Correlating clinical assessment and MRI findings in diagnosing calf injuries in elite male Australian rules footballers.

OBJECTIVE: Calf complex injuries represent a significant injury burden among Australian Rules athletes. To date, there has been limited research correlating clinical and radiological findings of pathology within the calf. The objective of this study is to determine how accurately magnetic resonance imaging (MRI) findings correlate with clinical measures of calf muscle complex pathology in elite male athletes. MATERIALS AND METHODS: A prospective cohort study was conducted on Australian rules elite athletes. A cohort of 45 athletes underwent a high-load training session of approximately 10 km of running. Athletes were then assessed by a sports physiotherapist who made a diagnosis of no pathology, delayed onset muscle soreness, strain or other. Subsequently, the athletes underwent MRI of their bilateral calf complexes. Radiologists interpreted the MRI findings and radiological diagnosis were correlated with clinical diagnosis. RESULTS: A total of 90 calf MRIs were performed. Correlation of clinical and radiological diagnosis occurred in 57 cases. Of the 33 cases which did not correlate, there were 4 radiologically significant acute calf strains in clinically asymptomatic athletes, 3 of which involved old scar tissue. CONCLUSION: MRI may detect clinically insignificant injuries within the calf complex. If an athlete does not have any clinically relevant symptoms, abnormal signal on MRI may represent a different diagnosis to muscle strain. Signal change on MRI proximal to scar tissue may represent reactive oedema. Clinical history and examination should be correlated with radiological findings is recommended when diagnosing calf injury in elite athletes.

MRI assessment of calf injuries in Australian Football League players: findings that influence return to play.

OBJECTIVE: Calf muscle strains have become increasingly prevalent in recent seasons of the Australian Football League (AFL) and represent a significant cause of time lost from competition. The purpose of this study was to examine the association between MRI features of calf muscle strains and games missed and to thereby identify parameters that are of prognostic value. MATERIALS AND METHODS: A retrospective analysis of MRI scans of AFL players with calf strains referred to a musculoskeletal radiology clinic over a 5-year period (2008-2012) was performed. The muscle(s) and muscle component affected, the site and size of strain, and the presence of an intramuscular tendon tear or intermuscular fluid were recorded. These data were cross-referenced with whether a player missed at least one game. Imaging features of prognostic value were thus identified. RESULTS: Sixty-three athletes had MRI scans for calf muscle strains. Soleus strains were more common than strains of other muscles. Players with soleus strains were more likely to miss at least one game if they had multiple muscle involvement (p = 0.017), musculotendinous junction strains (p = 0.046), and deep strains (p = 0.036). In a combined analysis of gastrocnemius and soleus strains, intramuscular tendon tears were observed in a significantly greater proportion of players who missed games (p = 0.010). CONCLUSION: Amongst AFL players with calf injuries, there is an association between missing at least one game and multiple muscle involvement, musculotendinous junction strains, deep strain location, and intramuscular tendon tears. In this setting, MRI may therefore provide prognostic information to help guide return-to-play decisions.

Direct B-mode NASCET-style stenosis measurement and Doppler ultrasound as parameters for assessment of internal carotid artery stenosis.

Doppler ultrasound grading of internal carotid artery (ICA) stenosis using the two parameters of spectral analysis and internal carotid to common carotid artery peak systolic velocity (ICA/CCA PSV) ratio is well established. The improvements in B-Mode ultrasound image quality now make direct ultrasound NASCET-style stenosis measurement possible. We demonstrate that longitudinal B-mode imaging can produce accurate North American Symptomatic Carotid Endarterectomy Trial (NASCET) style measurements which have good correlation with angiographic images. Ultrasound B-mode stenosis measurement provides a third parameter which can be used in conjunction with the two Doppler parameters for the assessment of ICA stenosis. Taking the highest grade of stenosis of the three parameters produces a sensitivity of 100% for the detection of greater than 50% and greater than 80% stenosis with specificity of 66 and 90%, respectively. The performance of satisfactory B-mode imaging against digital subtraction angiography (DSA) was very encouraging. When the B-mode stenosis measurement showed a normal ICA, the positive predictive value (PPV) of the DSA being normal was 94%. When the B-mode stenosis measurement was 35% or less, the PPV of the DSA stenosis being 35% or less was 93%. These excellent results support the use of good quality B-Mode NASCET style stenosis measurement as the initial ultrasound measurement, with Doppler ultrasound only being performed when the B-mode stenosis measurement is greater than 35% or if the B-mode image is unsatisfactory. This approach would save considerable time enabling better utilization of ultrasound resources.