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. 2024 Sep 12;14(11):7958–7968. doi: 10.21037/qims-24-298

Table 2. Translation to MRI of the ‘ultrasound classification of medial gastrocnemius injuries’.

Types Location of damage Imaging findings
US signs MRI signs
1 Muscular myoaponeurotic injury Morphologic and echostructural alteration of muscle fascicles and the interposed fibro-adipose septa Area of feathery edema is observed in the fibers anchored to the aponeurosis in fluid-sensitive sequences
2A Gastrocnemius aponeurotic injury (<50%) Morphologic and echostructural alteration of the aponeurosis continuity, as well as evidence of morphologic and echostructural alteration of muscle fascicles. Small hypo-anechoic collection (hematoma). Synchronous motion of the gastrocnemius and soleus muscles Increased signal area at the myoaponeurotic junction, along with irregularity in the fibrillar pattern of the anchorage and a clear discontinuity in the aponeurosis at that level. Small liquid-signal accumulation (hematoma). Synchronous motion of the gastrocnemius and soleus muscles
2B Gastrocnemius aponeurosis injury (>50%) Morphologic and echostructural alteration of the aponeurosis continuity, as well as evidence of morphologic and echostructural alteration of muscle fascicles. Large hypo-anechoic accumulation (hematoma). Usually, asynchronous motion of the gastrocnemius and soleus muscles Increased signal area at the myoaponeurotic junction, along with irregularity in the fibrillar pattern of the anchorage and a clear discontinuity in the aponeurosis at that level. Large liquid-signal accumulation (hematoma). Usually, asynchronous motion of the gastrocnemius and soleus muscles
3 FGA injury Morphologic and echostructural alteration of the FGA. Synchronous motion of the gastrocnemius and soleus muscles Exclusively a FGA discontinuity, and a small amount of fluid tends to accumulate superficially, although significant hematomas are not present. Synchronous motion of the gastrocnemius and soleus muscles
4 Mixed injury Combination of US findings of 2B and 3 types Combination of MRI findings of 2B and 3 types

MRI, magnetic resonance imaging; US, ultrasound; FGA, free gastrocnemius aponeurosis.