Biomedical subjects

M E Schweitzer

Publications and source records attributed to M E Schweitzer.

At least 19 recordsLinked to original sources

PubMed2006

MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts.

OBJECTIVE: To determine if a relationship exists between bone marrow edema-like signal and subchondral cysts on magnetic resonance imaging (MRI). DESIGN: Retrospective cohort of 32 patients with two sequential knee MRI. Patients with acute trauma, infection, neoplasm, or osteonecrosis were excluded. The degree of osteoarthritis was assessed using an adaptation of the Baltimore Longitudinal Study of Aging (BLSA) scale. Initial and follow-up exams were reviewed for presence, location, size and changes of marrow edema-like signal, subarticular cysts and cartilage abnormality. All locations in the knee were aggregated for analysis with descriptive statistics. RESULTS: The mean time interval between exams was 17.52 months (range 2.1-40.1 months). There were 23 cysts: 11 (47.8%) new, 6 (26.1%) increased size, 1 (4.4%) decreased size, and 5 (21.7%) no change in pre-existing lesions. Cysts always arose from regions of marrow edema-like signal. There were 68 subarticular areas of marrow edema-like signal: 16 (23.5%) new, 23 (33.8%) increased size, 17 (25%) decreased size, 11 (16.2%) resolved and 1 (1.5%) no change in pre-existing lesion. Marrow edema-like signal size always changed with cyst development: increased in 6/11 (54.5%), decreased in 2/11 (18.1%) and resolved in 3/11 (27.2%). Change in cyst size was always accompanied by a change in edema-like signal size. An MRI visible cartilage abnormality was adjacent to 87% (20/23) of cysts. The mean BLSA score changed from 2.6 to 3.6 indicating an overall progression of osteoarthritis. CONCLUSION: Subchondral cysts develop in pre-existing regions of subchondral bone marrow edema-like signal.

Adult↗

PubMed2006

Magnetic resonance imaging of para-acetabular insufficiency fractures in patients with malignancy.

AIM: To describe the characteristic magnetic resonance imaging (MRI) findings of para-acetabular insufficiency fractures in patients with malignancy, and compare the MRI appearance of these fractures with that of metastatic bone disease. MATERIALS AND METHODS: MRI examinations were reviewed in 16 patients with a known malignant tumour and severe hip pain that raised the possibility of local recurrence or metastatic disease. Six patients had received pelvic irradiation, and three patients were receiving steroid medication. RESULTS: The total number of fractures detected was 21: a solitary fracture was present in 11 patients and five patients had bilateral para-acetabular fractures. Two patients had associated sacral insufficiency fractures, and one of them had stress fractures involving both acetabular columns. Conventional radiography allowed the diagnosis of 14 (67%) fractures; six (28%) radiographic examinations were negative; and one (5%) examination was equivocal for fracture. Available scintigraphic and computed tomography (CT) studies revealed typical findings of fracture. Using MRI, insufficiency fractures appeared as linear regions of low signal intensity on T1- and T2-weighted images. Marked marrow oedema was evident in all cases. Fractures characteristically were parallel to the superior acetabulum in a curvilinear fashion in 18 (86%) instances, and were oblique in three (14%) instances. The fractures demonstrated considerable enhancement after intravenous gadolinium administration. No associated soft tissue masses were documented. CONCLUSION: Para-acetabular insufficiency fractures are a cause of hip pain, which may mimic skeletal metastasis in the patient with malignancy and pelvic irradiation. Recognition of the characteristic MRI findings of these fractures can preclude misdiagnosis and unnecessary bone biopsy.

Acetabulum↗

PubMed2003

Indirect magnetic resonance arthrography.

Indirect MR arthrography is useful for evaluation of joints such as the elbow, wrist, ankle and shoulder where there is a large synovial surface area relative to joint volume. It allows simultaneous assessment of both intra-articular and extra-articular soft tissues with the added advantage of minimal invasiveness. The established and potential uses of this imaging technique are reviewed below and the pathology that is demonstrated by this technique is discussed.

Arthrography↗

PubMed2001

Magnetic resonance imaging analysis of soft tissue disruption after flexion-distraction injuries of the subaxial cervical spine.

STUDY DESIGN: A retrospective study was performed with the use of magnetic resonance imaging to evaluate the type and degree of soft tissue disruption associated with flexion-distraction injuries of the subaxial spine. OBJECTIVE: To determine what soft tissue structures are injured in flexion-distraction injuries of the subaxial spine. SUMMARY OF BACKGROUND DATA: Prior published reports of unilateral and bilateral cervical facet dislocations have described the analyzed mechanisms and biomechanics of this injury subtype. No retrospective magnetic resonance imaging analysis of associated soft tissue disruption has been documented. METHODS: Magnetic resonance imaging evaluations of the cervical spine were obtained for all patients with a flexion-distraction injury, Stages 2 (unilateral facet dislocation) and 3 (bilateral facet dislocation), between September 1994 and May 1998. Two neuroradiologists, blinded to both clinical and radiographic findings, graded all the soft tissue structures for evidence of attenuation or disruption. The soft tissue structures were graded on a scale of 1 (intact), 2 (indeterminate), or 3 (disrupted). RESULTS: For this study, 48 patients satisfied the inclusion criteria: 25 with unilateral facet dislocation and 23 with bilateral facet dislocation. Disruption to the posterior musculature, interspinous ligament, supraspinous ligament, facet capsule, ligamentum flavum, and posterior and anterior longitudinal ligaments was found in a statistically significant number of patients with bilateral facet dislocation. For most of these structures, disruption was found to be statistically significant in patients with a unilateral facet dislocation, except for the posterior longitudinal ligament, in which significance was not consistently demonstrated using 95% confidence intervals in the binomial testing. In a comparison between unilateral and bilateral facet dislocations using a two-sided Fisher's exact test, it was found that disruption to the anterior and posterior longitudinal ligaments and the left facet capsule were statistically significant, with all three more prominent in bilateral facet dislocation. A multivariate analysis between unilateral and bilateral facet dislocations showed that disruption to the anterior longitudinal ligament was associated significantly with a bilateral facet dislocation. Disc disruption was found to be associated significantly with both injury types, but was more common in bilateral facet dislocation, although this difference in intergroup comparisons was not statistically significant. CONCLUSIONS: Unilateral and bilateral facet dislocations of the subaxial spine are associated with damage to numerous soft tissue structures that provide stability to the lower cervical spine. Damage to the posterior longitudinal ligament did not occur consistently in unilateral facet dislocations. Bilateral facet dislocations were associated significantly with disruption to the posterior and anterior longitudinal ligaments and left facet capsule, as compared with unilateral facet dislocations. Magnetic resonance imaging allows visualization of these disruptions.

Cervical Vertebrae↗

PubMed2001

MRI of the foot and ankle: prevalence and distribution of occult and palpable ganglia.

The purpose of this study was to evaluate the prevalence and anatomic distribution of occult and palpable ganglia of the foot and ankle as seen by MRI. Within a 7-year period MRI of the ankle was performed on 2813 patients, and MRI of the foot on 2277 patients using a 1.5T magnet. In all, 167 ganglia in 155 patients were detected. MR images of these patients were reviewed retrospectively by two observers with regard to prevalence, imaging characteristics, and exact anatomic location of ganglia. Clinical findings and (when available) surgical reports were also reviewed. One hundred fifty-seven ganglia in 145 patients were present on MR images of the ankle, and 10 ganglia in 10 patients on MR images of the foot, resulting in a prevalence of 5.6% (157/2813) in the ankle, and a prevalence of 0.4% (10/2277) in the foot. The most common location was the tarsal sinus or tarsal canal (57/167 ganglia [34.1%]). However, only four of these (7%) were palpable as a soft-tissue mass. The second most common location was around the Lisfranc joint (23/167 [13.8%]), of which 11/23 [47.8%] were clinically palpable. Palpable ganglia were statistically larger in size than occult ganglia measured in any of three diameters (P = 0.01-0.002). In addition, ganglia of the foot and ankle represented 42% of all clinically suspected soft-tissue masses. Ganglia in the foot and ankle are an infrequent finding on routine MRI of the foot and ankle. When they occur, these ganglia are most frequently located in the tarsal sinus and tarsal canal, where they are occult to clinical palpation. If ganglia are clinically palpable, they are most commonly located around the Lisfranc joint. In addition, palpable ganglia are larger than occult ganglia.

Adolescent↗

PubMed2001

Utility of MR arthrography in the diagnosis of adhesive capsulitis.

OBJECTIVE: Arthrographically, adhesive capsulitis is characterized by decreased joint volume; histologically, the capsule and synovium are thickened. We therefore compared using MR arthrography the joint volumes and capsule/synovial thickness of patients with and without adhesive capsulitis in order to assess the utility of MR arthrography in diagnosing adhesive capsulitis. DESIGN AND PATIENTS: The 1.5 T MR arthrography images of 28 subjects with (n=9) and without (n=19) adhesive capsulitis were compared. Adhesive capsulitis was diagnosed when there was an injected glenohumeral joint volume of less than 10 ml. Two masked observers working in consensus assessed the images for the relative amount of fluid in the biceps tendon sheath and axillary recess, corrugation at the margin of the capsule, capsule/synovial thickness, abnormalities of the rotator interval capsule, and for the presence of a cuff tear. RESULTS: There was a trend towards differences in capsular and synovial thickness (P>0.07) between the subjects with and without adhesive capsulitis; however, the controls had thicker synovium/capsules. Surprisingly, the amount of fluid in the axillary recess and biceps tendon sheath was not significantly different between the groups (P>0.25). There were more tears of the rotator cuff in controls than in patients with adhesive capsulitis (6, 3 vs 1, 1: complete, partial). Also, both corrugation (7 vs 0) and interval abnormalities (7 vs 0) were more common in the controls. CONCLUSION: There appear to be no useful MR arthrographic signs of adhesive capsulitis. Capsular/synovial thickness, static fluid volume, and the presence of corrugation are inconclusive as MR arthrographic signs for distinguishing shoulders with adhesive capsulitis from those without.

Adult↗

PubMed2001

Partial tears of the distal biceps tendon: MR appearance and associated clinical findings.

PURPOSE: To describe the magnetic resonance (MR) appearance and associated clinical findings of partial distal biceps tendon tears. DESIGN: Twenty elbow MR images at 1.5 T, performed over a 7 year period, were reviewed for an appearance of partial tears in the distal biceps. These images were assessed by two musculoskeletal radiologists for the extent of: (a) abnormal signal intensity within the tendon, and the presence of (b) bicipitoradial bursitis, and (c) bony microavulsive injury of the radial tuberosity. Medical records for nine of the 20 cases were reviewed for the clinical findings of ecchymosis, trauma, sensation of a "pop", loss of function, and acuity of onset. RESULTS: Twenty partial distal biceps tendon tears were seen. All displayed an abnormally increased signal in the distal biceps tendon. Three of 20 (15%) showed a 25% to 50% tear, ten of 20 (50%) showed a 50% tear, and seven of 20 (35%) showed a 75% to 90% tear. Bicipitoradial bursitis was seen in 11 of 20 (55%) cases. Bony microavulsive injury of the radial tuberosity was observed in 10 of 20 (50%). Of the nine cases reviewed for associated clinical findings, surprisingly, only three (33%) experienced an acute traumatic episode with an abrupt onset of pain. An insidious onset was reported in four of nine (44%). Sensation of a "pop" was recorded in only two of nine (22%) cases. Ecchymosis and loss of function were not seen in any of the cases. Finally, surgical conformation was obtained for three cases. CONCLUSION: Partial distal biceps tendon tears have a characteristic MR appearance, demonstrate little functional deficit, and may be attritional in their etiology due to the observation of a low number of patients reporting trauma or an acute onset.

Adult↗

PubMed2001

Indirect MR arthrography of the knee: effects of low-intensity ultrasound on the diffusion rate of intravenously administered Gd-DTPA in healthy volunteers.

RATIONALE AND OBJECTIVES: To evaluate whether application of low-intensity ultrasound may increase the diffusion rate of intravenously administered gadopentetate dimeglumine (Gd-DTPA) and increase the amount of joint fluid on indirect magnetic resonance (MR) arthrography. METHODS: Conventional MR imaging, indirect MR arthrography, and power Doppler ultrasonography were performed before and after application of therapeutic, pulsed low-intensity ultrasound in 12 asymptomatic knees of 12 volunteers. Intra-articular diffusion of intravenously administered Gd-DTPA as measured by signal intensity differences of the intra-articular joint fluid before and after ultrasound treatment was assessed. In addition, the amount of joint fluid was rated, and differences in synovial blood flow as evidenced by power Doppler ultrasonography were noted. RESULTS: All volunteers tolerated well the application of therapeutic low-intensity ultrasound. A significant increase in intra-articular diffusion of intravenously administered Gd-DTPA was noted in all knees, and an increase in joint fluid was noted in 8 of 12 knees (66.6%). Detection of power Doppler flow signal in the synovium of the suprapatellar recess was possible in one instance at posttreatment exam. CONCLUSIONS: Use of pulsed, therapeutic low-intensity ultrasound may increase the diffusion rate of intravenously administered Gd-DTPA and may induce joint effusion.

Adult↗

PubMed2001

MR imaging of the posterior cruciate ligament graft: initial experience in 15 patients with clinical correlation.

PURPOSE: To describe the magnetic resonance (MR) appearance of the posterior cruciate ligament (PCL) graft in the 1st postoperative year and to correlate the MR findings with clinical examination findings. MATERIALS AND METHODS: Nineteen MR examinations were performed in 15 patients (with 15 grafts) 1-33 months after PCL reconstruction. Results of clinical follow-up were available in 14 patients. Graft shape and thickness were recorded, and intrasubstance signal intensity at T2-weighted imaging was graded. The MR findings were correlated with the time between surgery and clinical examination. RESULTS: At MR imaging, 13 grafts appeared intact, one could not be assessed owing to hardware artifact, and one initially appeared disrupted. Graft thickness was 7-19 mm. There was no significant difference between graft thickness versus time since surgery and signal intensity versus time since surgery (P =.14). In two of three patients who underwent sequential MR examinations, graft thickness and intrasubstance signal intensity decreased as the time between reconstruction and MR imaging increased. Two of 14 patients who underwent physical examination had a posterior drawer, and one also had an anterior cruciate ligament graft tear. Both patients with knee instability demonstrated intact PCL graft fibers at MR imaging. There was no correlation between knee stability and graft thickness, signal intensity, or shape. CONCLUSION: After PCL reconstruction, MR imaging in the 1st year depicts a thickened graft with increased signal intensity. There does not appear to be a relationship between clinical stability and findings at MR imaging.

Adolescent↗

PubMed2001

MR imaging findings of entrapment of the flexor hallucis longus tendon.

OBJECTIVE: In this retrospective study, we describe the MR imaging patterns of various causes of flexor hallucis longus tendon entrapment. CONCLUSION: Entrapment of the flexor hallucis longus tendon may be due to an enlarged os trigonumtarsitarsi, calcaneal fracture, and soft-tissue scar. These disorders have characteristic imaging findings that may be revealed on MR imaging.

Adolescent↗

PubMed2001

Subtendinous bone marrow edema patterns on MR images of the ankle: association with symptoms and tendinopathy.

OBJECTIVE: We sought to describe a pattern of subtendinous bone marrow edema on MR images of the ankle and to determine if there is an association with location of symptoms and overlying tendinopathy. MATERIALS AND METHODS: At 1.5 T, 141 MR examinations of the ankle (116 clinical examinations of patients with chronic pain, 25 of asymptomatic control patients) were performed using T1-weighted, proton density-weighted fast spin-echo, and T2-weighted fat-suppressed fast spin-echo sequences. Images were retrospectively reviewed by two musculoskeletal radiologists for presence of bone marrow edema occurring in a subcortical location associated with the course of the medial or lateral tendon groups, as well as focal thickening or increased T2 signal within the tendons. These findings were correlated with clinical information regarding symptom location. The association of subtendinous marrow edema with tendinopathy and symptom location was statistically analyzed. RESULTS: Subtendinous bone marrow edema was present at 26 sites on 24 ankle MR examinations (17%) (at the medial malleolus [n = 17] associated with the posterior tibialis tendon, at the lateral malleolus [n = 6] and the calcaneus [n = 2] associated with the peroneus longus and brevis tendons, and at the cuboid [n = 1] associated with the peroneus longus tendon). These subtendinous bone marrow edema patterns were significantly associated with overlying tendon abnormality medially (p = 0.001) and laterally (p = 0.001), and with symptoms medially (p = 0.0016) but not laterally (p = 0.078). CONCLUSION: On MR images of the ankle, bone marrow edema localized in a subtendinous location is associated with overlying tendinopathy medially and laterally and with ankle pain medially.

Adult↗

PubMed2001

Elbow synovial fold syndrome: MR imaging findings.

OBJECTIVE: We describe the anatomy and MR imaging appearance of elbow plicae. MATERIALS AND METHODS: First, five cadavers were evaluated by sectioning and using MR arthrography for evidence of normal or prominent synovial folds to determine the potential origin of elbow plicae. Next, 164 consecutive MR images were evaluated to determine the frequency of the plicae in a clinical population. Last, we retrospectively studied a selected group of eight patients who underwent preoperative MR imaging and in whom enlarged synovial folds were confirmed at surgery. RESULTS: In the cadavers, the synovial fold appeared to originate from the synovium adjacent to a posterior fat pad. In the clinical population, half the patients showed a synovial fold at the same location; however, most folds were less than or equal to 2 mm in thickness. The eight patients presented clinically with symptoms mimicking an intraarticular body. The synovial fold in symptomatic patients was seen posteriorly just above the olecranon and averaged 3 mm in thickness. CONCLUSION: A synovial fold extending from the posterior fat pad in the elbow is a frequent finding on MR imaging. In a subgroup of patients, plicae, when thickened, may present clinically as a locking elbow. However, overlap exists between the thicknesses of symptomatic and asymptomatic plicae.

Adult↗

PubMed2001

MR imaging of the diabetic foot.

Diabetes is a common disease with potentially devastating complications affecting the foot and ankle. A combination of vascular disease, peripheral neuropathy, and immunopathy result in a cascade of conditions including ischemia/infarction, tendinopathy, atrophy, edema, deformity, neuropathic osteoarthopathy, callus, ulceration, and infection. The MR imaging appearance of these complications will be discussed. Recognition of these MR imaging patterns facilitates formulation of medical or surgical treatment plans.

Diabetic Foot↗

PubMed2001

MR imaging of inflammatory conditions of the ankle and foot.

Infection and noninfection inflammatory diseases commonly affect the foot and ankle; they have a significant impact on the cost of medical care and are a major source of referral for MR imaging evaluation. Recognition of the MR imaging appearance of the various manifestations of these disorders is important so that prompt and appropriate medical or surgical management can be instituted. This article emphasizes MR imaging of the most important diseases in this category, diabetic foot infection and the rheumatoid foot, but will also discuss manifestations in the foot and ankle of various other inflammatory diseases, such as gout and seronegative spondyloarthropathies.

Arthritis, Psoriatic↗

PubMed2000

Utilization of "used" vials: cost-effective technique for MR arthrography.

Because full vials of commercially available MR arthrographic contrast are expensive, we hypothesized that the small residual contrast in a "used" vial would be adequate for MR arthrography. After sterility testing and quantity analysis of the residual contrast in 28 vials, this method was successfully used in 10 patients. J. Magn. Reson. Imaging 2000;12:953-955.

Adult↗

PubMed2000

Prevertebral soft tissue swelling following trauma: usefulness following tube placement.

OBJECTIVE: Prevertebral soft tissue swelling (PVSTS) is an important marker of spinal trauma. In patients with missed or occult cervical fractures, it may be the only indication of serious injury. It has been anecdotally suggested that PVSTS is not useful following placement of a nasogastric (NGT) or endotracheal (ETT) tube because of possible iatrogenic trauma and/or soft tissue compression. Consequently, we investigated trauma patients for evidence of PVSTS, comparing radiographs performed before and after placement of NGTs and/or ETTs. DESIGN AND PATIENTS: PVSTS at the C2 and C6 levels was measured on lateral cervical spine radiographs in 102 patients with cervical spine fractures. Measurements were obtained in 66 patients before and after placement of either an NGT (23), ETT (8), or both an NGT and ETT (35). They were also obtained in 36 control patients with fractures and neither an NGT nor ETT, at presentation and after an interval temporally matched to that in the patients with tubes in place. RESULTS: The group with ETTs showed variable changes to PVSTS (31% increase, 63% decrease, and 6% no change). The group with NGTs also showed variable changes to PVSTS (33% increase, 53% decrease, and 13% no change). The group with ETTs and NGTs similarly showed variable changes to PVSTS (25% increase, 72% decrease, 3% no change). Surprisingly, the control group showed similar temporal changes without tube placement (49% increase, 36% decrease, 13% no change). Analyses using the one-tailed F-test of the ratio of the variance of the tube to non-tube groups and the Mann-Whitney test were performed. No significant difference was found in the prevertebral soft tissues at the C2 level between those with tubes in place and the control subjects. However, at the C6 level there was statistical significance between the groups with NGTs and both NGTs and ETTs versus the non-tube groups. Probability under the F-test for the groups with NGTs and both NGTs and ETTs was 0.001 and 0.005, respectively. Under the Mann-Whitney test, P values for groups with NGTs and both NGTs and ETTs were 0.0002 and 0.0001, respectively. CONCLUSION: The appearance of PVSTS showed variable and unpredictable changes following ETT, NGT, or combined ETT/NGT placement at the C2 level. This appears to be an artifact of temporal changes. However, at the C6 level, the presence of PVSTS following NGT or ETT and NGT placement (but not ETT placement alone) may be an accurate indirect sign of cervical spine injury.

Adolescent↗

PubMed2000

Are L5 fractures an indicator of metastasis?

OBJECTIVE: To determine whether L5 vertebral body fractures are an indicator of malignancy. DESIGN AND PATIENTS: A retrospective study of L5 vertebral body fractures was carried out using plain radiographs, CT, and/or MRI. Over a 5-year period, 51 patients with L5 vertebral body fractures were seen at our institution. Since L1 vertebral body fractures are common, 51 age- and gender-matched (20 men, 31 women; mean age 60 years) patients with L fractures were utilized as the control group. The frequency of neoplastic infiltration of the vertebrae was compared between these two populations to determine whether pathologic fracture was more frequent at L5. RESULTS: Twelve (24%) of the L5 fractures were pathologic compared with four (8%) of the L1 fractures (chi-square test, P<0.05). Neoplasm types included multiple myeloma (n=4), prostate (n=3), breast (n=2), lung (n=2), melanoma (n=2), bladder, colon, and leukemia (each n=1). CONCLUSION: Although most L5 fractures are not pathologic, there is an increased incidence of pathologic fractures in this location compared with L1. Therefore, a fracture of L5 should raise the suspicion of metastasis.

Adolescent↗

PubMed2000

MR imaging of the Achilles tendon: overlap of findings in symptomatic and asymptomatic individuals.

OBJECTIVE: To differentiate MR imaging characteristics of symptomatic as compared with asymptomatic Achilles tendons. DESIGN: 1.5 T MR images of 94 feet (88 patients) with "abnormal" MR examinations were retrospectively evaluated and clinically correlated. Two masked, independent observers systematically evaluated for intratendon T2 signal, tendon thickness, presence of peritendonitis, retrocalcaneal bursal fluid volume, pre-Achilles edema, bone marrow edema at the Achilles insertion, and tears (interstitial, partial, complete). These findings were correlated with symptoms (onset and duration) and physical examination results (tenderness, palpable defects, increased angle of resting dorsiflexion). RESULTS: Of the 94 ankles, 64 ankles (32 females, 29 males) were clinically symptomatic. No relationship between Achilles tendon disorders and age or gender was identified. Asymptomatic Achilles tendons frequently demonstrated mild increased intratendon signal (21/30), 0.747 cm average tendon thickness, peritendonitis (11/30), pre-Achilles edema (12/30), and 0.104 ml average retrocalcaneal bursal fluid volume. Symptomatic patients had thicker tendons (0.877 cm), greater retrocalcaneal fluid volume (0.278 ml), more frequent tears (23/64), a similar frequency of peritendonitis (22/64) but less frequent pre-Achilles edema (18/64). Sixty-four percent of the Achilles tendon tears were interstitial. Except for two interstitial tears in control patients, the majority of Achilles tears were in symptomatic patients (14/16). Only symptomatic tendons demonstrated partial or complete tendon tears. In addition, calcaneal edema was found almost exclusively in actively symptomatic patients. Thicker tendons were associated more often with chronic symptoms and with tears. When present in symptomatic patients, peritendonitis was usually associated with acute symptoms. The presence of pre-Achilles edema, however, did not distinguish acute from chronic disorders. CONCLUSION: There is significant overlap of MR findings in symptomatic and asymptomatic Achilles tendons. Furthermore, there is apparently a spectrum of disease in symptomatic tendons ranging from subtle intratendinous and peritendinous signal to partial and complete tendon tear.

Achilles Tendon↗