Purpose: To evaluate the value of dynamic contrast-enhanced MR imaging (DEMRI) and its correlation to symptoms and histopathology in chronic Achilles tendinosis.
Material and methods: Fifteen patients with severe symptoms underwent DEMRI preoperatively and 2 years postoperatively. US-guided core biopsies of tendinosis tissue were obtained preoperatively and the specimens were analyzed using a semiquantitative protocol. DEMRI was evaluated by calculating the area under curve (AUC) of signal alteration and the static MR by a semiquantitative grading scale. A questionnaire and clinical examination evaluated the clinical outcome.
Results: Early contrast enhancement (first 72 s) was seen in DEMRI at tendon lesions of the symptomatic Achilles tendons with a significant difference to asymptomatic contralateral tendon that revealed no or mild enhancement. Increased severity of tendon pathology (including fiber structure abnormality, increased vascularity, rounding of nuclei and increased amount of glycosaminoglycans) was correlated to both dynamic and static signal enhancement. Two years following surgical treatment, the signal alterations showed regression of early contrast enhancement (AUC decreased from 9 preoperatively to 2 postoperatively). The clinical outcome was as follows: 8 patients excellent, 4 good, 2 fair and 1 poor.
Conclusion: Patients with chronic painful achillodynia showed an early contrast-agent enhancement corresponding to the tendon lesion. Increased enhancement correlated to increased severity of tendon histopathology and patient symptoms. Two years after surgical treatment the contrast-agent enhancement decreased.