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Bildgebung von Muskelverletzungen im Sport

Imaging of muscle injuries in sports medicine

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Zusammenfassung

Hintergrund

Eine frühzeitige Diagnose von Muskelverletzungen ist von wesentlicher klinischer Bedeutung, um eine stadiengerechte Therapie einzuleiten und einen optimalen Heilungsverlauf zu ermöglichen.

Ziel

Ziel dieser Übersichtsarbeit ist es, ein Update zur bildgebenden Diagnostik von Muskelverletzungen in der Sportmedizin mit dem Schwerpunkt Sonographie und Magnetresonanztomographie (MRT) zu geben und neben den Verfahren in der Routinediagnostik auch experimentelle Ansätze vorzustellen.

Material und Methoden

Es wurde eine PubMed-Literaturrecherche durchgeführt zu den Stichworten: muscle, muscle injury, muscle imaging, muscle injury classification, delayed onset muscle soreness, ultrasound, MRI, sodium MRI, potassium MRI, ultra-high-field MRI, injuries of athletes. Fokus der Literaturrecherche war der Zeitraum 2012 bis 2022.

Ergebnisse

Bildgebende Verfahren spielen in der Diagnostik von Muskelverletzungen eine entscheidende Rolle, um eine klinische Verdachtsdiagnose zu bestätigen und das Verletzungsausmaß zu bestimmen. Das Ergebnis der Bildgebung hat unmittelbaren Einfluss auf Therapieentscheidungen und beeinflusst die Prognose. Der Bildgebung kommt besonders bei unklaren Beschwerden oder unklarem Verletzungsausmaß, rezidivierenden Verletzungen, und auch bei unerwartet prolongierten Heilungsverläufen oder in Fällen, die einer interventionellen oder chirurgischen Intervention bedürfen, eine große Bedeutung zu. Neben etablierten Verfahren wie der B‑Bild-Sonographie und der 1H‑MRT zeigen einzelne Studien vielversprechende Ansätze, um die Bildgebung von Muskelverletzungen zukünftig zu verbessern. Hinsichtlich einer konkreten Anwendung von neuen Verfahren wie der kontrastmittelverstärkten Sonographie oder der X‑Kern-MRT sind weiterführende Studien mit größeren Patientenkollektiven notwendig, um die bisherigen Erkenntnisse zu bestätigen und ggf. klinisch anwendbar zu machen.

Schlussfolgerung

Die B‑Bild-Sonographie bietet sich als leicht verfügbare, kostengünstige Modalität zur initialen Diagnostik von Muskelverletzungen an. Die MRT gilt weiterhin als Referenzstandard und ermöglicht eine genaue morphologische Erfassung des Verletzungsausmaßes. Insbesondere zur objektiven Bestimmung von „Return-to-Sports“-Kriterien und der individuellen Beurteilung von Belastungs- und Trainingsfähigkeiten stehen nach wie vor keine bildgebenden Verfahren zur Verfügung.

Abstract

Background

Early diagnosis of muscle injuries is indispensable in order to initiate appropriate treatment and to facilitate optimal healing.

Purpose

The aim of this review is to provide an update on imaging of muscle injuries in sports medicine with a focus on ultrasound and magnetic resonance imaging (MRI) and to present experimental approaches in addition to routine diagnostic procedures.

Materials and methods

A PubMed literature search for the years 2012–2022 using the following keywords was performed: muscle, muscle injury, muscle imaging, muscle injury classification, delayed onset muscle soreness, ultrasound, MRI, sodium MRI, potassium MRI, ultra-high-field MRI, injuries of athletes.

Results

Imaging is crucial to confirm and assess the extent of sports-related muscle injuries and may help establishing treatment decisions, which directly affect the prognosis. This is of importance when the diagnosis or grade of injury is unclear, when recovery is taking longer than expected, and when interventional or surgical management may be necessary. In addition to established methods such as B‑mode ultrasound and 1H‑MRI, individual studies show promising approaches to further improve the imaging of muscle injuries in the future. Prior to the integration of contrast-enhanced ultrasound and X‑nuclei into clinical routine, additional studies are needed to validate these techniques further.

Conclusion

B‑mode ultrasound represents an easily available, cost-effective modality for the initial diagnosis of muscle injuries. MRI is still considered the reference standard and enables an accurate morphological assessment of the extent of the injury. There are still no imaging approaches available for the objective determination of the optimal point of return to play.

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Authors and Affiliations

  1. Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland

    Rafael Heiss, Rolf Janka, Michael Uder, Lena Gast, Armin M. Nagel & Frank W. Roemer

  2. Unfallchirurgische und Orthopädische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland

    Thilo Hotfiel

  3. Osnabrücker Zentrum für Muskuloskelettale Chirurgie (OZMC), Klinikum Osnabrück, Osnabrück, Deutschland

    Thilo Hotfiel

  4. Abteilung Medizinische Physik in der Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland

    Armin M. Nagel

  5. Quantitative Imaging Center (QIC), Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA

    Frank W. Roemer

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  1. Rafael Heiss
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  4. Thilo Hotfiel
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Corresponding author

Correspondence to Rafael Heiss.

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Interessenkonflikt

R. Heiss, R. Janka, M. Uder, T. Hotfiel, L. Gast, A.M. Nagel und F.W. Roemer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Heiss, R., Janka, R., Uder, M. et al. Bildgebung von Muskelverletzungen im Sport. Radiologie 63, 249–258 (2023). https://doi.org/10.1007/s00117-023-01118-7

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