It Depends

If someone asks me what’s best between Mri and Ultrasound imaging in the study of muscles? I usually give the same answer: always use both modalities! It depends on what kind of informations you need to know from them. Take a look at the following images.

This is the case of an high degree strain of the biceps femoris, in a 17 years old professional football player. One month after injury a fibrotic scar is evident along the course of the proximal tendon-aponeurosis. Great panoramicity of Mri scan but with ultrasound exam you can best appreciate the real extent and morphology of the calcifications.

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Coronal and axial Mri scans: comparison between T1w and Pdw Spair acquisitions

 Sagittal dynamic ultrasound exam of the same patient

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The elastosonography evaluation well depicts the calcification hardness but stable scarring evolution; irregular thermoregulation is evident in the injured left thigh after one month.

I always use the thermographic camera during the recovery period, morover when the athletes come back to specific sport activity.

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Are Muscle Strains Hot?

As consultant radiologist for the U.S. Palermo football team, I had a collaboration with the Medical Staff directed by DrCristian Francavilla; Stefano Gari is one of the physiotherapists. He’s working on an interesting project: to study muscular activity with a thermographic camera. 

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Me and Stefano Gari together with Dr. Francavilla and the goalkeeper Stefano Sorrentino during Sassuolo-Palermo match of last year “Serie A”season.

From Wikipedia, the free encyclopedia: “A thermographic camera (also called an infrared camera or thermal imaging camera) is a device that forms an image using infrared radiation, similar to a common camera that forms an image using visible light. Instead of the 400–700 nanometer range of the visible light camera, infrared cameras operate in wavelengths as long as 14,000 nm (14 µm). Their use is called thermography.

Stefano started from a physiological consideration: the inflammatory process increases local temperature; the classical signs of acute inflammation are pain, heat, redness, swelling and loss of function. In the first 24 hours after an injury, a great difference of temperature occurs between the site of injury and the peripheral tissues. Before making the standard radiological examinations, he began to take several thermographic pictures of the injured muscle and then tried to correlate with Mri imaging. The results? In such cases the comparison is incredible. 

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2nd degree strain of gastrocnemius medial head – coronal stir mri study and thermography correlation

Thermographic camera never can be considered an alternative to others radiological examinations but a complementary study, especially during physiotherapy treatment follow-up of muscular strains, to better evaluate the progression to healing.

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Thermographic pictures taken 24 hours (A) and 48 hours (B) after a strain injury of the right biceps femoris in a professional football player.

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Coronal – Sagittal – Axial Stir Mri scans of the same patient performed two days after trauma.

Many colleagues often ask me what I think about the use of ultrasound exams immediately after a muscle trauma on the playground: is it useful? In my opinion the answer is no; too high the risk of underestimate a muscular lesion immediately after an injury. The perfect timing for a good ultrasound examination is about 48-72 hours after the trauma. Can the thermographic camera cover this time interval to have a pre-evaluation of the possible damages? I hope so; at this moment I find very interesting the possibility of monitoring the tissue changes during the physiotherapy treatments.

Come on Stefano, get down to it! I’m waiting for further studies!