Necrosis
Necrosis of the Achilles tendon is a consequence of a chronic inflammation of the tendon, which is accompanied by small tears and remodelling of the tendon. Parts of the Achilles tendon die in the process. In MRI, the tendon is distended and thickened due to the chronic inflammation and the light-colored necroses are located between the dark tendon fibers. These necroses can calcify over time and would then be more visible in ultrasound, as they are only dark in the MRI. These necrotic cavities can also be assessed by administering contrast medium, since the surrounding inflamed tissue absorbs the contrast medium well.
Tendinosis
Achilles tendon tendinosis is a chronic inflammation of the Achilles tendon with small tears in the tendon and conversion of the muscle into connective tissue. Even the smallest injuries of the Achilles tendon can be made visible in an MRI. These would show up by small brightenings in the otherwise black tendon.
In addition, the thickness of the Achilles tendon is assessed, which is normally not more than 6 mm. Between 6-8 mm the tendonosis is slightly pronounced, between 8-10 mm it is moderate, and more than 10 mm is considered a high degree of tendinosis.
