Table 4: AT pathology qualitative classification for DW and ADC images graded in accordance with physical performance and clinical examination scores applied, cell structure and MR signal appearance on routine images.

AT injury patient Performance Scoring Pathology Impact on cell structure and diffusivity MR Image Appearance Qualitative DW & ADC five-number summary scoring
Poor Tears, Complete Rupture Deformity with retraction, little/high swelling. Hyper-intense signal subtotal and complete discontinuity of the Achilles tendon. Possible wavy tendon morphology and retraction. High
Fair Partial/Micro Tears Up to 50% of the AT is damaged, swelling, positive for significant fibre disruption, probably including some retraction Possible hyper-intense focal defect and partial retraction of tendon fibres High-mid
Good Thickening and Tendinopathy A small number of ligament fibres are damaged. There is usually an area of increased oedematous swelling. MRI negative (hypo-intense AT). MR signal intensity increase is seen only in association with cases of oedema Medium
Great Inflammation No abnormalities or diffuse bleeding MRI negative (hypo-intense AT), No structural damage Mid-low
Excellent Normal Normal intact tendon Normal hypo-intense signal Low