[Imaging of the Achilles tendon on the computed tomogram. Normal findings and pathological changes]

Soft-Tissue Radiography, Computed Tomography, and Ultrasonography of Partial Achilles Tendon Ruptures

Ultrasonography (US) was compared with soft-tissue radiography (STR) and computed tomography (CT) for demonstration of partial Achilles tendon ruptures. Thirty-nine patients suffering from chronic localized painful Achilles tendon swelling were examined. The patients had all undergone a previous clinical examination, resulting in a suspicion of a non-healed partial tear in 62 out of the 78 tendons. STR showed unspecific tendon pathology such as thickening and diffuse tendon margins. CT resulted in a better delineation of intra- as well as extratendinous abnormalities compared to STR. Various pathologic changes were seen on CT in 54 tendons and in 29 of these, localized intratendinous hypodensities indicated partial ruptures. At US, abnormal changes were observed in 69 tendons, of which 54 had discontinuity of tendon fibers, focal hypoechoic areas, and localized swelling indicating partial ruptures. In 9 cases with surgically proven partial ruptures, US was correct in all cases, while CT was false-negative in 3. STR only showed localized swelling. It was concluded that US was a better method than STR and CT for the detection of partial ruptures and the US findings correlated well with the surgical findings.

[MR and ultrasound study of Achilles tendon injury]

In 24 patients with lesions of the achilles tendon MRI and ultrasound was performed to compare the results with clinical examination. MRI had an accuracy of 100%, ultrasound of 90%. Especially partial rupture with chronic degenerative lesions of the tendon can be diagnosed more accurate by MRI which enables easier indication for treatment. By MRI diagnostic differentiation of our patients in four groups was possible.

Computed tomography of tendinous xanthomata in cerebrotendinous xanthomatosis

Tendinous xanthomata with maximum expression on Achilles tendons are a characteristic feature of cerebrotendinous xanthomatosis, a rare autosomal recessive lipid storage disease. Twenty patients are under review; three of them, at different stages of the disease, underwent computed tomographic (CT) examination. CT demonstrates with a high degree of accuracy the increased size of the tendon and its heterogeneous structure resulting from cholesterol and cholestanol crystal deposits.