Diagnostic Imaging in Sports Medicine

Imaging in sports medicine plays an increasingly important role in the diagnosis of injury and decision-making regarding return to play.

Increasingly sophisticated imaging modalities allow for precise diagnosis of various patterns of injury but also present the care provider with a bewildering range of tests.

The continued participation of older athletes in sporting activities makes the interpretation of imaging studies challenging as degenerative findings become intermingled with those of sports-related injuries.

The approach to imaging in sports medicine mirrors the philosophy applied in clinical medicine as a whole. Imaging should primarily be pursued only when it is likely to alter the patient management and when benefits outweigh risks. The cost and availability of imaging studies are also important factors to consider ( Box 63.1 ).

It is important to consider risk of exposure to ionizing radiation, particularly in young or pregnant patients. In addition, discomfort, expense, and inconvenience of imaging to the patient are valid concerns.

Musculoskeletal imaging techniques used in sports medicine provide excellent depiction of anatomic structures and often facilitate precise diagnostic accuracy. Imaging modalities differ in the technique of image generation and in terms of cost and radiation exposure.

Radiography (plain radiographs) creates two-dimensional images of anatomy and typically serves as a first-line imaging study. Computed tomography (CT) also creates two-dimensional images, but in cross-section. Nuclear medicine examinations (including bone scintigraphy/bone scan) detect gamma rays emitted from a radiopharmaceutical administered intravenously to patients. Each of these modalities requires exposure to ionizing radiation.

Magnetic resonance imaging (MRI) does not use ionizing radiation but is contraindicated for certain patients with metallic implanted medical devices. Ultrasound is generally safe, although tissue heating may be a concern.

The use of the modern picture archiving and communication system (PACS) software allows diagnostic images to be stored and shared widely, which has greatly increased the portability of imaging information. As PACS software becomes available on a wide range of portable devices, it should be remembered that diagnostic radiology workstations are required to utilize special high-resolution graphics hardware and monitors.

The judicious use of ionizing radiation is critical in protecting the safety of sporting patients, particularly the young who face greater theoretical lifetime risks from exposure to ionizing radiation. Some common examinations and typical dose levels are listed in Table 63.1 .

The diagnosis and management of injuries in sports medicine greatly rely on accurate history and physical examination findings in addition to an understanding of the mechanism of injury. Communicating this information at the time of an imaging request allows the radiologist to interpret studies in the appropriate clinical context and provide the most accurate and relevant report.

A close working relationship among sports medicine providers, radiologic technologists, and diagnostic radiologists helps foster an efficient system and ensure that appropriate care is delivered to the patient.