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The hypoechoic normal tendon. A pitfall.

B D Fornage

    Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine
    |January 1, 1987
    PubMed
    Summary
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    Accurate ultrasound examination reveals normal tendons have a specific fibrillar pattern. Improper technique can cause artifactual hypoechogenicity, mimicking tendinitis and leading to misdiagnosis.

    Area of Science:

    • Musculoskeletal Ultrasound
    • Diagnostic Imaging
    • Tendinopathy Research

    Background:

    • Echogenicity of normal superficial tendons shows variable reporting in scientific literature.
    • Accurate ultrasound assessment of tendon echotexture is crucial for differentiating normal from pathological states.

    Purpose of the Study:

    • To describe the characteristic echogenic, longitudinally oriented fibrillar pattern of normal superficial tendons using high-resolution ultrasound.
    • To identify technical factors leading to artifactual hypoechogenicity in normal tendons.
    • To prevent misdiagnosis of tendinitis by understanding common ultrasound pitfalls.

    Main Methods:

    • Utilized high-resolution real-time linear-array ultrasound equipment for tendon examination.
    • Emphasized meticulous scanning techniques, including precise beam angulation and perpendicularity.

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  • Analyzed longitudinal and transverse scan planes to assess tendon echotexture.

    • Main Results:

    • Normal superficial tendons exhibit a distinct echogenic, longitudinally oriented fibrillar pattern.
    • Ultrasound beam obliquity in longitudinal scans and non-perpendicularity in transverse scans create artifactual hypoechogenicity.
    • This artifactual hypoechogenicity can be mistaken for inflammatory changes.

    Conclusions:

    • Mastery of ultrasound examination technique is essential for correctly visualizing normal tendon echotexture.
    • Awareness of technical pitfalls, such as artifactual hypoechogenicity, is critical for accurate diagnosis.
    • Preventing false-positive diagnoses of tendinitis relies on understanding these imaging artifacts.