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American Journal of  Medical 
Science and Innovation (AJMSI) 

High-Resolution Ultrasonography Versus MRI in the Diagnosis of  Achilles Tendon 
Lesions

Ahmed M. Fahmy1*

Volume 3 Issue 2, Year 2024
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v3i2.2801
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: July 03, 2024
Accepted: August 06, 2024
Published: August 09, 2024

Achilles tendon lesions are commonly assessed using noninvasive imaging methods such 
as ultrasound and magnetic resonance imaging (MRI). Both techniques are well-established 
in diagnosing and evaluating the condition of  the Achilles tendon. This prospective study 
aimed to compare the diagnostic efficacy of  high-resolution ultrasonography and MRI in 
identifying Achilles tendon lesions. The focus was on understanding the respective strengths 
of  each imaging modality in diagnosing different types of  lesions, including tendinopathy, 
partial thickness tear, and full thickness tear. Twenty patients, aged between 23 and 63 years, 
participated in the study, presenting with symptoms ranging from posterior ankle pain to 
limited movement and swollen ankles. Ultrasonography, performed with patients in a prone 
position, examined the Achilles tendon from its musculotendinous junction to its calcaneal 
insertion. MRI, conducted with patients in a supine position, utilized axial and sagittal T1, 
T2-weighted images, STIR, and proton density. Among the 20 patients examined, diagnoses 
included eight cases of  tendinopathy, five cases of  partial thickness tear (one inconclusive 
by ultrasound), and seven cases of  full thickness tear. The results indicate that ultrasound 
is comparable to MRI in diagnosing tendinopathy and full thickness tear. However, MRI 
demonstrates superiority in identifying partial thickness tears, while ultrasound excels in 
early enthesitis detection. Ultrasound emerges as a valuable complementary diagnostic tool 
for Achilles tendon lesions, demonstrating effectiveness comparable to MRI in certain 
aspects. While MRI outperforms in diagnosing partial thickness tears, ultrasound proves 
superior in the early detection of  enthesitis.

Keywords
Ultrasound, Magnetic Resonance 
Imaging, Achilles Tendon, 
Tendinopathy, Enthesitis

1 Al Azhar University, Cairo Governorate, Egypt
* Corresponding author’s e-mail: ahmed_mf80@yahoo.com

INTRODUCTION
The Achilles tendon, a robust band of  fibrous tissue 
connecting the calf  muscles to the heel bone, plays a 
pivotal role in facilitating ambulation and overall lower 
limb functionality, despite its robust nature, the Achilles 
tendon is susceptible to various pathological conditions, 
ranging from acute injuries to chronic degenerative 
changes, timely and accurate diagnosis of  Achilles tendon 
lesions is imperative for initiating appropriate therapeutic 
interventions and preventing long-term complications 
(Silbernagel et al., 2020). In the realm of  diagnostic imaging, 
both high-resolution ultrasonography (HRUS) and magnetic 
resonance imaging (MRI) have emerged as valuable tools for 
assessing Achilles tendon pathology, each offering distinct 
advantages and limitations (Gatz et al., 2021).
Historically, conventional diagnostic methods, such as 
physical examination and plain radiography, provided 
limited insights into Achilles tendon pathologies, the 
advent of  advanced imaging modalities has revolutionized 
the diagnostic landscape, enabling clinicians to delve 
deeper into the structural and functional aspects 
of  the tendon (Dams et al., 2017). High-resolution 
ultrasonography, characterized by its non-invasiveness, 
cost-effectiveness, and real-time capabilities, has gained 
widespread acceptance as an initial diagnostic tool for 
Achilles tendon disorders. HRUS allows for detailed 
visualization of  the tendon’s morphology, facilitating the 
identification of  abnormalities such as tears, tendinopathy, 

and bursitis (Tang et al., 2022).
Magnetic resonance imaging, with its unparalleled soft 
tissue contrast and three-dimensional capabilities, has 
become the gold standard for evaluating musculoskeletal 
pathologies, including Achilles tendon lesions (Shalabi, 
2004). MRI provides a comprehensive assessment of  
the tendon’s integrity, revealing subtle changes in signal 
intensity indicative of  degeneration, inflammation, or 
ruptures, MRI allows for a holistic evaluation of  the 
surrounding soft tissues, aiding in the identification of  
associated conditions and providing a broader context for 
clinical decision-making (Chang & Miller, 2009).
Despite the advantages offered by both HRUS and 
MRI, the choice between these imaging modalities in the 
diagnosis of  Achilles tendon lesions remains a subject of  
debate, several factors, including availability, cost, patient 
preferences, and the specific clinical scenario, influence 
the selection of  the most appropriate imaging technique 
(Dams et al., 2017). The comparative diagnostic accuracy 
of  HRUS and MRI in detecting Achilles tendon lesions has 
been a topic of  interest among researchers and clinicians 
(Gatz et al., 2021). Existing literature highlights the 
sensitivity and specificity of  HRUS in detecting Achilles 
tendon pathologies, emphasizing its utility as a first-line 
imaging modality, the real-time imaging capabilities of  
HRUS enable dynamic assessments of  the tendon during 
various ankle movements, providing valuable functional 
information (Dams et al., 2017). 



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MRI underscore its ability to provide high-resolution 
cross-sectional images, aiding in the precise localization 
and characterization of  Achilles tendon lesions, 
the multiplanar imaging capabilities of  MRI offer 
a comprehensive view of  the tendon, enabling the 
identification of  subtle changes that may be missed on 
ultrasonography, the drawbacks of  MRI, including higher 
costs, longer imaging times, and contraindications for 
certain patients, have fueled the ongoing discourse on 
the most judicious use of  this modality in routine clinical 
practice (Szaro et al., 2021).

LITERATURE REVIEW
Gross Anatomy of  the Achilles Tendon
The Achilles tendon, renowned as the body’s most 
substantial tendon, is a robust connective tissue structure 
crucial for lower limb biomechanics, which originates 
from the convergence of  the gastrocnemius and soleus 
muscles in the calf, forming a tendon that inserts into 
the calcaneus, and composed primarily of  collagen fibers 
arranged hierarchically, the Achilles tendon endows 
the ankle joint with strength and elasticity essential 
for activities like walking, running, and jumping, its 
histological composition contributes to the tendon’s 
ability to withstand considerable tensile forces while 
accommodating the dynamic movements of  the ankle 
(Freedman et al., 2014). High-resolution ultrasonography 
(HRUS) and magnetic resonance imaging (MRI) serve 
as invaluable tools in delineating the gross anatomy of  
the Achilles tendon. HRUS, utilizing a high-frequency 
transducer, provides real-time images with exceptional 
spatial resolution, allowing for dynamic assessments 
during ankle movements, study by Khan et al. (2003) 
have emphasized HRUS’s capability to capture subtle 
alterations in the tendon’s contour during plantarflexion 
and dorsiflexion, providing insights into its functional 
dynamics (Khan et al., 2003). MRI, with its superior soft 
tissue contrast and multiplanar imaging capabilities, excels 
in offering detailed cross-sectional views of  the Achilles 
tendon’s structure. This imaging modality provides a 
comprehensive assessment of  the tendon’s integrity, 
enabling the identification of  subtle changes indicative of  
degeneration, inflammation, or ruptures, study by Szaro et 
al. (2021) underscores MRI’s ability to precisely visualize 
the different components of  the tendon, aiding in the 
identification of  partial tears and complete ruptures 
(Szaro et al., 2021).
Understanding the gross anatomy of  the Achilles 
tendon is fundamental for interpreting imaging findings 
accurately, both HRUS and MRI contribute significantly 
to this understanding, providing clinicians with a detailed 
insight into the structural nuances of  the tendon, as we 
navigate through the comparative analysis of  HRUS 
and MRI in diagnosing Achilles tendon lesions, this 
foundational knowledge of  the tendon’s gross anatomy 
will play a pivotal role in contextualizing the diagnostic 
capabilities of  these imaging modalities (Pierre-Jerome et 
al., 2010).

Pathology of  Achilles Lesions
Achilles tendon lesions encompass a spectrum of  
pathological conditions, each presenting unique 
challenges in diagnosis and treatment, Tendinopathy, 
characterized by degenerative changes within the tendon 
without complete rupture, is a common affliction 
associated with pain, swelling, and functional impairment, 
High-resolution ultrasonography (HRUS) and magnetic 
resonance imaging (MRI) have proven instrumental in 
detecting early signs of  tendinopathy (Ferguson et al., 
2019).
HRUS, with its high spatial resolution, enables the 
identification of  hypoechoic areas within the tendon, 
indicative of  intratendinous degeneration, the real-
time imaging capabilities of  HRUS facilitate dynamic 
assessments, allowing clinicians to visualize alterations 
in the tendon’s structure during movement. Conversely, 
MRI’s ability to capture alterations in signal intensity aids 
in the early diagnosis of  tendinopathy, providing valuable 
information for timely intervention (Hodgson et al., 
2012).
Partial tears, representing an intermediate stage between 
tendinopathy and complete ruptures, pose diagnostic 
challenges due to their variable presentations, HRUS, with 
its dynamic imaging capabilities, can reveal disruptions in 
the tendon’s continuity during ankle movement, aiding 
in the identification of  partial tears, MRI’s multiplanar 
imaging, offering detailed cross-sectional views, facilitates 
precise localization and characterization of  partial tears, 
contributing to comprehensive diagnostic insights 
(Maffulli et al., 2011).
Complete ruptures, often associated with sudden forceful 
activities, require prompt and accurate diagnosis for 
appropriate management HRUS, with its real-time 
imaging capabilities, visualizes complete disruption of  
the tendon fibers, enabling immediate identification of  
ruptures(ElMaraghy et al., 2008). MRI, with its ability to 
capture the extent of  soft tissue damage and evaluate 
associated injuries, plays a crucial role in planning surgical 
interventions and predicting postoperative outcomes 
(Nunna et al., 2023).
The nuanced capabilities of  HRUS and MRI in delineating 
the pathology of  Achilles tendon lesions contribute to 
their complementary roles in clinical practice, as we delve 
into the comparative analysis of  these imaging modalities, 
understanding their efficacy in capturing the diverse 
manifestations of  Achilles tendon pathology becomes 
imperative for informed decision-making in the diagnostic 
and therapeutic landscape (Aström et al., 1996).

Technique for Imaging the Achilles Tendon
The diagnostic efficacy of  imaging modalities in assessing 
Achilles tendon lesions is intricately tied to the techniques 
employed during examinations, both high-resolution 
ultrasonography (HRUS) and magnetic resonance imaging 
(MRI) have established protocols, each offering unique 
advantages in capturing the structural and pathological 
nuances of  the Achilles tendon (Dams et al., 2017).



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HRUS involves the use of  a high-frequency transducer, 
typically ranging between 7-18 MHz, to obtain detailed 
real-time images of  the tendon. Patient positioning is 
crucial, often in a prone or supine stance, allowing easy 
access to the posterior aspect of  the ankle. Dynamic 
imaging, including ankle plantarflexion and dorsiflexion, 
enhances the assessment by providing insights into 
the tendon’s response to stress. Doppler ultrasound 
can be incorporated to evaluate vascularity, aiding in 
distinguishing between inflammatory and degenerative 
conditions  (Corvino et al., 2022).
MRI utilizes a strong magnetic field and radiofrequency 
pulses to generate detailed images. Various sequences, 
such as T1-weighted, T2-weighted, and fat-suppressed 
sequences, offer different contrasts for a comprehensive 
assessment. The patient is positioned feet-first in the MRI 
scanner, with the ankle typically in a neutral position. 
Administration of  gadolinium-based contrast agents may 
enhance the visualization of  vascularity and inflammatory 
changes within the tendon (Schmidt & Payne, 2015).
Comparative studies, such as that conducted by Alahmari 
et al. (2022), underscore the importance of  standardized 
protocols in ensuring reliable results from both HRUS 
and MRI. Meticulous attention to patient positioning, 
imaging parameters, and the incorporation of  dynamic 
assessments optimizes the diagnostic potential of  these 
modalities (Alahmari et al., 2022).
Understanding the nuances of  imaging techniques is 
pivotal for clinicians aiming to leverage the strengths of  
HRUS and MRI in diagnosing Achilles tendon lesions, as 
we navigate through the comparative analysis, recognizing 
the impact of  these techniques on diagnostic accuracy 
will contribute to a comprehensive understanding of  
the respective roles of  HRUS and MRI in the clinical 
management of  Achilles tendon pathologies (Reiman et 
al., 2014).
This study aims to assess the diagnostic efficacy of  high-
resolution ultrasonography versus MRI in detecting 
Achilles tendon lmodality, providing valuable insights 
to optimize the diagnostic approach for identifying and 
characterizing Achilles tendon pathology.

MATERIALS AND METHODS
Study Design
This prospective study includes 20 patients whose ages 
ranged from 23 to 63 years and for the duration of  one 
year between December 2019 to December 2020. Sixteen 
patients complaining of  posterior ankle pain, while in 
six patients had ankle swelling, three had limitation of  
movements with walking, four patients were involved 
in a car accident while two patients had sport-related 
trauma. All patients were subjected to history taking and 
clinical provisional diagnosis. This study was conducted 
according to the guidelines of  the ethics committee of  our 
University and was approved by our institutional review 
board; all patients gave us informed consent to be imaged 
in our study. Privacy and confidentiality of  all patients 

data were guaranteed and there has been a code number 
for every patient file that includes all investigations. All 
data provision were monitored and used for scientific 
purpose only. 

Inclusion and Exclusion Criteria
The inclusion criteria for this study encompassed 
both males and females without any age predilection. 
Participants were required to present with unilateral 
posterior ankle pain and have a history of  ankle trauma or 
problems resulting from a motor car accident. In contrast, 
the exclusion criteria excluded claustrophobic individuals 
who were unable to undergo MRI scans.

Clinical Examination
Patients underwent a comprehensive clinical examination, 
involving detailed history-taking encompassing personal, 
operative, drug, and family history. Specific clinical tests, 
such as the Thompson test and hyperdorsiflexion sign, 
were conducted to evaluate Achilles tendon problems.

Imaging Modalities
Ultrasound Examination
Ultrasound Examination performed using a PHILIPS 
HD 11 instrument with a 7–10 MHz probe, ultrasound 
examinations included longitudinal and transverse scans. 
Thickness measurements were taken in the short axis 
image.

MRI Examination
MRI examination conducted on a GE MSOW 1.5 Tesla 
machine with standard circular extremity coils. Sequences 
included scout T1-weighted images, axial and sagittal T1-
weighted images, axial and sagittal T2-weighted images 
with fat suppression, and sagittal short-tau inversion 
recovery (STIR) images.

Ethical Approval
Ethical considerations for this study involve obtaining 
approval from the local committees in the radiology 
department, college, and university prior to its 
commencement. It is ensured that there is no conflict of  
interest related to the study, authorship, and subsequent 
publication. Moreover, the privacy of  patient data and 
study results is a paramount concern, with a commitment 
to maintaining confidentiality. Patients possess the right 
to maintain control over their information and have the 
assurance that their data will be handled with the utmost 
discretion and respect for their privacy.

Statistical Analysis
Statistical analysis was performed using the statistical 
package for the social sciences (SPSS). Patient 
characteristics were analysed using descriptive data. 
Diagnostic data were statistically described in terms of  
frequencies (number of  cases) and percentages when 
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RESULTS
Table 1 shows the demographic data of  the studied 
group. Age ranged from 23-63 years with a mean age 
of  41.667±9.99 years. Male cases were 16 (80.0%) while 
female cases were 4 (20.0%)

Table 4 shows that 7 (35.0%) of  cases are affected at the 
insertion site of  the tendon while 13 (65.0%) are affected 
in the mid portion of  the tendon.
Table 5 shows USG Findings of  the studied group 
and it show that 7 (35.0%) patients had full-thickness 
tear, 4 (20.0%) partial-thickness tear and 9 (45.0%) had 
tendinopathy.Table 1: Distribution of  studied sample according to 

patient’s demographic data
Number Percent

Age (years)
≤30 2 10.0
>30 18 90.0
Range 23-63
Mean±S.D. 41.667±9.99
Sex
Male 16 80.0
Female 4 20.0

Table 2: Distribution of  studied sample according to 
patient’s Complain/History
Complain/History Number Percent
Posterior Ankle Pain 16 80.0
Swelling 6 30.0
Motor Car Accident (MCA) 4 20.0
Limitation of  Movement 3 15.0
Sport-related Trauma 2 10.0

Table 3: Distribution of  studied sample according to 
patient’s leg side
Leg Side Number Percent
Leg Side 6 30.0
Left 14 70.0
Right 20 100

Table 5: Distribution of  studied sample according to 
patient’s USG Findings
USG Findings Number Percent
Full thickness tear 7 35.0
Partial thickness tear 4 20.0
Tendinopathy 9 45.0
Total 20 100

Table 6: Distribution of  studied sample according to 
patient’s MRI Findings
MRI Findings Number Percent
Full thickness tear 7 33.0
Partial thickness tear 5 26.0
Tendinopathy 8 41.0
Total 20 100

Table 7: Distribution of  studied sample according to 
patient’s USG diagnosis
USG diagnosis Number Percent
Retro Calcaneal Bursitis 17 85
Enthesophyte 10 50
Increased Tendon Thickness 12 60
Partial Tear 4 20
Full Thickness Tear 7 30
Altered Intrasubstance Signal 20 100

Table 4: Distribution of  studied sample according to 
anatomic location of  lesion
Anatomic location Number Percent
Anatomic location 13 65
Around the Mid Portion 7 35
Insertion Site 20 100

Table 2 shows complain/history of  the studied group 
and it show that 16 (80.0%) had Posterior ankle pain, 6 
(30.0%) had swelling, 4 (20.0%) had motor car accident 
(MCA), 3(15.0%) had limitation of  movement and 
2(10.0%) had Sport-related trauma.

Table 3 shows leg side of  the studied group show that 
6 (30.0%) are affected in left side and 14 (70.0%) are 
affected in right side.

Table 6 shows MRI Findings of  the studied group and 
it shows that 7 (33.0%) patients had full-thickness tear 
while 5 (26.0%) patients had partial-thickness tear and 8 
(41.0%) patients had tendinopathy.

Table 7 shows USG diagnosis of  the studied group show 
that 17(85.0%) had retro calcaneal bursitis, 10(50.0%) 
had enthesophyte, 12(60.0%) had Increased Tendon 
Thickness, 4(20.0%) had Partial Tear, 7(30.0%) had Full 
Thickness Tear and 20(100.0%) had altered intrasubstance 
signal of  tendon.

Table 8 shows MRI diagnosis of  the studied group 
show that 17(85.0%) had retro calcaneal bursitis, 
4(20.0%) had enthesophyte, 12(60.0%) had Increased 
Tendon Thickness, 5(25.0%) had Partial Tear, 7(30.0%) 
had Full Thickness Tear and 20(100.0%) had Altered 
Intrasubstance Signal.



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The kappa coefficient was used to assess the agreement 
between USG and MRI. The strength of  agreement on 
diagnosis is considered as good (k=0.923), as shown in 
Table 9.

DISCUSSION
The Achilles tendon, the largest and strongest tendon 
in the human body, is frequently prone to injury due to 
increased participation in sports-related activities and 
overuse conditions (Alrashidi et al., 2018). The diagnostic 
evaluation of  Achilles tendon abnormalities involves 
various imaging techniques, including plain radiography, 
computed tomography (CT), ultrasonography (US), and 
magnetic resonance imaging (MRI) (Moretti et al., 2020).
According to Nyssonen (2020), Plain radiography and 
CT are limited in their ability to assess avulsion fractures, 
Haglund’s deformity, or other bony pathologies (Moretti 
et al., 2020). On the other hand, high-resolution US, 
particularly when performed with linear-array probes, 
has become increasingly important due to its cost-
effectiveness, speed, availability, and lack of  ionizing 
radiation. US provides a detailed depiction of  normal 
anatomical structures and is effective in evaluating tendon 
integrity. Its dynamic capabilities enhance visibility, aiding 
in the identification, localization, and differentiation of  
various inflammatory conditions (Sconfienza et al., 2015).
The Achilles tendon, with its fibrillar echotexture on 
US, consisting of  densely packed longitudinally arranged 
collagen fibers, is highly sensitive to early diagnosis of  
enthesitis. Moreover, US is more cost-effective than MRI 
for this purpose (Mascarenhas, 2020). However, MRI, 
with its superior multiplanar capability and soft tissue 

contrast, plays a crucial role in diagnosing tendon injuries. 
It offers valuable insights into abnormalities in bones and 
soft tissues that may not be immediately evident in other 
imaging modalities (Elgohary et al., 2017).
The present study aimed to assess the role of  high-
resolution ultrasonography versus MRI in diagnosing 
Achilles tendon lesions. Inclusion criteria comprised 20 
patients aged 23 to 63 years, presenting with ankle pain 
and, commonly, limitations in daily activities. The study 
noted a male predominance for Achilles lesions, aligning 
with findings from previous research (Nyyssönen, 2020).
The affected zone in the Achilles tendon was identified 
as the mid-portion, consistent with existing literature 
suggesting the zone of  relative avascularity, located 2–6 
cm from the calcaneal insertion, as commonly affected, 
Tendinopathy, particularly full or partial thickness tears, 
emerged as the most prevalent disorders in the study 
(Wong et al., 2018).
Both US and MRI were utilized for diagnostic purposes, 
with tendinopathy diagnosed in eight cases through 
US. The study focused on the characteristic US and 
MRI findings for tendinopathy, partial thickness tear, 
and full thickness tear, including alterations in tendon 
morphology, echogenicity, and disruptions in tendon 
fibers (Hodgson et al., 2012). The findings of  the study 
align with existing literature on the diagnostic reliability 
of  US in cases of  tendinopathy, partial thickness tear, and 
full thickness tear. Ultrasound, with its dynamic and real-
time capabilities, emerged as a valuable tool in primary 
clinics, offering advantages over static MRI, particularly 
in terms of  cost-effectiveness and physiological 
movement visualization (Dong & Fessell, 2009). The 
diagnostic evaluation of  Achilles tendon lesions requires 
a comprehensive understanding of  the strengths and 
limitations of  imaging modalities such as high-resolution 
US and MRI. These techniques play complementary 
roles, with specific advantages in different clinical 
scenarios. The study contributes valuable insights into 
the diagnostic accuracy of  these imaging modalities, with 
implications for clinical practice and potential avenues for 
further research in the field (Dams et al., 2017).
The Achilles tendon, considered the largest and strongest 
tendon in the human body, is frequently prone to injury due 
to increased participation in sports-related activities and 
overuse conditions (Alrashidi et al., 2018). The diagnostic 
evaluation of  Achilles tendon abnormalities involves 
various imaging techniques, including plain radiography, 
computed tomography (CT), ultrasonography (US), and 
magnetic resonance imaging (MRI) (Moretti et al., 2020). 
Plain radiography and CT are limited in their ability to 
assess avulsion fractures, Haglund’s deformity, or other 
bony pathologies (Nyyssönen, 2020). On the other hand, 
high-resolution US, particularly when performed with 
linear-array probes, has become increasingly important 
due to its cost-effectiveness, speed, availability, and lack 
of  ionizing radiation. US provides a detailed depiction 
of  normal anatomical structures and is effective in 
evaluating tendon integrity. Its dynamic capabilities 

Table 8: Distribution of  studied sample according to 
patient’s MRI diagnosis
MRI diagnosis Number Percent
Retro Calcaneal Bursitis 17 85
Enthesophyte 4 20
Increased Tendon Thickness 12 60
Partial Tear 5 25
Full Thickness Tear 7 30
Altered Intrasubstance Signal 20 100

Table 9: Kappa agreement test between the two 
methods according to patient’s diagnosis
Diagnosis USG MRI

No. % No. %
Retro Calcaneal Bursitis 17 85 17 85
Enthesophyte 10 50 4 20
Increased Tendon Thickness 12 60 12 60
Partial Tear 4 20 5 25
Full Thickness Tear 6 30 6 30
Altered Intrasubstance Signal 20 100 20 100
Kappa Agreement 0.923



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enhance visibility, aiding in the identification, localization, 
and differentiation of  various inflammatory conditions 
(Sconfienza et al., 2015).
The Achilles tendon, with its fibrillar echotexture on 
US, consisting of  densely packed longitudinally arranged 
collagen fibers, is highly sensitive to early diagnosis of  
enthesitis. Moreover, US is more cost-effective than MRI 
for this purpose (Mascarenhas, 2020). However, MRI, 
with its superior multiplanar capability and soft tissue 
contrast, plays a crucial role in diagnosing tendon injuries. 
It offers valuable insights into abnormalities in bones 
and soft tissues that may not be immediately evident 
in other imaging modalities (Elgohary et al., 2017). The 
present study aimed to assess the role of  high-resolution 
ultrasonography versus MRI in diagnosing Achilles 
tendon lesions. Inclusion criteria comprised 20 patients 
aged 23 to 63 years, presenting with ankle pain and, 
commonly, limitations in daily activities. The study noted 
a male predominance for Achilles lesions, aligning with 
findings from previous research (Nyyssönen, 2020).
The affected zone in the Achilles tendon was identified 
as the mid-portion, consistent with existing literature 
suggesting the zone of  relative avascularity, located 2–6 
cm from the calcaneal insertion, as commonly affected 
(Wong et al., 2018). Tendinopathy, particularly full or 
partial thickness tears, emerged as the most prevalent 
disorders in the study.
Both US and MRI were utilized for diagnostic purposes, 
with tendinopathy diagnosed in eight cases through US. 
The study focused on the characteristic US and MRI 
findings for tendinopathy, partial thickness tear, and full 
thickness tear, including alterations in tendon morphology, 
echogenicity, and disruptions in tendon fibers. The 
findings of  the study align with existing literature on the 
diagnostic reliability of  US in cases of  tendinopathy, partial 
thickness tear, and full thickness tear. Ultrasound, with its 
dynamic and real-time capabilities, emerged as a valuable 
tool in primary clinics, offering advantages over static MRI, 
particularly in terms of  cost-effectiveness and physiological 
movement visualization (Dong & Fessell, 2009).

CONCLUSION
In conclusion, the Achilles tendon, prone to injuries from 
sports activities, presents various conditions, and imaging 
modalities like MRI and ultrasound play crucial roles in 
diagnosis. While ultrasound is cost-effective and dynamic, 
MRI excels in assessing bone and soft tissue. Ultrasound 
complements MRI for tendinopathy and full-thickness 
tear diagnosis, but MRI proves superior for partial-
thickness tears. The choice depends on clinical needs, 
with ultrasound excelling in early enthesitis detection.

Strengths and Limitations
The strength of  this study is that the study contributes 
valuable insights into the diagnostic accuracy of  high-
resolution ultrasonography versus MRI in assessing 
Achilles tendon lesions, enhancing our understanding of  
their complementary roles in clinical practice. While the 

limitation is the study’s sample size of  20 patients may 
limit generalizability, and further research with a larger 
cohort is warranted

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