Imaging
Tendonitis
- Preliminary Diagnosis: Tendonitis
-
I. What imaging technique is first-line for this diagnosis
- II. Describe the advantages and disadvantages of this technique for diagnosis of tendonitis.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of tendonitis.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Tendonitis
I. What imaging technique is first-line for this diagnosis
MR imaging
II. Describe the advantages and disadvantages of this technique for diagnosis of tendonitis.
Advantages
Able to detect other causes of pain or weakness in the joint such as tenosynovitis or tears of the tendons.
Does not use ionizing radiation.
Disadvantages
Expensive
Time-consuming imaging modality
Requires marked patient cooperation to limit motion artifact.
MR imaging with intravenous contrast requires that the patient have good renal function with a GFR greater than 60. Administration of intravenous contrast is decided individually on a case-by-case basis with a GFR > 30 and < 60.
III. What are the contraindications for the first-line imaging technique?
Contraindicated in patients with non-MR compatible metallic hardware and foreign bodies.
IV. What alternative imaging techniques are available?
Radiography
Ultrasound
CT with or without contrast.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of tendonitis.
Radiography
Advantages
Inexpensive and easy to perform
Requires minimal patient cooperation.
Can detect calcific tendinopathy and heterotopic calcifications in chronic cases.
Disadvantages
Low sensitivity, radiographs usually normal.
Ultrasound
Advantages
Able to detect disruption of normal tendon architecture and areas of tear.
Color Doppler can aid diagnosis without the potential complications of contrast administration.
Relatively inexpensive and portable imaging modality
Does not use ionizing radiation.
Disadvantages
Requires a skilled technician trained in musculoskeletal imaging with a high index of suspicion for detection of pathology.
Limited evaluation in obese patients.
CT with or without contrast
Advantages
Can detect calcific tendinopathy and heterotopic calcifications in chronic cases better than radiography.
Further detail of bone to assess for fracture and degenerative changes.
Relatively quick imaging procedure
Requires little patient cooperation and is associated with less motion artifact.
Disadvantages
Soft tissue structures and tendons are better evaluated with MRI.
Exposes patient to intravenous contrast
VI. What are the contraindications for the alternative imaging techniques?
Radiography
No significant contraindications exist.
Ultrasound
No significant contraindications exist.
CT with or without contrast
Contraindicated in a pregnant patient, especially within the first two trimesters.
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