September - October 2003 Vol. 14, No. 5 | Contents
TRAINING Sports Injury Imaging by Aaron Haydu, D.C.	The world of sports injuries has seen many changes over recent years and advances in diagnostic imaging are no exception. Technology has allowed sports medicine doctors to better understand the nature of an injury, injury risk, and body mechanics as it relates to the injured athlete. This article will discuss some of the most common choices you and your doctor may make in the evaluation of your injury Most commonly, plain film radiograph (X-ray) is the initial image of choice and its primary goal is to show fractures, dislocations, or instability. Modern x-ray machines are capable of fine detail, much of which can now be produced digitally. Also, newer machines allow much less radiation exposure to the patient. X-ray examination always involves multiple views that allow a complete evaluation of the injured bone or joint. Often, non-specific soft tissue swelling can be seen based on the nature and severity of the injury. X-ray is limited to bone only, as it does not allow for detailed soft tissue evaluation.  MRI (magnetic resonance imaging) has become the premiere choice for evaluating injuries because of its detail for soft tissue injuries. MRI does not use radiation because magnetic fields allow a computer to produce a picture of the area. It is incredibly useful in evaluating ligament, spinal disc, tendon, and muscle tears and sprains. Often, small fractures not seen on an x-ray are readily apparent on MRI. Depending on the nature of the injury, MRI may be the ordered as the first method of evaluation. Surgeons depend largely on the detail of MRI to plan treatment protocols and surgical techniques.  CT (computed tomography) has also seen wide use in the workup of athletic injury. CT is an advanced form of x-ray, allowing doctors to see various layers of bone injury, especially useful in head injuries, and injuries to the large bones such as the pelvis, spine, and other pelvic trauma. CT can also provide clear pictures of the internal organs for the evaluation of chest and abdominal trauma.  There are also other, more specialized, imaging techniques such as bone scan and diagnostic ultrasound. A bone scan is a specialized radiation scan, which can show bone changes and fractures that may be missed with x-ray or MRI. Ultrasound can help determine muscle injury and injury to internal organs.  Of paramount importance in any diagnostic study is quality of the image and a specialist to read the films and interpret the results. Having an open dialogue with your physician will help determine the image of choice for your particular injury. Consider an imaging center familiar with sports injury, as athletes can present with unique challenges to a radiologist. Hopefully none of these procedures will be necessary in your upcoming season!
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