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Review
. 2023 May;52(5):349-358.
doi: 10.1007/s00132-023-04368-4. Epub 2023 Apr 11.

[MRI or ultrasound-which imaging technique do we need?]

[Article in German]
Markus H Lerchbaumer  1   2 , Torsten Diekhoff  3
Affiliations
Review

[MRI or ultrasound-which imaging technique do we need?]

[Article in German]
Markus H Lerchbaumer et al. Orthopadie (Heidelb). 2023 May.

Abstract
in English, German

Diagnostic imaging of epicondylitis is primarily performed using widely available, radiation-free ultrasound. The dynamic examination allows a rapid point-of-care assessment. Typical imaging findings of epicondylitis include intratendinous hypoechogenic foci at the humeral origin, ossification at the enthesis, intratendinous calcifications, or (partial) rupture. In particular, Doppler sonography increases sensitivity by assessing possible neovascularization within the tendon. When sonographic findings are unclear or extensive, or when ultrasound machines or the required expertise in elbow examinations are not available, magnetic resonance imaging is indicated. Here, the use of proton density-weighted sequences is appropriate for assessing bone marrow and soft tissue edema and tendon tears, while ossifications are best delineated in T1weighted sequences. Projection radiography and computed tomography can be helpful for larger ossifications, although they are not part of the standard imaging protocol.

Die bildgebende Diagnostik der Epikondylitis erfolgt primär durch den breitflächig verfügbaren und strahlungsfreien Ultraschall. Die dynamische Untersuchung erlaubt eine schnelle Point-of-Care-Aussage. Typische Bildbefunde einer Epikondylitis umfassen echoarme Strukturstörungen innerhalb des Sehnenursprungs am Humerus, Ossifikationen im Ursprungsbereich, intratendinöse Kalzifikationen oder (partielle) Rissbildungen. Insbesondere die Dopplersonographie erhöht die Sensitivität durch die Beurteilung einer Neovaskularisation. Die Magnetresonanztomographie kommt dann zur Anwendung, wenn der Ultraschall unklare oder sehr ausgeprägte Befunde ergibt bzw. entweder Gerätschaften oder Erfahrungen für die Sonographie des Ellenbogens nicht verfügbar sind. Hier ist die Nutzung von protonendichtegewichteten Sequenzen zur Beurteilung von Weichteil- und Knochenmarködemen und Rissbildung geeignet, wobei Ossifikationen in der T1-gewichteten Sequenz am besten abgrenzbar sind. Projektionsradiographie und Computertomographie können bei groben Ossifikationen hilfreich sein, sind aber keine bildgebenden Standardverfahren.

Keywords: Epicondylitis; Imaging modalities; Musculoskeletal system; Ossification; Ultrasound.

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References

Literatur

    1. De Maeseneer M, Brigido MK, Antic M, Lenchik L, Milants A, Vereecke E, Jager T, Shahabpour M (2015) Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves. Eur J Radiol 84:671–681. https://doi.org/10.1016/J.EJRAD.2014.12.007 - DOI - PubMed
    1. Connell D, Burke F, Coombes P, McNealy S, Freeman D, Pryde D, Hoy G (2001) Sonographic examination of lateral epicondylitis. AJR Am J Roentgenol 176:777–782. https://doi.org/10.2214/AJR.176.3.1760777 - DOI - PubMed
    1. Latham SK, Smith TO (2014) The diagnostic test accuracy of ultrasound for the detection of lateral epicondylitis: a systematic review and meta-analysis. Orthop Traumatol Surg Res 100:281–286. https://doi.org/10.1016/J.OTSR.2014.01.006 - DOI - PubMed
    1. Dones VC, Grimmer K, Thoirs K, Suarez CG, Luker J (2014) The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review. BMC Med Imaging 14:10. https://doi.org/10.1186/1471-2342-14-10 - DOI - PubMed - PMC
    1. Du Toit C, Stieler M, Saunders R, Bisset L, Vicenzino B (2008) Diagnostic accuracy of power doppler ultrasound in patients with chronic tennis elbow. Br J Sports Med 42:572–576. https://doi.org/10.1136/BJSM.2007.043901 - DOI

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