Equine flexor tendon imaging part 2: Current status and future directions in advanced diagnostic imaging, with focus on the deep digital flexor tendon.
Authors: Ehrle Anna, Lilge Svenja, Clegg Peter D, Maddox Thomas W
Journal: Veterinary journal (London, England : 1997)
Summary
# Editorial Summary Flexor tendon injuries remain a leading cause of performance-limiting lameness and premature retirement in equine athletes, yet ultrasonography alone provides limited insight into internal tendon architecture and early degenerative change. This literature review synthesises current evidence on advanced imaging modalities—specifically low- and high-field MRI and computed tomography—for detecting and characterising deep digital flexor tendon pathology, examining practical considerations including the magic angle artefact (which can create false echogenicity patterns on MRI), optimal injection and contrast protocols, and comparative diagnostic accuracy. Both MRI and CT offer superior soft-tissue discrimination compared to ultrasound, with particular value in detecting longitudinal fibre disruption, core lesions, and subclinical changes; however, availability, cost, and interpretation expertise remain significant limiting factors for routine clinical use. Future developments aim to move beyond lesion detection towards predictive assessment of tendon microstructure and healing potential, with emerging techniques such as ultra-high field MRI and positron emission tomography—already validated in human sports medicine—offering potential to identify at-risk tissue before catastrophic failure occurs. Practitioners should consider that while advanced imaging provides valuable prognostic information for high-value athletes, integration with clinical examination, ultrasonographic findings, and functional assessment remains essential for evidence-based rehabilitation planning and return-to-work decisions.
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Practical Takeaways
- •Advanced imaging (MRI and CT) should be considered complementary to ultrasound for complex flexor tendon cases, particularly when determining prognosis and return-to-work timelines.
- •Understanding 'magic angle' artefacts in MRI is essential to avoid misinterpretation of deep digital flexor tendon lesions.
- •Newer imaging protocols including contrast-enhanced MRI and emerging techniques may improve early detection of tendon pathology before clinical signs become apparent.
Key Findings
- •Advanced diagnostic imaging modalities (MRI and CT) are becoming more widely available for detection and monitoring of flexor tendon lesions beyond conventional ultrasonography.
- •The 'magic angle' artefact is a significant consideration in MRI interpretation of flexor tendons that can affect diagnostic accuracy.
- •Ultra-high field MRI and positron emission tomography represent emerging techniques to provide enhanced structural information about tendon architecture for injury prevention.