001;39(3):465–483 13. Helms CA. The impact of MR imaging in sports medicine. Radiology 2002;224:631–635 14. Featherstone T. Magnetic resonance imaging in sports medicine. An overview. British Journal of Sports Medicine 1994;28(2):84–89.

THE AUTHORS

Dr Amit Lakkaraju is specialist registrar in musculoskeletal radiology at Leeds Teaching Hospitals.

Dr Philip O’Connor is a consultant musculoskeletal radiologist

at the Leeds Teaching Hospitals. He is the director of the Biomedical Research Unit at Leeds and he leads the Imaging Work Stream for the London Organising Committee of the Olympic Games and Paralympic Games (LOCOG).

sportEX medicine 2010;43(Jan):7-10