Consistency of MRI diagnosis of acute lower limb muscle injuries in professional football: The role of radiologists in implementing an accurate rehabilitation protocol

Purpose of the study: to assess the consistency of MRI interpretations among radiologists with varying levels of expertise in working with athletes when evaluating MRIs of players with acute non-contact muscle injuries (ANСMI).

Materials and methods. A retrospective review of MRI interpretation protocols for lower limb muscle injuries in adult professional football players from three prominent Russian Premier League football clubs was conducted. Reports were interpreted by general radiologists with limited experience in sports medicine (Group 1), whereas Group 2 comprised radiologists with over 10 years of experience in sports radiology. The reporting protocols included assessment of injury localization, grading of injury severity according to the respective classification system, identification of associated tendon injuries, and quantification of muscle edema volume.

Results. Out of 130 primary ANСMI cases, the British Athletic Association classification system was used by Group 1 radiologists in only 14 (10.8 %) cases, while 20 (15.4 %) reports employed the Stoller classification. The remaining 96 (73.8 %) reports did not specify any classification system. Comparative analysis of interpretations by the two groups demonstrated agreement regarding anatomical injury locations in 61.5 % of all evaluated cases (80 out of 130). No statistically significant difference was observed in the mean edema volume assessments between the groups (p = 0.075). However, when evaluating intramuscular tendon involvement, identical assessments were seen by both groups in 67 cases (59.8 %), whereas discrepancies occurred in 45 cases (40.2 %). Cohen’s κ coefficient was 0.132, indicating weak agreement beyond chance.

Conclusion. Significant variability was observed in defining the precise anatomical location of muscle injuries and in recognizing intramuscular tendon lesions between experienced sports radiologists and general radiologists without such expertise. To improve diagnostic accuracy in MRI evaluations of ANСMI within athletic populations, it is strongly recommended to involve radiologists with relevant specialization and sufficient clinical experience in sports medicine.

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