Skip to main content
SpringerLink
Log in

Diffusion tensor imaging of hamstring muscles after acute strain injury and throughout recovery in collegiate athletes

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To identify the region of interest (ROI) to represent injury and observe between-limb diffusion tensor imaging (DTI) microstructural differences in muscle following hamstring strain injury.

Materials and methods

Participants who sustained a hamstring strain injury prospectively underwent 3T-MRI of bilateral thighs using T1, T2, and diffusion-weighted imaging at time of injury (TOI), return to sport (RTS), and 12 weeks after RTS (12wks). ROIs were using the hyperintense region on a T2-weighted sequence: edema, focused edema, and primary muscle injured excluding edema (no edema). Linear mixed-effects models were used to compare diffusion parameters between ROIs and timepoints and limbs and timepoints.

Results

Twenty-four participants (29 injuries) were included. A significant ROI-by-timepoint interaction was detected for all diffusivity measures. The edema and focused edema ROIs demonstrated increased diffusion at TOI compared to RTS for all diffusivity measures (p-values < 0.006), except λ1 (p-values = 0.058–0.12), and compared to 12wks (p-values < 0.02). In the no edema ROI, differences in diffusivity measures were not observed (p-values > 0.82). At TOI, no edema ROI diffusivity measures were lower than the edema ROI (p-values < 0.001) but not at RTS or 12wks (p-values > 0.69). A significant limb-by-timepoint interaction was detected for all diffusivity measures with increased diffusion in the involved limb at TOI (p-values < 0.001) but not at RTS or 12wks (p-values > 0.42). Significant differences in fractional anisotropy over time or between limbs were not detected.

Conclusion

Hyperintensity on T2-weighted imaging used to define the injured region holds promise in describing muscle microstructure following hamstring strain injury by demonstrating between-limb differences at TOI but not at follow-up timepoints.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

BAMIC:

British athletic muscle injury classification

BFsh:

Biceps femoris short head

BFlh:

Biceps femoris long head

CI 95%:

Confidence intervals

DTI:

Diffusion tensor imaging

FA:

Fractional anisotropy

HSI:

Hamstring strain injury

IDEAL:

Iterative decomposition of water and fat with echo asymmetry and least-squares estimation

MD:

Mean diffusivity

MRI:

Magnetic resonance imaging

RD:

Radial diffusivity

ROI:

Region of interest

RTS:

Return to sport

SM:

Semimembranosus

SPGR:

Spoiled gradient recalled echo sequence

ST:

Semitendinosus

TOI:

Time of injury

12wks:

12-weeks after return to sport

References

  1. de Mello R, Ma Y, Ji Y, Du J, Chang EY. Quantitative MRI musculoskeletal techniques: an update. AJR Am J Roentgenol. 2019;213(3):524–33.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Opar DA, Williams MD, Shield AJ. Hamstring strain injuries: factors that lead to injury and re-injury. Sports Med. 2012;42(3):209–26.

    Article  PubMed  Google Scholar 

  3. Wangensteen A, Almusa E, Boukarroum S, Farooq A, Hamilton B, Whiteley R, Bahr R, Tol JL. MRI does not add value over and above patient history and clinical examination in predicting time to return to sport after acute hamstring injuries: a prospective cohort of 180 male athletes. Br J Sports Med. 2015;49(24):1579–87.

    Article  PubMed  Google Scholar 

  4. Reurink G, Brilman EG, de Vos RJ, Maas M, Moen MH, Weir A, Goudswaard GJ, Tol JL. Magnetic resonance imaging in acute hamstring injury: can we provide a return to play prognosis? Sports Med. 2015;45(1):133–46.

    Article  PubMed  Google Scholar 

  5. Reurink G, Goudswaard GJ, Tol JL, Almusa E, Moen MH, Weir A, Verhaar JA, Hamilton B, Maas M. MRI observations at return to play of clinically recovered hamstring injuries. Br J Sports Med. 2014;48(18):1370–6.

    Article  PubMed  Google Scholar 

  6. Greenky M, Cohen SB. Magnetic resonance imaging for assessing hamstring injuries: clinical benefits and pitfalls - a review of the current literature, Open Access. J Sports Med. 2017;8:167–70.

    Google Scholar 

  7. Rudisill SS, Kucharik MP, Varady NH, Martin SD. Evidence-based management and factors associated with return to play after acute hamstring injury in athletes: a systematic review. Orthop J Sports Med. 2021;9(11):23259671211053833.

    PubMed  PubMed Central  Google Scholar 

  8. Monte JR, Hooijmans MT, Froeling M, Oudeman J, Tol JL, Strijkers GJ, Nederveen AJ, Maas M. Diffusion tensor imaging and quantitative T2 mapping to monitor muscle recovery following hamstring injury. NMR Biomed. 36(7):e4902. https://doi.org/10.1002/nbm.4902

  9. Berry DB, Regner B, Galinsky V, Ward SR, Frank LR. Relationships between tissue microstructure and the diffusion tensor in simulated skeletal muscle. Magn Reson Med. 2018;80(1):317–29.

    Article  PubMed  Google Scholar 

  10. Biglands JD, Grainger AJ, Robinson P, Tanner SF, Tan AL, Feiweier T, Evans R, Emery P, O’Connor P. MRI in acute muscle tears in athletes: can quantitative T2 and DTI predict return to play better than visual assessment? Eur Radiol. 2020;30(12):6603–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Zaraiskaya T, Kumbhare D, Noseworthy MD. Diffusion tensor imaging in evaluation of human skeletal muscle injury. J Magn Reson Imaging. 2006;24(2):402–8.

    Article  PubMed  Google Scholar 

  12. Giraudo C, Motyka S, Weber M, Karner M, Resinger C, Feiweier T, Trattnig S, Bogner W. Normalized STEAM-based diffusion tensor imaging provides a robust assessment of muscle tears in football players: preliminary results of a new approach to evaluate muscle injuries. Eur Radiol. 2018;28(7):2882–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. J Orthop Sports Phys Ther. 2010;40(2):67–81.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pollock N, James SL, Lee JC, Chakraverty R. British athletics muscle injury classification: a new grading system. Br J Sports Med. 2014;48(18):1347–51.

    Article  PubMed  Google Scholar 

  15. Andersson JL, Skare S, Ashburner J. How to correct susceptibility distortions in spin-echo echo-planar images: application to diffusion tensor imaging. Neuroimage. 2003;20(2):870–88.

    Article  PubMed  Google Scholar 

  16. Andersson JLR, Sotiropoulos SN. An integrated approach to correction for off-resonance effects and subject movement in diffusion MR imaging. Neuroimage. 2016;125:1063–78.

    Article  PubMed  Google Scholar 

  17. Manjon JV, Coupe P, Concha L, Buades A, Collins DL, Robles M. Diffusion weighted image denoising using overcomplete local PCA. PloS One. 2013;8(9):e73021.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Jenkinson M, Beckmann CF, Behrens TE, Woolrich MW, Smith SM. Fsl. Neuroimage. 2012;62(2):782–90.

    Article  PubMed  Google Scholar 

  19. Jenkinson M, Bannister P, Brady M, Smith S. Improved optimization for the robust and accurate linear registration and motion correction of brain images. Neuroimage. 2002;17(2):825–41.

    Article  PubMed  Google Scholar 

  20. Hooijmans MT, Damon BM, Froeling M, Versluis MJ, Burakiewicz J, Verschuuren JJ, Niks EH, Webb AG, Kan HE. Evaluation of skeletal muscle DTI in patients with duchenne muscular dystrophy. NMR Biomed. 2015;28(11):1589–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Okamoto Y, Mori S, Kujiraoka Y, Nasu K, Hirano Y, Minami M. Diffusion property differences of the lower leg musculature between athletes and non-athletes using 1.5T MRI. MAGMA. 2012;25(4):277–84.

    Article  PubMed  Google Scholar 

  22. Sanfilippo JL, Silder A, Sherry MA, Tuite MJ, Heiderscheit BC. Hamstring strength and morphology progression after return to sport from injury. Med Sci Sports Exerc. 2013;45(3):448–54.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Froeling M, Nederveen AJ, Nicolay K, Strijkers GJ. DTI of human skeletal muscle: the effects of diffusion encoding parameters, signal-to-noise ratio and T2 on tensor indices and fiber tracts. NMR Biomed. 2013;26(11):1339–52.

    Article  PubMed  Google Scholar 

  24. Damon BM. Effects of image noise in muscle diffusion tensor (DT)-MRI assessed using numerical simulations. Magn Reson Med. 2008;60(4):934–44.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ababneh Z, Beloeil H, Berde CB, Gambarota G, Maier SE, Mulkern RV. Biexponential parameterization of diffusion and T2 relaxation decay curves in a rat muscle edema model: decay curve components and water compartments. Magn Reson Med. 2005;54(3):524–31.

    Article  PubMed  Google Scholar 

  26. Fan RH, Does MD. Compartmental relaxation and diffusion tensor imaging measurements in vivo in lambda-carrageenan-induced edema in rat skeletal muscle. NMR Biomed. 2008;21(6):566–73.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This work is supported by NBA and GE Healthcare Orthopedics and Sports Medicine Collaboration (MYT-015, D223) and NIH award TL1TR002375. The authors would like to acknowledge the Sports Medicine staff in the University of Wisconsin-Madison Division of Athletics for their commitment to the welfare of the student athletes and contributions to the Badger Athletic Performance program.

Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA

    Christa M. Wille & Bryan C. Heiderscheit

  2. Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 6136 UW Medical Foundation Centennial Bldg, 1685 Highland Ave, Madison, WI, 53705, USA

    Christa M. Wille, Elizabeth Schmida & Bryan C. Heiderscheit

  3. Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA

    Christa M. Wille, Elizabeth Schmida & Bryan C. Heiderscheit

  4. Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA

    Samuel A. Hurley & Kenneth Lee

  5. Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA

    Elizabeth Schmida

  6. Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA

    Richard Kijowski

Authors
  1. Christa M. Wille
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samuel A. Hurley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth Schmida
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kenneth Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Richard Kijowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bryan C. Heiderscheit
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bryan C. Heiderscheit.

Ethics declarations

Conflict of interest

Dr. Bryan C. Heiderscheit declares a potential conflict of interest directly related to this work (research support to institution from NBA and GE Healthcare). The remaining authors (CMW, SAH, ES, KL, RK) of this manuscript declare no direct relationships with any companies, whose products or services may be related to the subject matter of the article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(DOCX 2418 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wille, C.M., Hurley, S.A., Schmida, E. et al. Diffusion tensor imaging of hamstring muscles after acute strain injury and throughout recovery in collegiate athletes. Skeletal Radiol 53, 1369–1379 (2024). https://doi.org/10.1007/s00256-024-04587-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-024-04587-6

Keywords

Search

Navigation