Abstract
ObjectivesTo assess acute muscle tears in professional football players by diffusion tensor imaging (DTI) and evaluate the impact of normalization of data.MethodsEight football players with acute lower limb muscle tears were examined. DTI metrics of the injured muscle and corresponding healthy contralateral muscle and of ROIs drawn in muscle tears (ROItear) in the corresponding healthy contralateral muscle (ROIhc_t) in a healthy area ipsilateral to the injury (ROIhi) and in a corresponding contralateral area (ROIhc_i) were compared. The same comparison was performed for ratios of the injured (ROItear/ROIhi) and contralateral sides (ROIhc_t/ROIhc_i). ANOVA, Bonferroni-corrected post-hoc and Student’s t-tests were used.ResultsAnalyses of the entire muscle did not show any differences (p>0.05 each) except for axial diffusivity (AD; p=0.048). ROItear showed higher mean diffusivity (MD) and AD than ROIhc_t (p<0.05). Fractional anisotropy (FA) was lower in ROItear than in ROIhi and ROIhc_t (p<0.05). Radial diffusivity (RD) was higher in ROItear than in any other ROI (p<0.05). Ratios revealed higher MD and RD and lower FA and reduced number and length of fibre tracts on the injured side (p<0.05 each).ConclusionsDTI allowed a robust assessment of muscle tears in athletes especially after normalization to healthy muscle tissue.Key Points• STEAM-based DTI allows the investigation of muscle tears affecting professional football players.• Fractional anisotropy and mean diffusivity differ between injured and healthy muscle areas.• Only normalized data show differences of fibre tracking metrics in muscle tears.• The normalization of DTI-metrics enables a more robust characterization of muscle tears.
Highlights
Acute muscle injuries are very common in elite and non-elite athletes, and tears due to indirect active traumatic events especially have a high prevalence [1, 2]
Stimulated Echo Acquisition Mode (STEAM)-based Diffusion tensor imaging (DTI) allows the investigation of muscle tears affecting professional football players
Even though DTI allows an accurate assessment of muscle anatomy [15,16,17,18] and disorders [13, 14, 19,20,21], it is affected by challenges [22] and artifacts [23,24,25]
Summary
Acute muscle injuries are very common in elite and non-elite athletes, and tears due to indirect active traumatic events especially have a high prevalence [1, 2]. Diffusion tensor imaging (DTI) [10,11,12] has been successfully used to investigate muscle tears on an animal model (i.e. dystrophic and wild mice) [13] as well as in patients (i.e. two patients with acute muscle tears) [14]. Even though DTI allows an accurate assessment of muscle anatomy [15,16,17,18] and disorders [13, 14, 19,20,21], it is affected by challenges (i.e. short T2 relaxation times of muscle) [22] and artifacts [23,24,25]. Promising results were recently obtained using a Stimulated Echo Acquisition Mode (STEAM) sequence, which, among other advantages, is hardly affected by eddy current distortions and enables long diffusion times without strong T2-induced signal-to-noise ratio (SNR) loss via the application of mixing time (TM) [25, 29]
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