Magnetic resonance imaging for diagnosing and managing deep digital flexor tendinopathy in equine athletes: Insights, advances and future directions.
Authors: Scharf Alexandra, Acutt Elizabeth, Bills Kathryn, Werpy Natasha
Journal: Equine veterinary journal
Summary
Deep digital flexor tendinopathy represents one of the most challenging diagnoses in equine lameness work, particularly when trying to predict which horses will return to athletic soundness; this comprehensive review synthesises current knowledge on how MRI—distinguished by its superior soft tissue contrast—has transformed our ability to characterise these injuries compared to ultrasonography and radiography alone. The authors critically compare high-field and low-field MRI systems, examining how technical parameters such as field strength and pulse sequence selection directly influence diagnostic accuracy and lesion characterisation, whilst also evaluating the complementary roles of computed tomography and ultrasound when MRI access is limited. Key findings emphasise that lesion configuration, location within the tendon, and imaging features visible on serial scans—rather than a single static image—provide meaningful prognostic information; emerging quantitative MRI techniques and PET-MRI hybrid imaging offer promising avenues for detecting microstructural changes and metabolic activity that conventional sequences may miss. For equine practitioners, the practical takeaway is substantial: integrating serial MRI into rehabilitation protocols allows objective monitoring of tendon healing progression and better-informed decision-making regarding return-to-work timelines, whilst a multidisciplinary approach combining advanced imaging with tailored physiotherapy and training modifications significantly improves clinical outcomes. Identifying the specific lesion pattern, location, and response to early intervention on follow-up imaging should reshape how we counsel clients on prognosis and rehabilitation duration for these career-threatening injuries.
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Practical Takeaways
- •MRI should be integrated into your diagnostic approach for horses with foot pain and suspected DDFT injury to enable accurate diagnosis and prognosis assessment
- •Serial MRI imaging during rehabilitation is essential for monitoring lesion progression and guiding return-to-work decisions in DDFT cases
- •When MRI is unavailable, ultrasound and computed tomography can provide complementary diagnostic information, though MRI remains the gold standard for soft tissue characterization
Key Findings
- •MRI has revolutionized diagnosis and management of deep digital flexor tendon injuries in equine athletes
- •High-field and low-field MRI systems differ in clinical utility; field strength and sequence selection are critical for accurate diagnosis
- •Lesion configuration and imaging features on MRI correlate with prognosis and guide rehabilitation monitoring
- •Complementary imaging modalities including CT, ultrasound, and emerging techniques like PET-MRI provide additional diagnostic value when MRI is not feasible