Renal Cell Carcinoma or Oncocytoma? The Contribution of Diffusion-Weighted Magnetic Resonance Imaging to the Differential Diagnosis of Renal Masses.

Background and Objectives: Renal Cell Carcinoma (RCC) accounts for 85% and oncocytomas constitute 3-7% of solid renal masses. Oncocytomas can be confused, especially with hypovascular RCC. The purpose of this research was to evaluate the contribution of diffusion-weighted imaging (DWI) and contrast-enhanced MRI sequences in the differential diagnosis of RCC and oncocytoma Materials and Methods: 465 patients with the diagnosis of RCC and 45 patients diagnosed with oncocytoma were retrospectively reviewed between 2009 to 2020. All MRI acquisitions were handled by a 1.5 T device (Achieva, Philips Healthcare, Best, The Netherlands) and all images were evaluated by the consensus of two radiologists with 10-15 years' experience. The SPSS package program version 15.0 software was used for statistical analysis of the study. Chi-square test, Mann-Whitney U test or the Kruskal-Wallis tests were used in the statistical analysis. A receiver operating characteristic (ROC) curve was used to calculate the cut-off values Results: The results were evaluated with a 95% confidence interval and a significance threshold of p < 0.05. ADC values (p < 0.001) and enhancement index (p < 0.01) were significantly lower in the RCC group than the oncocytoma group. Conclusion: DWI might become an alternative technique to the contrast-enhanced MRI in patients with contrast agent nephropathy or with a high risk of nephrogenic systemic fibrosis, calculation of CI of the oncocytoma and RCCs in the contrast-enhanced acquisitions would contribute to the differential diagnosis.

Renal Artery Doppler Findings in the Patients with Polyhydramnios before and after the Conservative Treatment.

OBJECTIVE: The aim of this study was to evaluate the foetal renal blood flow with colour Doppler ultrasonography. Patients with polyhydramnios were investigated for the foetal renal artery pulsatility index (PI) at the beginning of the treatment, and after the conservative treatment in those who reached the normal amniotic fluid index. MATERIALS AND METHODS: In this prospective study, 39 foetuses with polyhydramnios were evaluated at gestational weeks 26 to 36. The foetal development parameters, right and left foetal renal artery PIs, and amniotic fluid index were measured at the beginning of the treatment in all of these patients. Of these patients, 19 who responded to the conservative treatment were also revaluated when their amniotic fluid index reached normal levels, and statistical analyses were performed for the renal artery PIs before and after the treatment. RESULTS: In this study, 19 patients fulfilled the inclusion criteria as patients with polyhydramnios who responded to conservative treatment. For these patients, the mean foetal renal artery PI was 2.08 (range 1.5-3.0) at the first sonographic examination, and the mean foetal renal artery PI was 1.94 (range 1.53-2.69) after the conservative treatment. However, there was no statistically significant difference between these two groups (p=0.117). CONCLUSION: In this study, no statistically significant difference was found in the foetal renal artery PIs of the patients with polyhydramnios before and after the conservative treatment. These results suggest that the renal artery blood flow may not have any effect on the renal artery PI; therefore, these findings indicate that the renal artery PI cannot be used as a marker in the evaluation of polyhydramnios.

Evaluation of Enteroneovesical Fistula by 64-Detector CT Enterography: A Case Report.

Enterovesical fistula is an abnormal communication between the bladder and the intestine. The accurate localization of leakage is important for accurate treatment planning. Some imaging techniques can not demonstrate the fistula; therefore, choosing the appropriate imaging technique is necessary. CT enterography (CTE) is a new technique for evaluation of the small bowel and the entire abdomen. CTE examination with multi-detector CT (MDCT) enables us to get excellent quality reformatted images with high spatial resolution. We report a patient with neobladder and enteroneovesical fistula. We showed the exact location of the fistula and its' association with the bowels and neobladder by CTE. The aim of this report is to show that CTE can be a new and effective modality in the detection of enteroneovesical fistulas and to discuss the efficacy of CTE in the detection and evaluation of enterovesical fistula referring to the literature. In conclusion, CTE may be a useful, sensitive, effective, and non-invasive technique for the evaluation of enteroneovesical fistula, leakage from the anastomose sides, and other extraintestinal complications such as urinary tract obstruction or abscess formation.

"Thickened" ligamentum flavum caused by laminectomy.

OBJECTIVE: The purpose of this study was to evaluate the effect of a laminectomy on the adjacent ligamentum flavum (LF) by measuring LF thickness using magnetic resonance imaging (MRI). MATERIALS AND METHODS: A total of 78 patients (31 man, 47 woman) with laminectomy were included in our study. After determination of laminectomy level, measurements were done from the thickest parts of the bilateral LF at the upper level of the laminectomy where bilateral facet joints were evident at the slice. RESULTS: Ipsilateral ligamentum flavum with laminectomy was significantly thicker than the contralateral ligamentum flavum with laminectomy. CONCLUSION: Laminectomy cause thickening of ligamentum flavum. Therefore we assume that it should kept in mind that LFH may develop at the adjacent level to the laminectomy and careful clinical and radiological assessments' should be done to exclude LFH in cases who complain about the recurrence of complaints during the post-operative period after laminectomy.

Choroid plexus separation in fetuses without ventriculomegaly: Natural course and postnatal outcome.

PURPOSE: To evaluate fetuses with choroid plexus separation without ventriculomegaly in terms of fetal malformations, behavior of the separation during follow-up, and postnatal outcome. METHODS: In total, 172 fetuses with choroid plexus separation without ventriculomegaly were included in this prospective study. Fetal sonography was performed at 2- to 4-week intervals, and detailed physical and neurologic examinations were performed after their delivery. Fetuses were categorized into normal and abnormal subgroups according to the outcome. RESULTS: Sixteen fetuses (9.3%) were included in the abnormal-outcome group and 156 fetuses (90.7%) were included in the normal-outcome group. Both the initial mean lateral ventricular diameter (9.3 mm versus 8.6 mm) and the initial mean choroid plexus separation (4.8 mm versus 3.3 mm) were greater in the abnormal group than in the normal group (p < 0.001 for both comparisons). We found that 4.0 mm was the best cutoff point of choroid plexus separation to detect a major anomaly, with 87.5% sensitivity and 93.6% specificity. CONCLUSIONS: Choroid plexus separation without ventriculomegaly often resolves within the third trimester and does not affect postnatal outcome. It can be associated with various fetal malformations; however, with a comprehensive examination, all fetal malformations can be detected prenatally. Follow-up sonography studies would be useful, especially in the case of suspected corpus callosum agenesis.

The limbic degradation of aging brain: a quantitative analysis with diffusion tensor imaging.

INTRODUCTION: The limbic system primarily responsible for our emotional life and memories is known to undergo degradation with aging and diffusion tensor imaging (DTI) is capable of revealing the white matter integrity. The aim of this study is to investigate age-related changes of quantitative diffusivity parameters and fiber characteristics on limbic system in healthy volunteers. METHODS: 31 healthy subjects aged 25-70 years were examined at 1,5 TMR. Quantitative fiber tracking was performed of fornix, cingulum, and the parahippocampal gyrus. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) measurements of bilateral hippocampus, amygdala, fornix, cingulum, and parahippocampal gyrus were obtained as related components. RESULTS: The FA values of left hippocampus, bilateral parahippocampal gyrus, and fornix showed negative correlations with aging. The ADC values of right amygdala and left cingulum interestingly showed negative relation and the left hippocampus represented positive relation with age. The cingulum showed no correlation. The significant relative changes per decade of age were found in the cingulum and parahippocampal gyrus FA measurements. CONCLUSION: Our approach shows that aging affects hippocampus, parahippocampus, and fornix significantly but not cingulum. These findings reveal age-related changes of limbic system in normal population that may contribute to future DTI studies.

The use of bronchial arteries in the characterization of primary lung cancer: an MDCT study.

OBJECTIVE: The purpose of this study was to discuss the use of ipsilateral bronchial artery dilatation when a solitary lung mass is detected on multidetector computed tomography (MDCT). MATERIALS AND METHODS: We retrospectively evaluated 55 patients with solitary lung mass. An MDCT scanner was used for the study. Location and the greatest size of the tumor, and ipsilateral bronchial artery caliper (dilated if >2 mm) were noted for each patient. TNM staging of each patient with primary lung cancer was also recorded. Statistical analyses were applied to both groups using SPSS 17.0. χ test was used for the statistical analyses. RESULTS: Statistically strong correlation was observed between ipsilateral bronchial artery dilatation and primary lung carcinoma. Among the 11 benign lung masses, only 2 (18%) showed ipsilateral bronchial artery dilatation. But 39 (88.6%) of the 44 primary lung carcinoma patients and 36 (92.3%) of the 39 primary lung carcinoma patients with predominantly extramediastinal (lung) location showed ipsilateral bronchial artery dilatation on MDCT. When only predominantly extramediastinal lesions were taken into account, sensitivity of the study was 92.31%, specificity was 81.82%, positive predictive value was 94.74%, and negative predictive value was 75%. CONCLUSIONS: Lesion characterization and accuracy was very high when the only criteria of bronchial artery dilatation are taken into account. Sensitivity and negative predictive value were higher in the patients with extramediastinal lesions.

Bouveret syndrome: evaluation with multidetector computed tomography and contrast-enhanced magnetic resonance cholangiopancreatography.

Cholecystenteric fistula is one of the rarest complications of biliary lithiasis, with a frequency of less than 1%. Bouveret syndrome is a gastric outlet obstruction produced by gallstone(s) located in the distal stomach or proximal duodenum. The route of gallstone migration to the bowel is most commonly via a cholecystoduodenal fistula; however, fistulization of the stomach is a rarer variation. Early diagnosis of this situation is crucial to reduce morbidity and mortality. In this report, we present a patient with cholecystogastric fistula and Bouveret syndrome. To our knowledge, there is no published paper in the literature related to the diagnosis of Bouveret syndrome with multidetector computed tomography (MDCT) (64 detectors) and/or contrast-enhanced magnetic resonance cholangiopancreatography (CE-MRCP). Our aim was to discuss the efficacy of MDCT and CE-MRCP in the detection and evaluation of cholecystenteric fistulas. We showed the exact localization and relation of biliary stones and the fistula by MDCT and CE-MRCP. We also evaluated the biliary system with CE-MRCP physiologically. In conclusion, when biliary lithiasis and ileus are detected in plain radiography, the first-line diagnostic tool should be MDCT. In complicated cases or when biliary obstruction is suspected, CE-MRCP can give important morphological and physiological information regarding the whole abdomen and biliary system.

Unusual manifestation of acute retrocecal appendicitis: pericholecystic fluid.

Subhepatic-retrocecal appendicitis is a rare entity in which the diagnosis is challenging. In patients presenting with right abdominal pain with atypical clinical, laboratory and ultrasound (US) findings, acute appendicitis should be eliminated with computed tomography (CT). Multi-detector CT (MDCT) can be used effectively for the diagnosis of retrocecal appendicitis without additional preparation or focused examination. Here, we present a patient with acute subhepatic-retrocecal appendicitis in whom the clinical and US findings mimicked acute cholecystitis. To the best of our knowledge, there is no previous report related to acute appendicitis presented only with pericholecystic fluid that could be diagnosed with MDCT. Retrocecal-subhepatic appendicitis is a rare condition that might present with atypical clinical, laboratory and radiological signs. US is usually insufficient for the definitive diagnosis. In this situation, MDCT could be a rapid and efficient tool for localizing the appendix and for the differential diagnosis.

Real-time elastography for distinguishing angiomyolipoma from renal cell carcinoma: preliminary observations.

OBJECTIVE: The objective of this study was to determine the diagnostic performance of sonoelastography for differentiating angiomyolipomas from renal cell carcinomas. SUBJECTS AND METHODS: Twenty-eight angiomyolipomas and 19 renal cell carcinomas were prospectively examined with real-time elastography. Lesions were classified according to four elastographic patterns on the basis of the distribution of the blue area (representing no strain and hardest tissue component). The elasticity patterns and the strain ratios of the angiomyolipomas and renal cell carcinomas were evaluated independently by two observers. Diagnostic performance and interobserver agreement were analyzed. RESULTS: All angiomyolipomas were classified as having a high-strain elastographic pattern (blue areas in < 50% of lesion, considered type 1 or type 2) by both radiologists, whereas 18 of 19 renal cell carcinomas were classified as having a low-strain elastographic pattern (blue areas in ≥ 50% of lesion, considered type 3 or 4) by both radiologists. The respective mean strain ratios measured by two radiologists were 0.15 ± 0.06 and 0.18 ± 0.09 for the angiomyolipomas and 0.64 ± 0.15 and 0.63 ± 0.19 for the renal cell carcinomas. There were significant differences between the elasticity patterns and strain ratios for angiomyolipomas and renal cell carcinomas (p < 0.001). Interobserver agreement was excellent for elasticity patterns and strain ratios, with a weighted kappa coefficient of 0.96 and an intraclass correlation coefficient score of 0.95. CONCLUSION: Our results show that real-time elastography may be useful in differentiating angiomyolipomas from renal cell carcinomas, by use of both elasticity patterns and strain ratios.

A novel biphasic oral contrast solution for enterographic studies.

PURPOSE: To compare the efficacy and patients' tolerance of a new mixed biphasic oral contrast solution with routine biphasic oral contrast agent in magnetic resonance (MR) enterography (MRE). MATERIALS AND METHODS: Thirty-seven patients (group 1) had MRE with the new mixture, whereas 14 patients (group 2) had MRE with biphasic oral contrast agent (lactulose). Magnetic resonance enterography images were evaluated by 2 experienced radiologists. Each intestinal segment was evaluated for luminal distension (LD), distinction from the surrounding tissue (wall conspicuity), and the confidence of radiologist for evaluation of the specified segment (radiological evaluation confidence). Comparisons between the 2 groups were performed using the Mann-Whitney U test. Interrater and intrarater agreement values were obtained. In addition, patients' acceptability and tolerance were assessed. RESULTS: The new mixture was more effective than the oral contrast agent used in group 2 for LD, wall conspicuity, and radiological confidence. The values of interrater and intrarater agreement in scoring LD, wall conspicuity, and radiological confidence were generally moderate. CONCLUSION: Our new mixture allowed good-quality enterographic images, and this solution was well tolerated by patients. In addition, this mixture is useful for evaluation of small bowels and colonic segments. We suggest the use of it for enterographic examinations.

Evaluation of spontaneous third ventriculostomy by three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) sequence by 3T MR imaging: preliminary results with variant flip-angle mode.

PURPOSE: This prospective study aimed to evaluate the use of three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) in the diagnosis of spontaneous third ventriculostomy (STV) and to compare it with phase-contrast cine magnetic resonance imaging (PC-MRI). METHODS: PC-MRI and 3D-SPACE images were obtained in 15 patients with hydrocephalus for evaluation of STV as well as in 10 control cases. The presence of STV was evaluated visually by two experienced radiologists on both PC-MRI and 3D-SPACE images, and the results were statistically compared. RESULTS: There was a strong correlation between PC-MRI and SPACE scores for both readers (correlation coefficient [r]=0.784; P=0.001). There was also a good correlation between PC-MRI scores and consensus-based results. Interobserver reliabilities were strong for all STV scores. In addition, there was excellent correlation between 3D-SPACE scores and consensus-based results (first reader's kappa value: 0.87; second reader's kappa value: 1). CONCLUSION: 3D-SPACE can provide morphological-physiological information for the evaluation of STV with no need for additional PC-MRI analysis or other sequences. As a non-invasive test, it can also be included among the first line of choices of MRI sequences for patients with obstructive hydrocephalus.

The effect of morphometric relationship between the glenoid fossa and the humeral head on rotator cuff pathology.

OBJECTIVE: The aim of this study was to investigate the impact of the morphometric association between the glenoid fossa and the humeral head on rotator cuff pathology. METHODS: Shoulder MRI examinations performed for any cause in study centers between August 2008 and August 2009 were retrospectively evaluated. Shoulder MRI exams having rotator cuff pathology, such as trauma, degeneration, and acromion Type 2, 3 and 4 were excluded. The study included 62 shoulder exams with rotator cuff pathology having Type 1 acromion morphology and 60 shoulder exams without rotator cuff pathology (control group). Glenoid anteroposterior distance and the humeral head diameter in axial images, humeral head diameter and glenoid articular surface diameter in coronal images and their ratios were measured in both groups. Subacromial distance was measured using sagittal images. The rotator cuff was evaluated in fat-suppressed T2-weighted and proton density-weighted images. RESULTS: The difference between subacromial distances in the rotator cuff pathology group (8.94 ± 1.43 mm) and control group (10.96 ± 1.62 mm) was statistically significant (p<0.001). There was no statistical significance between the two groups in humeral head diameter, glenoid articular surface diameter, glenoid anteroposterior distance and their ratios (p>0.05). CONCLUSION: There is no association between the humeral head and the glenoid articular surface which can result in rotator cuff pathology. The glenohumeral joint was determined as a compatible joint morphometrically. Therefore, if they cannot be explained by an extrinsic cause, pathologies related to the rotator cuff itself should be investigated in subjects with rotator cuff pathology.

Assessment of lumbar vertebrae morphology by magnetic resonance imaging in osteoporosis.

OBJECTIVE: To investigate the lumbar spinal morphology in patients with and without osteoporosis by comparing the endplate changes, intervertebral disc changes, and vertebral heights. DESIGN: This is a retrospective study. Medical records of the 3,530 patients admitted to the Physical Medicine and Rehabilitation outpatient clinics with low back pain between August 2010 and August 2011 were retrospectively reviewed. A total of 64 patients of whom 57 were females (89.1 %) and seven were males (10.9 %) were included in the study. Participants were divided into an osteoporosis group, an osteopenia group, and a nonosteoporotic control group, according to bone mineral densities. RESULTS: In this study, mid heights of L3, L4, and L5 vertebrae were found to be higher in the normal group than in both the osteopenic and osteoporotic groups. Mid part heights of L1-2, L2-3, and L5-S1 intervertebral discs were significantly lower in the normal group when compared to the osteopenic and osteoporotic groups. End-plate marrow abnormality was detected in L1 lower end plate in 75 % of normal subjects, 40.6 % of osteopenics, and 25 % of osteoporotics. Statistically significant difference in the presence of Schmorl nodes in L5 vertebra lower end plates was present between groups; 58.3 % of normals, 34.4 % of osteopenics and 15 % of osteoporotics had Schmorl nodes in L5 vertebra lower end plates. There was a significant difference regarding disc degeneration and intradiscal gas presence in L5-S1 intervertebral discs between groups; 66.7 % of normals, 28.1 % of osteopenics, and 25 % of osteoporotics had severe disc degeneration and intradiscal gas was present in L5-S1 intervertebral discs. CONCLUSIONS: Significant changes in morphology of the lumbar spine and intervertebral discs were found. It was revealed that the effects of osteoporosis are not limited to the bone but also present in the intervertebral discs. Mid heights of intervertebral discs were higher in the osteoporotic and osteopenic groups when compared to normal subjects along with the lowered mid heights of lumbar vertebrae. It was also observed that stronger vertebral bones were associated with more disc and vertebral degeneration.

Contrast-material-enhanced MR urography in evaluation of postoperative lower urinary tract fistulae and leakages.

Urinary fistulas and leakages of lower urinary tract are serious complications of various surgical procedures. Radiologists need to have enough information about these situations to perform precise diagnosis and treatment. Various techniques [such as intravenous pyelography, ultrasound, computed tomography (CT), CT urography, cystoscopy, cystography and magnetic resonance (MR) imaging] are used for the diagnosis of these conditions. Application of all these techniques reduces the comfort and cooperation of the patients and increases the cost. Here we present four postoperative patients with lower urinary tract fistula or leakage. To the best of our knowledge, there is no report regarding the use of contrast-material-enhanced MR urography (CE-MRU) in the demonstration of postoperative lower urinary tract fistulae and leakages. In conclusion, CE-MRU could show the existence and location of the urinary fistulae and leakages clearly without the need for another investigation technique, as described in our patients. Also, CE-MRU is a safe and relatively inexpensive technique that avoids exposure to radiation as well as nephrotoxic and more allergic contrast-material administration.

Decreased echogenicity of the embryo is correlated with absence of cardiac activity.

PURPOSE: The purpose of this study was to investigate whether the sonographic echogenicity of embryos is associated with cardiac activity in utero. METHODS: The present study reviewed a total of 164 embryos having a gestational age between 6 and 8 weeks. These embryos were examined by transvaginal ultrasonography and a comparison of their echogenicity was made with respect to those of the placenta and the myometrium. Grade II embryos were less echogenic than the placenta or had similar echogenicity with the myometrium, whereas grade I embryos shared the same echogenicity as the placenta. In contrast, grade III embryos were less echogenic than the myometrium. RESULTS: Most of the embryos with cardiac activity were detected to have grade II echogenicity (78/130, 60.0%), whereas the remaining embryos had grade I echogenicity (52/130, 40.0%). In contrast, most of the embryos without cardiac activity had grade III echogenicity (20/34, 58.8%), whereas the remaining embryos had either grade II (8/34, 23.5%) or grade I (6/34, 17.7%) echogenicity. CONCLUSIONS: Decreased echogenicity of embryos on grayscale ultrasound in the early first trimester is correlated with an absence of cardiac activity.

Glenoid axis is not related with rotator cuff tears--a magnetic resonance imaging comparative study.

PURPOSE: The relationship between glenoid version angle and rotator cuff pathology has been described. However, the effect of glenoid version angle on rotator cuff pathology is still unknown. The aim of this study was to investigate whether there is an impact of glenoid version angle on rotator cuff pathology. METHODS: All shoulder MRI examinations performed in the study centres between August 2008 and August 2009 were evaluated retrospectively. Shoulder MRI examinations having rotator cuff pathology such as trauma, degeneration, and acromion type 2-3-4 reported in previous studies were excluded from the study. Sixty-two shoulder MRIs with rotator cuff pathology having type 1 acromion morphology and 60 shoulder exams without rotator cuff pathology were included in the study. Glenoid version angle was calculated in axial images. Rotator cuff was evaluated in fat-suppressed T2-weighted and proton density-weighted images. RESULT: The mean values for glenoid version angle were 2.41° and 0.61° in the control and the study groups, respectively. No statistically significant difference was found between the two groups (p > 0.05). In addition, 26.6% and 33.8% of the glenoids were retroverted and 73.4% and 66.2% were anteverted in the control and the study groups, respectively (all p > 0.05). CONCLUSION: This study demonstrated no significant relationship between glenoid version angle and rotator cuff pathology. Therefore, the pathologies that can be related to the cuff itself should be investigated if the pathology cannot be explained by an extrinsic cause in subjects with rotator cuff pathology.

Desmoid Tumor Associated With Familial Adenomatous Polyposis: Evaluation With 64-Detector CT Enterography.

Desmoid tumors (DTs) are benign tumors which are not seen very often, and most of the radiologists and clinicians do not know the characteristics of them very well. Correct and early diagnosis of DTs is important for decreasing mortality and morbidity. Computed tomography enterography (CTE) is a new modality for small bowel imaging which combines the improved spatial and temporal resolution of multidetector computed tomography (CT) with large volumes of ingested enteric contrast material to permit evaluation of the small bowel wall and lumen and also the entire abdomen. We report a familial adenomatous polyposis (FAP) patient with localized mesentery and abdominal wall DTs. We showed the exact location of the DTs and their relation with the small bowel by CTE. In conclusion, CTE is a useful technique for DT localization, the degree of extension and invasion to local structures, presence of partial and complete small bowel obstruction, and the relationship of the tumors with vasculature and whether ischemia has occurred as a result or not.

Real-time sonoelastography of the Achilles tendon: pattern description in healthy subjects and patients with surgically repaired complete ruptures.

OBJECTIVE: The purpose of this study is to describe the elastographic appearance of the Achilles tendon in healthy subjects and patients with surgically repaired complete ruptures. MATERIALS AND METHODS: Nineteen Achilles tendons of 16 amateur footballers with surgically repaired complete ruptures and their contralateral asymptomatic Achilles tendons were assessed with ultrasound and real-time sonoelastography. Additionally, 40 asymptomatic Achilles tendons of 20 healthy amateur footballers were assessed. The Achilles tendons were divided into the distal, middle, and proximal thirds for elastographic image evaluation. Tendons were classified into three main types according to the elasticity features: type 1, blue (hardest tissue); type 2, blue/green (hard tissue); or type 3, green (intermediate tissue). In addition, three subtypes were determined: homogeneous, relatively homogeneous, and heterogeneous. RESULTS: Most of the Achilles tendons of the patients with surgically repaired complete ruptures were detected to have type 2 elasticity (64.9%), and the remaining had type 1 (35.1%). In contrast, most of the healthy tendons had type 2 (64.2%), and the remaining had either a type 3 (20.8%) or a type 1 (15%) elastographic pattern. All of the ruptured tendons had a heterogeneous structure, whereas all of the healthy Achilles tendons had a homogeneous or relatively homogeneous structure. CONCLUSION: In sonoelastography, the recognition of normal tendon structure will be useful in assessing pathologies of the Achilles tendon. Additionally, in patients with excellent American Orthopedic Foot and Ankle Society (AOFAS) scores and surgically repaired complete ruptures, a hard and heterogeneous pattern of tendon structure may be a natural consequence of tendon healing.