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Hamstring Injury in Athletes: Using MR Imaging Measurements to Compare Extent of Muscle Injury with Amount of Time Lost from Competition

John P. Slavotinek1, Geoffrey M. Verrall2 and Gerald T. Fon3

1 Department of Medical Imaging, Flinders Medical Centre, Flinders Dr., Bedford Park, Adelaide, South Australia 5042, Australia.
2 Sportsmed SA (Sports Medicine Clinic), 32 Payneham Rd., Stepney, South Australia 5069, Australia.
3 Perrett Medical Imaging, 199 Ward St., North Adelaide, South Australia 5006, Australia.



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  		Fig. 1A. —Transverse inversion recovery T2-weighted turbo spin-echo MR images (TR/TE, 5032/30) obtained from 25-year-old male athlete with T2 hyperintensity in semitendinosus muscle show technique for determination of extent of muscle injury. Measurements of maximal anteroposterior (arrowheads) and transverse (arrows) dimensions of intramuscular abnormality were combined with craniocaudal extent as determined from slice position notation to estimate volume of muscle injury.

 


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  		Fig. 1B. —Transverse inversion recovery T2-weighted turbo spin-echo MR images (TR/TE, 5032/30) obtained from 25-year-old male athlete with T2 hyperintensity in semitendinosus muscle show technique for determination of extent of muscle injury. During measurement of percentage of abnormal muscle cross-sectional area, irregular regions of interest were drawn around entire muscle belly (solid line) and region of intramuscular T2 hyperintensity (dotted lines) to compute surface areas. Ratio of abnormal to total muscle surface area was expressed as percentage.

 


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  		Fig. 2. —Transverse inversion recovery T2-weighted turbo spin-echo MR image (TR/TE, 5032/30) reveals prominent extramuscular T2 hyperintensity at lateral aspect of biceps femoris muscle in 20-year-old male football player. Length of extramuscular hyperintensity was measured at scanner console using routine software that automatically summed total length of straight line segments corresponding to region being measured (black line).

 


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  		Fig. 3A. —28-year-old male athlete with injury predominantly affecting long head of biceps femoris muscle. Sagittal T1-weighted turbo spin-echo MR image (TR/TE, 676/12) shows slight hyperintensity (arrowheads) adjacent to intramuscular tendon.

 


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  		Fig. 3B. —28-year-old male athlete with injury predominantly affecting long head of biceps femoris muscle. Sagittal inversion recovery T2-weighted turbo spin-echo MR image (5000/30) corresponding to A shows extensive hyperintense signal among muscle fasciculi and adjacent intramuscular tendon (arrowhead) that results in featherlike appearance.

 


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  		Fig. 3C. —28-year-old male athlete with injury predominantly affecting long head of biceps femoris muscle. Transverse inversion recovery T2-weighted turbo spin-echo MR image (5032/30) illustrates distribution of hyperintense signal in long head of biceps femoris muscle (arrows) and extensive extramuscular T2 hyperintensity (arrowheads).

 


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  		Fig. 3D. —28-year-old male athlete with injury predominantly affecting long head of biceps femoris muscle. Axial gradient-echo MR image (610/18; flip angle, 20°) reveals less intense abnormal signal that occupies similar distribution to that seen in C.

 


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  		Fig. 4A. —20-year-old male football player with hemorrhagic injury predominantly affecting adductor magnus muscle. Axial T1-weighted turbo spin-echo MR image (TR/TE, 802/12) shows small region of hyperintensity (arrowheads) in adductor magnus muscle.

 


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  		Fig. 4B. —20-year-old male football player with hemorrhagic injury predominantly affecting adductor magnus muscle. Axial inversion recovery T2-weighted turbo spin-echo MR image (5032/30) shows corresponding focal hypointensity (arrowhead), intramuscular T2 hyperintensity, and extramuscular fluid (arrow), most prominent medially.

 


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  		Fig. 4C. —20-year-old male football player with hemorrhagic injury predominantly affecting adductor magnus muscle. Axial gradient-echo MR image (610/18; flip angle, 20°) at same level as B reveals more obvious T2* hypointensity (arrowhead) that is in keeping with blood products. Posteriorly situated hyperintensity was considered artifactual.

 

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