Marathon runners will test their tendons in small trial

A Boston radiologist studying how well a faster form of ultrasound can detect breast cancer is training the same tool on marathon runners and their tendons.

Dr. Alda Cossi, director of ultrasound in the radiology department at Boston Medical Center, hopes to improve the way both cancer and sports injuries are treated by getting a better picture of them before they get worse.

Typical ultrasound machines, like the ones in an obstetrician's office, send out sound waves, like ripples in a pond. When they meet tissue they compress it slightly, but too fast for the movement to be recorded. A newer kind of ultrasound technology called shear wave elastography borrows software from video games that captures images 10 times as fast, at 3,000 frames per second. That reveals the vibration of the sound waves on the tissue and allows radiologists to measure how stiff the tissue is.

That's important in cancer diagnosis because malignant tissue tends to be harder. That quality is also relevant in for athletes, who know the pain of muscle or tendon stiffness. Or the agony when they rupture, often without warning.

"We're pretty poor at looking at tendons," Cossi said. "You can do an MRI, but all you can tell is is, does a tendon have a hole or a tear? You're not really looking at the behavior of the tendon."

So with the elastography ultrasound equipment she is using as part of a multi-center, international trial of breast cancer detection, Cossi is examining 15 runners in the Boston Marathon before and after their race to measure stiffness in their quadriceps, patella, and Achilles tendons.

A mix of young and old, men and women, charity runners and elite athletes, they are being measured this week and will come in again in the week after they have run their 26.2 miles on Monday. They will be asked both times how stiff or relaxed their tendons feel.

A runner herself, Cossi knows athletes aren't the best judges of their condition, pushing themselves for competitive reasons when the better course might be a day of rest. She also knows some damage to tendons is so insidious that it goes unnoticed until too late.

Her hope is better information on tendon stiffness can prevent injuries and monitor recovery if they happen.